Question

Your patient is a 32-year-old male who has been successfully treated for depression with a selective serotonin reuptake inhibitor. The patient's wife is concerned, because over the past few days her husband has not slept and has been spending most of his time trading stocks online and making extravagant purchases. He has been talking about taking a trip to Spain to run with the bulls in Pamplona. She states that he is talking incessantly and seems "wired." The patient had a similar episode about a month ago that came on suddenly but resolved when the patient "crashed" and slept for several days. Which of the following is most consistent with this situation?

A) Cocaine use

B) Schizoaffective disorder

C) Methamphetamine use

D) Bipolar disorder

Answer 1

The symptoms described by the patient's wife suggest bipolar disorder, characterized by alternating episodes of mania and depression. The SSRI treatment for depression might have contributed to the onset of a manic episode, indicating a need to reassess medication and treatment strategy.

Step-by-step explanation:

The patient's symptoms which include periods of high energy, lack of sleep, impulsive behavior such as excessive spending and making grandiose plans, followed by a "crash" where the patient sleeps for several days, are highly indicative of bipolar disorder. This condition involves episodes of mania or hypomania and typically periods of depression.

Treatment options for bipolar disorder can vary but generally include psychotherapy, medications such as mood stabilizers, and sometimes antidepressants. In this case, the patient has been treated with a selective serotonin reuptake inhibitor (SSRI) for depression, which might have triggered or exacerbated a manic episode. The administration of SSRIs needs careful consideration in patients with bipolar disorder due to the risk of inducing mania.