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Chief Complaint

“I don’t need to be here; I was brought by police because I am the chosen”

History of Present Illness

Mr. Johnson is a 41-year-old man with a diagnosis of bipolar disorder who was brought to the state psychiatric hospital’s admissions unit from the county police due to aggressive and manic behavior. The patient reports self-titrating his Seroquel at home and started decompensating. Patient reports his body has been taken over by his death father. Patient reports being a preacher and sees demons and casts them away. Per the patient’s wife, his manic episode started 2 months ago when he cut his Seroquel dose in have and started accusing her of cheating.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What signs and symptoms of bipolar disorder does this patient have?

    Hint: See Clinical Presentation and Diagnosis and Table 40-1 in PPP

  2. What prescribed or nonprescribed drugs could be exacerbating this patient’s illness?

    Hint: See Treatment and Table 40-3 in PPP

  3. What is the purpose of the laboratory examination?

    Hint: See Treatment and Table 40-3 in PPP

  4. Should drug therapy be initiated with mood-stabilizing monotherapy, antipsychotic drug monotherapy, or mood-stabilizing and antipsychotic drug combination therapy?

    Hint: See Treatment and Table 40-2 in PPP

  5. What risks of drug therapy would you discuss with this patient when he is appropriate for patient education?

    Hint: See Outcome Evaluation and Table 40-5 in PPP


Drug therapy is initiated with the combination of a mood stabilizer, and antipsychotic agent. He responded well to this regimen and was discharged on the antipsychotic and mood stabilizer. He was counseled to moderate caffeine intake and limit cannabis use. The length of stay in the hospital was 17 days. After 6 months, still feeling well with a generally euthymic mood state, his wife says he would like to stop the medications stating he does not like having to take medication every day and complains of weight gain

How should he be advised about this issue?

Hint: See Outcome Evaluation in PPP


Global Perspective

There have been several epidemiological studies that have suggested an estimated global lifetime prevalence of 1% for bipolar type I in the general population. A recent meta-analysis of 25 studies found a pooled lifetime prevalence of 1.06% for bipolar I and 1.57% for bipolar type II; however, the majority of these studies were conducted in North and South America. Still, a similar prevalence has been found in the UK, Germany, and Italy. ...

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