Mood Stabilization
1. Joyce, a 60-year-old woman, has been treated for the last 10 years for a mood disorder with some anxiety.  She comes to on Pristiq 100 mg for the last two years
along with Trazodone 150 mg for sleep, and clonazepam 2 mg BID.  She reports that in the past she took Ambien and Trazodone together for sleep.  Last night she did not
sleep well.  She typically sleeps 7 hours, only having a “bad night” every once in a while.  You refill her scripts while questioning some of the dosages and
combinations, telling her that you may want to make some changes.
One month later her husband of 32 years accompanies the patient to her appointment.  They are thinking that she has ADHD because of her impulsive behavior, and always
seeming to be in a hurry.  On further questioning, you find out that she has bought a dog and purchased tickets for a cruise without consulting her husband.  She has
not slept for three days, wants a divorce, and is on a dating website.  Looking back at her records you see that she was on Zyprexa for two months, three years ago.
She said that she went off of it because she gained 30# in a short period of time.  The patient and her husband deny any history of mania.
• What is going on?  Come up with a plan of care.   (6 points)
2.  What kind of testing needs to be done before prescribing lithium to a patient (consider that you are prescribing across the lifespan)?  (2 points)• What are the various uses of lithium?  (2 points)• How often should labs be drawn and why?  (1 point)• What does “trough level” mean, and why is it important?  (1 point)• What is the therapeutic level of lithium?(1 point)• Does someone always need to be on a therapeutic level?  Explain. (1 point)
3. What is amedication recommendation for maintenance treatment of Bipolar I? (1  point)
4. What medication would be recommended for Bipolar I – Depressed? (1 point)
5. What medication would be recommended for Bipolar I – Manic? (1 point)
6. What questions need to be asked prior to prescribing an antidepressant to a patient with depressive symptoms? (2 points)
7. What are the guidelines for the recognition of mixed depression? (2 points )
8. What are the guidelines for the treatment of mixed depression? (2 points)
9. How is bipolar disorder treated during pregnancy? (2 points)
10.  Can an antidepressant ever be used for someone with bipolar disorder? (1 point)

spelling, grammar, references, etc.  (4 points)
What is going on with Joyce and what is your plan of care?(-Describe her symptoms in relation to Bipolar, in relation to ADHD.  If she has bipolar, based on medication she already taking, what other additional treatment
therapy you would add both psychotherapeutic and psychopharmacologic?, give rationales of your treatments of choice) 6 points What kind of testing needs to be done prior to prescribing lithium (taking lifespan into consideration) 2 points What are the various uses of lithium? 2 points Once on Lithium, how often should labs be drawn and why? 1 points What does trough level mean? 1 point What is the therapeutic level of lithium? 1 point Does someone always need to be at a therapeutic level? Explain. 1 point What is the medication that is recommended as maintenance for Bipolar  I? 1 point What is the medication that is recommended for Bipolar I depressed? 1 point What is the medication that is recommended for Bipolar I  – Manic? 1 point What questions need to be asked prior to prescribing antidepressant? 2 points What are guidelines for recognition of mixed depression? 2 points What are guidelines for treatment of mixed depression? 2 points How is Bipolar disorder treated during pregnancy? 2 points Can an antidepressant ever be used for someone with bipolar disorder? 1 point APA formatting : references/spelling/ grammar 4 points