Joe W. is a 28-year-old man with bipolar disorder who is currently having an acute manic episode

Joe W. is a 28-year-old man with bipolar disorder who is currently having an acute manic episode


Joe W. is a 28-year-old man with bipolar disorder who is currently having an acute manic episode. He has been progressively more irritable and violent over the last few days, and has not slept for 3 days. The patient states he was previously taking medication in the past, but he stopped taking it out of fear that there could be negative interactions with alcohol. He reports that he has been having racing thoughts as well as vivid, grandiose delusions over the past several days. Rapid cycling is a common occurrence in patients with bipolar disorder, so therapy with mood stabilizers should be implemented immediately to prevent worse side effects from occurring.

Completing pharmacologic therapy for manic episodes is challenging for any patient, but it can be particularly difficult for patients who do not accept the diagnosis of bipolar disorder. Joe W. has a history of mood swings that appear to be bipolar in nature, but he has not responded positively to previous medication trials. The first goal when considering treatment for Joe should be to stabilize him physically and emotionally in order to treat his acute manic episode. It is important that his caregivers are constantly monitoring him and ensuring that he is taking his medications as prescribed (eg, not skipping doses or taking more than prescribed).

Joe is a 28-year-old male with an 8-year history of bipolar disorder with a lengthy history of manic episodes. During these episodes he has been violent, psychotic, and has sleep deprivation. Joe also has a very poor history of noncompliance with psychiatric medications and has not taken any medications for the past 3 months. Because of his poor history with noncompliance and the severity of his current symptoms, it is your opinion that Joe needs to be on some form of psychiatric medication.

This young man meets criteria for a manic episode. A major concern is that he has not slept in days. Due to the possibility of violent behavior, a hospitalization is warranted. The health history shows that Joe has difficulty taking medications consistently, so rotation between different medications may be necessary.

Joe’s signs and symptoms are potentially dangerous to himself, others, and his community. The mood stabilizers lithium and carbamazepine have been shown to be effective in preventing manic episodes. Patient education is key in increasing compliance with taking medications.

This patient has exhibited symptoms of mania for the last three days, including: racing thoughts, decreased need for sleep, pressured speech, and irritability. This is a manic episode, which can get triggered by changes in his mood stabilizing medication or other stressors. Mania can be extremely dangerous during pregnancy and may even cause fetal harm. Common medications used to treat bipolar disorder may include: Lithium (can also cause fetal harm) and carbamazepine (more common).

A manic episode is a period of time during which an individual experiences three or more symptoms of mania. These symptoms include, but are not limited to, feelings of euphoria and elation, rapid speech patterns and increased arousal. The manic phase is often followed by a depressive episode in which a person becomes sad, irritable and lethargic. During the depressive phase, the individual may have difficulty sleeping, feel hopeless and worthless, and have suicidal thoughts.


Joe W. is a 28-year-old male who is currently having an acute manic episode. He has not slept for 3 days, is extremely irritable, and is prone to violent outbursts of anger. He reports what is clearly a sustained episode of racing thoughts and has experienced psychotic episodes. According to his history, Joe has been on mood stabilizing medication in the past, but he is very unreliable when it comes to follow-up. When considering medication therapy for Joe, the PMHNP knows that:

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