I have a case study with final diagnosis of (F31.5)

I have a case study with final diagnosis of (F31.5) Bipolar I disorder, most recent episode depressed, severe with psychotic features QUESTION: Explain What factors may have contributed to this diagnosis? I have to discuss in two or more paragraphs: Assignment Content IDENTIFICATION: The patient is a 25-year-old single, third-generation, American-born Caucasian female of Jewish heritage who is one of three children. She has never been married, has no children, and lives independently in a one-bedroom apartment for the past 10 months until 2 weeks ago when her mother moved in. She is being evaluated on the inpatient psychiatric unit to which she has recently been admitted on a voluntary status. CHIEF COMPLAINT: “I am hearing voices to kill myself and my mom and boyfriend.” HISTORY OF CHIEF COMPLAINT: This is the sixth inpatient admission for this 20-year-old female. She presented to the crisis center last night on a voluntary basis after a recommendation by her private psychiatrist. She reports being plagued with command auditory hallucination to cut her wrist with a razor or a knife and to kill her mother and boyfriend with a knife or a gun. She reports experiencing these command auditory hallucinations of a man’s voice at least 10 to 20 times daily for the past 2 weeks along with paranoid delusions of others laughing and talking about her. She denies any past or present suicide or homicide attempts. She denies access to weapons. She alleges that she has not been able to work for the past 2 weeks because of her symptoms. However, as per collateral from her mother, the patient has not been able to work consistently for the past 3 months due to multiple hospitalizations. The patient reports irritability, racing thoughts, feelings of sadness, lack of interest in usual activities, poor appetite, fatigue, lack of motivation, interrupted sleep of 4 hours per night, increased anxiety, and fears about the future for the past 2 weeks. She reports sporadic compliance with topiramate and risperidone for the past 2 weeks. She attributes the auditory hallucinations to medication changes from lithium and valproic acid to topiramate and risperidone due to her declining renal status. Recent stressors include her mother moving in with her 2 weeks ago after mother broke up with her own boyfriend. Mother has been voicing her disapproval of the patient’s boyfriend since moving in, which the patient identifies as being stressful. The patient is requesting to be placed back on lithium and valproic acid. Her psychotropic medications prior to admission include topiramate 100 mg PO HS, risperidone 1 mg PO BID, trazodone 100 mg PO HS, and hydroxyzine 50 mg PO Q4h PRN. PAST PSYCHIATRIC HISTORY The patient was initially diagnosed with bipolar disorder 5 years ago at age 15 during her sophomore year when she was first hospitalized at a psychiatric hospital due to aggressive behavior toward her mother and sister. She was treated with lithium 600 mg PO BID and valproic acid 1000 mg PO HS. Following her hospitalization, she was treated by a private therapist and psychiatrist. Her second psychiatric hospitalization was at the age of 16 for depression related to her father’s death and regret that she did not confront him about past sexual abuse. Prior to the hospitalization, she confronted her mother about the abuse, and the mother denied ever knowing about the abuse and expressed remorse. A third inpatient psychiatric hospitalization occurred when she was 18 for depression. During this hospitalization, there were no medication changes and she was discharged to outpatient treatment after a few days. The fourth hospitalization occurred a year ago (when she was 19) for manic symptoms and her first episode of command auditory hallucinations to hurt random people. During that admission, her medication was changed because of declining renal status from valproic acid 1000 mg PO HS and lithium 600 mg PO BID to topiramate 100 mg PO HS and paliperidone 6 mg PO BID. The paliperidone helped eliminate her homicidal thoughts and voices for about 2 months; however, symptoms returned and precipitated her fifth psychiatric admission. She reports that the paliperidone was discontinued. She was then started on haloperidol 5 mg PO BID which was stopped due to EPS after 2 days and then started on risperidone 1 mg PO BID. Trazodone 100 mg PO HS, and hydroxyzine 50 mg PO Q4h PRN were also ordered during the hospitalization.. The patient reports that she was discharged after a week to her outpatient therapist and private psychiatrist. Two weeks ago her symptoms returned. MEDICAL HISTORY Review of previous hospital admission records indicates electrocardiogram (ECG) findings with slight QTc prolongation of 460 ms. No known allergies, medical hospitalizations, or surgeries. The patient has a history of: Hypertension currently treated with carvedilol 3.125 mg PO BID and losartan 50 mg PO BID. Type II diabetes currently treated with glipizide 5 mg PO am. Hyperlipidemia Obesity, Gout treated with allopurinol 300 mg PO am. She was diagnosed with sleep apnea 6 months ago and uses a continuous positive airway pressure machine at HS. HISTORY OF DRUG OR ALCOHOL ABUSE: She denies past or present use of substances including tobacco and alcohol. FAMILY HISTORY: The patient is one of three children. Her non-Hassidic Orthodox Jewish maternal grandparents severed ties with her mom when she married her dad who was not very religious even though of a non-Hassidic Orthodox Jewish background. She states her family only went to the temple occasionally during holidays while growing up. Her father died when the patient was 18 years old. Her mother is currently living with her. No known psychiatric illnesses in the family. PERSONAL HISTORY Perinatal: No known perinatal complications. Childhood: No history of head banging, rocking, attachment issues, intellectual or motor skill deficits, separation anxiety, gender identity development, friendship difficulties, learning disabilities, nightmares, phobias, bedwetting, fire setting, or cruelty to animals. Adolescence: Attended public school as opposed to a Jewish school, which she later regretted and was jealous about her sister attending a Jewish school. She was a sophomore in high school when she was initially admitted to a psychiatric hospital for aggressiveness toward her mother and sister. The patient was able to graduate high school with a B average. She reports having had a few friends in high school. Adulthood: She got a job in the Jewish community center as a youth worker shortly after high school. The patient subscribes to the Jewish religion. She currently observes Rosh Hashanah and Yom Kippur. The patient has never been married, has no children, and has lived independently in a one-bedroom apartment for the past 10 months until 2 weeks ago when her mother who recently broke up with her boyfriend moved in. The patient has a boyfriend who is American born of Italian heritage. She has been seeing him for 9 months and he spent weekends at her apartment until her mother moved in. The patient met her boyfriend at work. The patient denies any criminal or delinquent history and has never served in the military. TRAUMA/ABUSE HISTORY: As a child, the patient experienced sexual abuse by her father. She never spoke about sexual abuse to anyone until she saw a therapist for the first time when she was 15 and was admitted to a psychiatric unit. She did not want to provide any details about the sexual abuse, such as the frequency or length of time, to this provider at the time of this evaluation.

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