Care Plan Assignment #3- Shadow Health Virtual Simulation - Focused Exam- bipolar disorder

Bipolar I Disorder is characterized by the occurrence of at least one manic episode that persists for a minimum of one week (or necessitates inpatient care) and the symptoms must cause significant dysfunction, including psychosocial or occupational functioning. Symptoms are elevated self-esteem or grandiosity, a decreased need for sleep, pressured speech, flight of ideas, distractibility (i.e., attention too easily drawn to unimportant stimuli), increased goal-directed activity that can manifest as the readiness to solve complex problems or engage in activities with potential consequences (American Psychiatric Association, 2022). Although depressive episodes frequently arise in this population, their presence is not a criterion for establishing the diagnosis. By contrast, Bipolar II Disorder entails at least one hypomanic episode (lasting four or more days) as well as at least one major depressive episode (persisting for a minimum of two weeks). Hypomania — a milder form that includes the same manic symptoms but causes little or no impairment and has no psychotic features. If a full manic episode happens during that period, the diagnosis changes to Bipolar I (APA, 2022). Mental Status Examination Mr. Lucas Callahan is a 25-year-old white male who was brought to the ED at 11:30PM by the police for erratic behavior in a grocery store parking lot. Full code status. During mental status exam, patient posture is bent or hunched, clothing is dirty and disheveled, grooming and self-care are otherwise adequate, eye contact is direct. Attitude suspicious, guarded, or evasive. Behaviour hyperverbal and restless. Cooperative with interview but with guarded engagement. Speech rapid in rate, with appropriate volume and no appreciable issues with articulation. Frequent and appreciable mood changes during interview. Affect expansive and cheerful, with frequent laughter or smiling. Thought processes disorganized, featuring rapid thinking, word salad, neologisms, echolalia, and clanging associations. Though content grandiose and paranoid delusions, with no perceptual disturbances or hallucinations noted. Denied suicidal or homicidal ideation, plan or intent. Alert and oriented to person, place, time, and situation (A&O ×4). Cognition intact: he completed serial sevens successfully, demonstrated abstract thinking with similarities testing, and had intact remote and immediate memory. Visuospatial ability was normal, as shown through performance on an interlocking shapes test. Impaired insight lacks awareness of illness and expresses unwillingness to seek treatment. Judgment appeared intact during the interview.