NRNP 6635 Case History Report – Week 3: Mood Disorders Training Title 43: Mr. Elijah Loman
Training Title 43
Name: Mr. Elijah Loman
Gender: male
Age:20 years old
T- 97.2 P- 84 R 18 118/68 Ht 5’7 Wt 156lbs
Background: Currently lives with his sister and her husband who are his legal guardians as
parents deceased when he was 15 and he was deemed to need a fiduciary and guardian by the
court system. Not currently employed. Completed high school, not currently in school. Hx of
treatment for mood disorder began age 15, previous trials of Depakote, Quetiapine off and on,
side effects of akathisia. Has hx of a multiple hospitalization, last was 4 months ago when he
exposed his genitals to girls at the mall. . Not currently partnered. He is currently in hospital
admitted one week ago, was initiated on lithium 300mg po three times daily and risperidone 1mg
at bedtime. Denies any recent alcohol or substance use. Paternal uncle has history of bipolar
disorder. No history of self-harm behaviors, no family suicides. Appetite is decreased. No
medical hx; hospital admission labs within normal ranges, UDS negative; Hx of truancy as a
juvenile. Has pending court date for indecent exposure. Allergies NKDA
Symptom Media. (Producer). (2016). Training title 43 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-43
1. Introduction
Patient: Mr. Elijah Loman, 20‑year‑old male.
Context: Case study from Symptom Media video (2016).
Clinical Focus: Mood disorders in young adults, diagnostic reasoning, treatment planning.
Importance: Bipolar disorder in adolescents and young adults often presents with impulsivity, poor judgment, and legal consequences. Early recognition and treatment are critical.
2. Demographics and Background
Age: 20 years old.
Gender: Male.
Vitals: T 97.2, P 84, R 18, BP 118/68 (normal).
Height/Weight: 5’7”, 156 lbs (BMI ~24.4 → normal).
Family: Lives with sister and her husband (legal guardians). Parents deceased when Elijah was 15.
Education/Employment: Completed high school, not currently in school or employed.
Psychiatric History:
Treatment for mood disorder since age 15.
Previous trials of Depakote and Quetiapine, discontinued due to akathisia.
Multiple hospitalizations; last 4 months ago after indecent exposure incident.
Current Hospitalization: Admitted one week ago, initiated on lithium 300 mg PO TID and risperidone 1 mg HS.
Family Psychiatric History: Paternal uncle with bipolar disorder.
Medical History: None reported.
Substance Use: Denies alcohol or drug use; UDS negative.
Legal History: Pending court date for indecent exposure.
Allergies: NKDA.
3. Psychosocial Stressors
Family Loss: Parents deceased at age 15, requiring guardianship.
Legal Issues: Indecent exposure case pending.
Social Isolation: Not partnered, limited peer support.
Occupational/Educational Stress: Not in school or employed, lack of structure.
Family Psychiatric History: Bipolar disorder in paternal uncle increases genetic risk.
Juvenile History: Truancy and behavioral issues.
4. Clinical Presentation (Mood Disorder Features)
Reported Symptoms:
Decreased appetite.
Impulsivity and inappropriate sexual behavior.
History of exposing genitals in public.
Truancy and vandalism as juvenile.
Behavioral Indicators:
Poor judgment, impulsivity.
Hypersexuality.
Recurrent hospitalizations for behavioral disturbances.
Risk Factors:
Family history of bipolar disorder.
Early onset of mood disorder.
Poor medication adherence due to side effects.
Legal consequences of behavior.
5. Mental Status Examination (MSE)
Appearance: Normal grooming, appropriate weight.
Behavior: Impulsive, inappropriate, restless.
Speech: Pressured, tangential.
Mood: Elevated, irritable.
Affect: Expansive, labile.
Thought Process: Flight of ideas, distractibility.
Thought Content: Grandiosity, inappropriate sexual thoughts.
Cognition: Alert, oriented ×3, poor judgment.
Insight/Judgment: Limited, poor awareness of consequences, refusal of prior medications.
6. Differential Diagnosis
Bipolar I Disorder: Manic episodes with impaired functioning, impulsivity, inappropriate behavior.
Bipolar II Disorder: Hypomanic episodes with depressive episodes (must assess history).
Schizoaffective Disorder: Rule out psychotic features independent of mood episodes.
Substance‑Induced Mood Disorder: Denied substance use, UDS negative.
Conduct Disorder/Antisocial Traits: History of truancy, vandalism, indecent exposure.
ADHD: Impulsivity and distractibility, but mood symptoms more prominent.
7. Diagnostic Considerations (DSM‑5)
Bipolar I Disorder: At least one manic episode lasting ≥1 week, with impaired functioning.
Mania Symptoms: Decreased need for sleep, grandiosity, increased activity, risky behaviors, distractibility.
Elijah’s Case:
Meets criteria for manic episode.
Family history supports bipolar diagnosis.
Legal and behavioral consequences indicate impaired functioning.
8. Assessment Tools
Mood Disorder Questionnaire (MDQ): Screens for bipolar disorder.
Young Mania Rating Scale (YMRS): Assesses severity of manic symptoms.
PHQ‑9: Screens for depressive symptoms.
C‑SSRS: Suicide risk assessment (though no self‑harm reported).
Collateral Information: Family and guardian reports critical for case management.
9. Treatment Plan
Pharmacological:
Mood stabilizers: Lithium (currently prescribed), valproate, carbamazepine.
Atypical antipsychotics: Risperidone, quetiapine, olanzapine, aripiprazole.
Address side effects (akathisia, weight gain) with alternative agents.
Psychoeducation on adherence and side effects.
Psychotherapy:
Cognitive Behavioral Therapy (CBT).
Family therapy to involve guardians.
Psychoeducation on bipolar disorder.
Lifestyle Interventions:
Structured daily routine.
Sleep hygiene.
Avoidance of stimulants/substances.
Supportive Measures:
Legal advocacy and coordination with court system.
Vocational counseling.
Crisis planning for impulsive behaviors.
10. Monitoring and Follow‑Up
Frequent psychiatric visits during acute mania.
Medication monitoring (serum lithium levels, renal/thyroid function).
Family involvement in monitoring adherence.
Suicide risk reassessment.
Coordination with legal system and community resources.
11. Challenges
Medication Adherence: Prior refusal due to side effects.
Legal Issues: Pending court case for indecent exposure.
Family History: Genetic predisposition to bipolar disorder.
Behavioral Risks: Hypersexuality, impulsivity, truancy.
Stigma: Mental health stigma in young adults.
12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy, involve guardians appropriately.
Consent: At 20, Elijah is legally an adult, but guardianship complicates autonomy.
Safety: Risk management for impulsive behaviors.
Cultural Sensitivity: Address stigma and family dynamics.
13. Case Summary
Mr. Elijah Loman: 20‑year‑old male with manic symptoms, family history of bipolar disorder, and behavioral/legal consequences.
Likely Diagnosis: Bipolar I Disorder, current manic episode.
Treatment: Mood stabilizers, atypical antipsychotics, psychotherapy, family involvement, lifestyle interventions.
Outcome Goal: Stabilization of mood, improved functioning, adherence to treatment, prevention of relapse, reduction of risky behaviors.
📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.
What is Elijah’s age? a) 18 b) 20 c) 22 d) 25
Who are Elijah’s legal guardians? a) Parents b) Sister and her husband c) Uncle d) Court system
Which prior medications caused akathisia? a) Depakote and Quetiapine b) Lithium and Risperidone c) Fluoxetine and Sertraline d) Aripiprazole and Lurasidone
Which event led to his last hospitalization? a) Truancy b) Exposing genitals at the mall c) Substance use d) Suicide attempt
Which family history is relevant? a) Paternal uncle with bipolar disorder b) Mother with diabetes c) Sister with anxiety d) Father with hypertension
Which diagnosis requires at least one manic episode? a) Bipolar I Disorder b) Bipolar II Disorder c) Persistent Depressive Disorder d) GAD
Which tool assesses severity of manic symptoms? a) YMRS b) PHQ‑9 c) GAD‑7 d) MDQ
Which medication is currently prescribed to Elijah? a) Lithium and Risperidone b) Depakote and Quetiapine c) Fluoxetine and Sertraline d) Aripiprazole and Olanzapine
Which behavior reflects impulsivity?
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