Madam Sue, a 45 year old teacher was brought to the emergency department by her husband after she threw a glass cup at their 15-year old daughter. She had been well for the last two years but began having trouble sleeping for the past month since she was promoted to head of Mathematics unit at school. She started planning for various activities, working throughout the night and continuing on to the next day with little rest. She had several altercations with her colleagues because according to Madam Sue: “They wouldn’t even listen to the first three ideas I had for their units, and I had a dozen suggestions that I wanted to share with them. How rude!” For the past week she became easily irritated which led to an argument with her daughter where she threw the glass that led to her presentation.

Madam Sue has been under psychiatric follow up since 20 years old and is compliant to her medication.

Examination shows an irritated lady talking in a loud voice and angry tone. She shouts at you when it is suggested she be admitted and she attempted to storm out of the room. She became physically aggressive when the attending nurse tried to stop her

A. How will you manage the patient at this point?

B. State your provisional diagnosis

C. You manage to admit Madam Sue to the female psychiatric ward and would like to start her on a medication. State 3 classes of medication that can be used for Madam Sues condition as mentioned in B.

D. What are the common side effects that you may expect from each of these medication?

E. Other than those mentioned in C, what other medication/s would you consider giving her on a regular basis? Explain your decision.

F. Madam Sue became increasingly aggressive in the ward and had several physical fights with other patients. What other treatment options will you consider at this point?

G. Madam Sue started to improve after initiation of the treatment in F. You subsequently decide that she is fit for discharge. Outline you plan for her on discharge.

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