You are a Psych NP working in an outpatient clinic. You have been seeing Maria, a 34 year old Hispanic female for the last 6 months. She initially presented with severe Major Depressive symptoms and you have been treating her with Zoloft and have titrated up to 150 mg a day.
Her last visit last month she was not depressed had no anhedonia, no suicidality, and was sleeping well.
BP 110/70, pulse 70. BMI 23 with a family history of diabetes and hypertension. CBC, comp panel, thyroid panel were WNL. The LDL was elevated at 150.
Today, you get a phone call from Maria’s husband that she went out and bought a $60,000 car and has been driving recklessly for the last week. He tells you that she has been sleeping about 2 hours each night for the last week, cleaning the house, staining the garage, painting the house at all hours.
You bring her in and she and her husband recall that she had an episode like this last year when she wasn’t on any medication, when she didn’t sleep for about a week, spent about $30,000 in “stuff” on her credit card, was very irritable, thought she could do no wrong, and was talking and texting “fast”. They also recall (and never told you before) that she was on lithium at one time about 4 years ago for a few months but stopped it because of the weight gain.
Today she is irritable, stating she was thinking that she wished she was dead because she “can’t think straight”. She denies any active plan to kill herself. She is easily distractible, is not as cooperative as in most visits, talking rapidly, loud, and thoughts are disorganized. You had to redirect her on multiple occasions. She did sleep for 4 hours last night and has not lost any weight. Her husband also notes that he has noticed Maria has been drinking alcohol, about 3-4 glasses of wine at night which is not her usual 1-2 glasses a week. Maria denies any drug use.
4. What would lead you to believe that it was not alcohol induced mood disorder?
5. What are some things you would express to her about her drinking related to these risks and related to medications?
6. If Maria is unwilling you participate in further assessment, what method will you use to help her?
Sample Solution
