4.9 of 10 Ratings
A 35-year-old female presents to the ED at the request of her husband after 3 weeks of erratic behavior. The patient has been staying up all night online shopping on eBay. Despite a lack of sleep, she is "full of energy" during the day at her teaching job, which she believes is "beneath [her], anyway." She has not sought psychiatric treatment in the past, but reports an episode of self-diagnosed depression 2 years ago. The patient denies thoughts of suicide. Pregnancy test is negative. The patient is acutely agitated and is pacing back and forth across the room and states she is going to leave. Which of the following is the best initial treatment?
Valproate and venlafaxine
Valproate and olanzapine
Select Answer to see Preferred Response
A 20-year-old woman is brought in by police for trying to break into a museum after hours. The patient states that she is a detective on the trail of a master collusion scheme and needs the artifacts from the museum to prove her case. Her family reports that she has been acting strangely for the past week. She has been up perusing the internet all night without taking breaks. Her husband states that she has had increased sexual interest for the past week; however, he did not report this to the physician when he first noticed it. The patient is unable to offer a history as she cannot be redirected from her current theory. Her temperature is 99.0°F (37.2°C), blood pressure is 122/81 mmHg, pulse is 97/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable only for a highly-energized patient. Laboratory studies are ordered as seen below.Urine:Color: YellowNitrite: NegativeBacteria: NegativeLeukocytes: NegativehCG: PositiveBenzodiazepines: NegativeBarbiturate: NegativeCocaine: NegativeAcetaminophen: NegativeWhich of the following is the most appropriate next step in management?