A 28-Year-Old Man with a History of Bipolar I Disorder

question 333

Multiple Choice

A 28-year-old man with a history of bipolar I disorder is brought to the emergency department after being pulled over by police for driving erratically.  The police report indicates that the patient appeared alcohol-intoxicated and refused to cooperate with questions, stating, "I have the skills of a race car driver and a need for speed."  He has been on lithium for years and says he has been adherent.  The patient has a history of bilateral knee injuries sustained in an accident when he jumped from a high ledge.  He has no other medical history.  The emergency physician contacts the outpatient psychiatrist, who reports that the patient has been treated with lithium for the past 3 years.  He had a therapeutic lithium level and appeared stable at his last visit 2 weeks ago.  The patient is re-interviewed when he is sober.  He felt upset after his girlfriend left him and was turned down for a job, and so decided to "get drunk."  He is apologetic for driving recklessly and says he intends to follow up with his outpatient psychiatrist.  Although the patient admits to a history of crack cocaine use, he currently uses no illicit substances other than marijuana on weekends.  Temperature is 37.2 C (99 F) , blood pressure is 140/80 mm Hg, and pulse is 88/min.  Physical examination is normal.  The patient is alert, and his speech is nonpressured.  Urine toxicology screen is negative for illicit substances. On further questioning, the patient acknowledges that he has been feeling very depressed since losing his job and breaking up with his girlfriend.  He has struggled with suicidal thoughts on and off and admits that his previous jump from a ledge was a suicide attempt that occurred during a period of severe depression.  He has had no suicidal thoughts for over a year until tonight, when he started drinking.  Which of the following questions is the most important to ask the patient at this time?

• A)"Do you have any guns at home?"
• B)"Has anyone in your family ever attempted suicide?"
• C)"Have you attempted suicide other times?"
• D)"Have you felt so depressed that you thought you might be better off dead?"
• E)"Were you intending to kill yourself when you were driving?"

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Definitions:

Relatively Permanent

Describes a condition or effect that is long-lasting or enduring, though not necessarily unchangeable.

Reproduce Actions

The ability to mimic or perform the same actions as observed from others or as previously learned.

Acquire Skills

The process of learning or developing abilities and knowledge through practice, study, or experience.

Conditioned Response

The learned response to the conditioned stimulus that occurs after conditioned stimulus-unconditioned stimulus pairing.