Chaotic Mood Disorder
Scenario: A 32 year old female reports a history of depression, crying spells, substance abuse, and behaviors that include eating and sleeping very little, talking excessively, and gambling. The patient is sarcastic during the initial evaluation.
Based on this scenario, respond to the following questions:
- Does this case potentially involve a patient with a unipolar or chaotic condition and why? What do you know about the etiology of this condition?
- According to the DSM V-TR, what is the criteria for the probable psychiatric condition?
- What treatment options will you offer this patient and why? (Provide non-pharmacological and pharmacological interventions, including nursing interventions)
- What do you know about the mechanism of action of mood stabilizers? What labs should you order prior to or during the course of treatment for patients on mood stabilizers and why?
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Chaotic Mood Disorder
Diagnosis and Etiology
The patient’s symptoms—depression, crying spells, substance abuse, minimal sleep, excessive talking, and gambling—strongly suggest chaotic I Disorder, given the presence of depressive . Etiologically, bipolar disorder has genetic underpinnings, with environmental stressors and neurochemical imbalances (especially involving dopamine, serotonin, and norepinephrine) contributing to its development.
DSM-5-TR Criteria
According to the DSM-5-TR, a diagnosis of chaotic I requires at least one exciting episode lasting at least one week, often alternating with depressive episodes. Symptoms must impair social or occupational functioning. The described behaviors align with these criteria, indicating a probable manic episode.
Treatment and Nursing Interventions
Treatment includes mood stabilizers (e.g., lithium, valproate), psychotherapy (CBT), and education. Lithium’s mechanism of action involves altering sodium transport in neurons and modulating neurotransmission. Baseline labs (renal, thyroid, CBC) and ongoing lithium level monitoring are essential due to its narrow therapeutic window. Nursing care should focus on medication adherence, sleep hygiene, and reducing risk behaviors.
