When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely be:

When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely be:

Answer:

The PMHNP is on call at the local county correctional facility. He is asked to evaluate M.S., a 21-year-old male who was just arrested following an altercation at a local bar. M.S. has never been incarcerated before and apparently has no psychiatric or medical history available. His toxicology screen was negative for alcohol or any drugs of abuse.

My name is Brian, and I’m a psychiatric nurse practitioner (PMHNP). Today I have been chosen to evaluate M.S., a 21-year-old male who just got arrested for assault. M.S has never been incarcerated before, and apparently has no contraindications for detention. He does not have a history of psychiatric treatment or drug use, according to his mother.

Before anything else, the PMHNP is going to need some time alone with M.S. to assess his situation. Coping mechanisms for being suddenly and unexpectedly incarcerated might differ from those for having symptoms of depression, bipolar disorder, anxiety, or schizophrenia. The best way to determine if he?s manic or hypomanic at this point is to observe him and gather data about his symptoms in their natural environment, outside of a structured medical exam. When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely be:

Many patients with mania exhibit a distinct history of elation, flight of ideas, pressured speech, racing thoughts, and sometimes even grandiosity. Typically someone experiencing a bipolar episode is not just talking quickly but they’re talking on a number of different topics or thoughts at the same time and can get easily confused and off track. The patient is likely to also be disorganized or make poor decisions in terms of what they’re doing and how they’re relating to other people.

Marty sounds agitated and paranoid, but it also sounds like he’s trying to convince himself of something. He is saying things that don’t necessarily make sense or seem accurate, like the people from his office were celebrating a birthday? That’s not possible since we were just at work yesterday. He has concerns about how the police will treat him since this is his first arrest. He says he feels completely normal and that no one cares about him. When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely be:

You?ve been arrested for committing a crime. Now the police want to evaluate you and see whether or not you need to be hospitalized. It?s important that you cooperate with them and give them honest answers to their questions. Your case will go faster if you are polite and helpful. The doctors at the county correctional facility want to help you get back on your feet as quickly as possible, so that you can return to your family, friends, and job.

The patient is probably experiencing a manic episode because his speech is pressured and his thoughts are racing. Notice how the patient jumps from one idea to another, for example, his talk about the bar fight immediately evolving into a story about his job and how he presents himself in life. He also seems to be loving ?dramatic? and describes some of his feelings as ecstasy.

When someone gets very excited and is showing signs of attention and activity that are out of the ordinary, even if they have not taken drugs that make them high, we say they are having a manic episode. A doctor who has studied mental health can tell you what to expect during such an attack, and give you medicine that might help to reduce the intensity or have it end sooner.

Normal level of speech, goal-directed, not overly voluble or tangential.

“Let me tell you my side of the story. I was at the party minding my business when that guy came up to me and said some really inappropriate comments about my girlfriend. I just lost it, and went crazy. Of course I feel bad about hitting him and causing all this trouble.”

Question:

The PMHNP is on call at the local county correctional facility. He is asked to evaluate M.S., a 21-year-old male who was just arrested following an altercation at a local bar. M.S. has never been incarcerated before and apparently has no psychiatric or medical history available. His toxicology screen was negative for alcohol or any drugs of abuse.

His mother says that he has in the past had some occasions when he got kind of agitated, but this is the first time it’s been a problem. Reportedly some people from his office were at the bar celebrating a birthday, and before anyone knew what happened an argument escalated into M.S. getting very loud, yelling, and acting ?crazy? before he punched a coworker and started breaking bottles. When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely be:

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