Joy, a 32-year-old African American female, is on your schedule as an initial assessment. During the ...

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Joy, a 32-year-old African American female, is on your schedule as an initial assessment. During the intake interview, the patient reported that she was recently hospitalized after an “incident” with her husband. She reports that she had gotten into an argument in the front yard of her home and was screaming “at nobody and everybody at the same time.” She states, “My neighbors said I looked possessed or something. They said I was yelling at people that weren’t even there.” She reports she has never been hospitalized and has one sister with bipolar disorder. She is not close with her sister and knows little information about her mental illness. She reports that she thinks this happened because “I smoked some bad weed” and does not regularly smoke marijuana. She reports being taken to the ER one other time for evaluation for a similar episode years ago but was released. She states she has taken some medications before but cannot remember what they were. She was seeing a psychiatrist for a while, and she thinks he diagnosed her with schizoaffective disorder. The patient reports she was hospitalized for 17 days because the staff noticed she had “some cuts” on her legs. The patient reports that a few weeks prior to her hospitalization, she got into a heated argument with her sister-in-law and went home and cut herself. She reports she has never done anything like this before. She denies any suicidal ideation at this time. The patient reports being diagnosed with schizoaffective disorder, bipolar type. Her current medications are Depakote® 500 mg BID and risperidone 3 mg BID. You notice that the patient is not making eye contact and does not appear to be blinking. Her affect is flat. She reports she stopped taking the risperidone because she wasn’t feeling like herself. She reports feeling lethargic, “moving in slow motion,” slurring her speech, weakness, and some tremors. Currently, she reports feeling sad, anxious, and worried about how her medications are making her feel. She denies any suicidal ideation. She also denies any hallucinations. She states she is having difficulty sleeping at night because she is restless. She thinks this is making her mood and anxiety worse the next day. She is also feeling tired because she isn’t sleeping well. She reports getting about 4 hours of sleep a night, but she wants to go to sleep. What would be your assessment and plan for this patient based on the information provided? Include ICD-10 codes and what diagnostic criteria the patient meets for your diagnosis. Answer the following questions: What phenomenon do you think this patient is experiencing? Include the ICD-10 code if applicable. What is the pathophysiology behind this phenomenon? What is the rationale behind your treatment plan? Is there a tool you can use to assess or monitor her symptoms and/or response to your treatment plan? Is this tool validated? Do you have any other concerns for this patient (i.e., safety, medical concerns, co-existing mental illness disorders, etc.)?