Patient Case: Bipolar Disorder and Epilepsy

<p>Below is the patient case information:</p> <p>63-year-old white male.</p> <p class="p1"><strong>Problem List</strong><br /> Bipolar II disorder</p> <p class="p1">Insomnia</p> <p class="p1">Epilepsy (tonic-clonic seizures)</p> <p class="p1">Dyslipidemia/hypertriglyceridemia</p> <p class="p1">Hypertension</p> <p class="p1">Recent weight gain</p> <p class="p1">History of hyponatremia<span class= "Apple-converted-space"> </span></p> <p class="p1">Diabetes type 2(controlled)</p> <p class="p1"><strong>Medications</strong></p> <p class="p1">Clonazepam 2 mg QHS</p> <p class="p1">Risperdal 2 mg twice daily</p> <p class="p1">Carbamazepine 200 mg twice daily</p> <p class="p1">Divalproex DR 500 mg three times daily</p> <p class="p1">Levetiracetam 1000 mg twice daily</p> <p class="p1">Losartan 100 mg daily</p> <p class="p1">HCTZ 25 mg daily</p> <p class="p1">Atorvastatin 40 mg daily</p> <p class="p1">Fenofibrate 48 mg daily</p> <p class="p1">Metformin ER 500 mg twice daily</p> <p><strong>Vitals:</strong></p> <p>Blood pressure is currently 144/86 mmHg</p> <p><strong>Lipids:</strong></p> <p>LDL-C: 98</p> <p>Triglycerides: 245 (down from 423 4 months ago)</p> <p><strong>CMP:</strong></p> <p>Na+: 133</p> <p>K+: 4.1</p> <p>eGFR: 95</p> <p>All others WNL as well</p> <p><strong>CBC:</strong></p> <p>Hgb: 10:1 g/dL</p> <p>MCV: 73</p> <p>Ferritin: 17</p> <p><strong>A1c:</strong></p> <p>6.9%</p> <p><strong>Current Appointment</strong></p> <p>The patient has seen multiple neuro and psych providers over the last year. </p> <p>The R­­isperdal and divalproex were for the bipolar II disorder. The patient is experiencing depression symptoms. His family notes that he has also been uncharacteristically aggressive lately and becomes agitated over minor issues. His family has recently noticed that while talking with him, his face is grimacing, his tongue will randomly protrude from his lips, as well as other facial movements.</p> <p>The clonazepam for insomnia. It helped with insomnia symptoms for a few weeks, but the symptoms are back to pre-