CASE STUDY: Miss B is a 20 year old Caucasian female of Irish heritage who was a

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CASE STUDY: Miss B is a 20 year old Caucasian female of Irish heritage who was arrested for walking along the roadway on her college campus shouting obscenities at oncoming traffic. She is agitated states"leave me alone. I am in perfect health and know my own mind." Her mother and boyfriend arrive and state that she has been taking lithium carbonate 600mg t.i.d. for Bipolar Disorder II for the past 5 years, with good results until several weeks ago. Her boyfriend states that she has been 'up all night' for the past few days and has a "harebrained scheme to become a Rhodes Scholar". Miss B's mother states that she suffers from chronic depression and that she is worried since Miss B is pregnant. She says, "I have bad genes, but is there anything that we can do to keep my grandchild from having a mental disorder?" Case Study Guidelines: You will be divided into groups of 3 to 6 (based on enrollment). Each group will respond to the questions in the case study. Each group will place their report in the drop box by the due date listed by the week. Absence from the group presentation will result in the deduction points for the individual. Case Study Guidelines: Each will respond to the questions in the case study. Diagnosis: What test should be done? Who should be tested? What are the implications of the results? What do you think the results will be and why? In addition include a pedigree 1. Identify additional information/history that should be elicited in relation to this case. 2. Identify the pattern of inheritance for the disease/condition, and discuss the reason for your answer. 3. Identify family members that may be at risk for this disease, explain your answers. 4. Discuss any other alternative explanations for the disease/condition pattern noted in the Pedigree. Please refer to the book: Genetics and Genomics in Nursing and Health Care(2012)

Explanation / Answer

Diagnosis
What test should be done?
Physical examination: identifying the medical problems that could be causing the symptoms.
Psychiatric assessment: consulting a psychiatrist, to analyze the thoughts, feelings and behavior patterns and getting history from relatives and friends.
Mood charting and observing the criteria for bipolar disorder and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Who should be tested?
Miss B, Miss B's mother and the fetus (through amniocentesis) should be tested.

What are the implications of the results?
The results would tell us if Miss. B had a genetic predisposition to the disease and might help the doctor's identify the right medications for Miss. B and her mother.

What do you think the results will be and why?
The results would justify Miss. B's condition and might also suggest a hereditary pattern. Miss. B's mother would have been a heterozygous patient (note:she had depression) and would have transferred the recessive gene to Miss. B.

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