Carrie presents to you again while in her first semester of college at the age of 19. She is taking a leave of absence after she began experimenting with cocaine at college and had a manic episode characterized by a lack of sleep without fatigue, persistent unabating energy, rapid and pressured speech, and ultimately, concern from her college friends. She was admitted to a psychiatric unit and stabilized on a second-generation antipsychotic, risperidone, which has solid evidence for mania, but she and you are now concerned about longer-term metabolic effects.15,16
You discuss monitoring her lipid profile and hemoglobin A1c, in addition to weight gain and waist circumference. She has connected with a therapist and psychiatrist through the college counseling center and hopes to return next semester with a fresh start and commitment to sobriety and social rhythms therapy known to be helpful for patients with bipolar disorder.17
While it is challenging to manage a chronic illness at her age, she feels hopeful that she can make better choices for her overall health with your support and the support of her family and mental health team.
Dr. Pawlowski is a child and adolescent consulting psychiatrist. She is a division chief at the University of Vermont Medical Center, Burlington, where she focuses on primary care mental health integration within primary care pediatrics, internal medicine, and family medicine.
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2.. 2021 Jun 25. doi: 10.1186/s40345-021-00225-5.
3.. 2018 Dec 11. doi: 10.1176/appi.ajp.2018.18040461.
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6.Short Form – H/B (Revised Version, 2008).
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10.2020 Apr 20. doi: 10.1186/s40345-020-00185-2.
11.. 2021 Jun 25. doi: 10.1186/s40345-021-00225-5.
12.. 2017 Sep 25. doi: 10.1111/bdi.12556.
15.. 2012 Jan 2. doi: 10.1001/archgenpsychiatry.2011.1508.
16. The Carlat Child Psychiatry Report.Newburyport, Mass.: Carlat Publishing, 2012.