Select an appropriate screening tool for Kristin and provide a score for the tool.

Select an appropriate screening tool for Kristin and provide a score for the tool.
The appropriate screening tool for Kristin would be the Bipolar Spectrum Diagnostic Scale (BSDS).  Utilizing the assessment data provided the score arrived at was 13.  This screener is considered positive, with Bipolar Spectrum Disorder, moderate probability. A positive screen delineates clinical diagnostic evaluation for bipolar disorder (Sayyah, Delirrooyfard & Rahim, 2022). 

Provide a rationale for the screening tool you selected.
The client’s reported symptoms include anger with provocation, uncontrollable crying, inability to focus, missing several days of work due to symptoms (client works at home), disturbed sleep patterns due to racing thoughts, ability to stay up 3 to 4 days in a row to complete crafting projects, weight loss and no appetite, and finds online shopping is the only thing that makes her happy reporting draining her bank savings account.  Signs and symptoms are reported to be prevalent for at least the last month.  All of the signs and symptoms reported are relevant to bipolar disorder and a manic episode.

The BSDS is a patient self-reporting screener, thus allowing the practitioner to obtain further assessment answers that may have been missed or misconstrued during the assessment interview.  Research has found two screeners outperform on sensitivity and specificity in comparison to the BSDS, the Bipolarity Index (BI) and the Mood Disorder Questionnaire (MQS) providing more accurate diagnoses of bipolar disorders (Sayyah, Delirrooyfard & Rahim, 2022).  In the interest of evidence-based findings the BI was utilized, but required ratings for current pharmacological responses, which Kristin currently is not prescribed any psychiatric medications.  The MQS had multiple questions that could not be answered based on the information provided in the case study.  While research supports the utilization of the BI and MQS over the BSDS screener, it was not appropriate for this case study and provided information. 

Determine the most likely diagnosis for Kristin based on the available information.
Utilizing the DMS-5-TR and the BSDS results, a differential diagnosis of Bipolar 1, manic episode was reached due to meeting all 4 diagnostic criteria with 4 of the mood symptoms being positive (American Psychiatric Association, 2022).  While the mood of the client was reported to be observed as depressed it is important to note the client has not lost interest in things that bring pleasure, such as her crafting.   

Provide the ICD-10-CM code for the selected diagnosis
The ICD-10 code is F31.12, Bipolar I, manic episode, moderate (American Psychiatric Association, 2022).  The specifier cannot be determined due to lack of information related to total length of current episode, previous similar moods, signs and symptoms.

Provide a treatment plan with rationale for each plan step.
Treatment Plan:

Prescribe Quetiapine 300 mg daily.  Quetiapine treats acute mania, acute bipolar depression, mood episodes, mania and depression (Boland & Verduin, 2022).  The patient should be educated to start medication and ongoing required monitoring with treatment. The patient should be educated on possible side effects that may subside dizziness, headache, dry mouth, increased appetite and constipation.  The patient should also be educated on adverse side effects such as TD, EPS, symptoms worsening, and or thoughts of suicide or self-harm and to contact the provider immediately.  Quetiapine is an atypical antipsychotic require the following monitoring protocols after obtaining a baseline for each (Boland & Verduin, 2022):

Weight monthly for first 3 months, then every 3 months
BP and FBG every 3 months for first year, then annually
Fasting lipid profile after 3 months, then annually
ECG due to the clients daily vaping of nicotine annually
Prolactin levels every six months
The patient should be referred to therapy for cognitive behavioral therapy treatment to decrease the signs and symptoms.  Pharmacotherapy has shown to lower the risks associated with Bipolar I with medication and cognitive behavioral treatment (Boland & Verduin, 2022).  While pharmacotherapy is the best dual treatment for the client, accepting therapy treatment and referral is a patient decision.  The patient will return in 4 weeks for a follow-up appointment and complete labs prior to appointment ordered for monitoring.  This will allow the practitioner to evaluate the efficacy of the prescribed medication and to complete the required monitoring of weight, blood pressure, and fasting blood glucose.  If the efficacy of the prescribed medication is low and signs and symptoms show no or little impro