Psychiatric Mental Health Nurse Practitioner Track


Case Study #3


Directions: Please read the following case presentation. Answers are to be typed, double-spaced and references must be in APA format. References must include the DSM-5 and at least 2 current scholarly references.



A 75 yo male presents worried that he has recently developed quite a marked tremor and nothing he can do helps control it. He has no other concerns and is currently well. The man has a long established diagnosis of bipolar disorder, which has been well-controlled with Lithium. His medication was recently changed.


Mental State examination


The man is cooperative and communicative with good eye contact. His speech is normal. His mood is objectively and subjectively stable. He does not express any ideas of self-harm. There is no evidence of psychosis. He is oriented in time, place and person and there is no cognitive impairment.


Physical examination


The man looks well and there is nothing of note except a marked coarse tremor. The tremor is not rhythmic and is present at rest and when he attempts a task. There is no indication of any cogwheel rigidity or lack of facial expressions.




  1. What is the differential diagnosis (25 points)?


  1. What are the signs of lithium toxicity (25 points)?


  1. How should lithium toxicity be managed (25 points)?


  1. How can the potential the lithium toxicity be minimized (25 points)?