History and current patterns of substance abuse

Chantel is a 19-year-old female who presents for care because she thinks she is bipolar. During her initial interview, she admits that she has a long history of feeling like she was the person in the family of whom there were always high expectations, and she was never able to express concerns or feelings of inadequacy. When asked why she thinks she is bipolar, she says she gets very moody. She was at the grocery store last week and slipped and fell.
While waiting for help, she could not control her anger and reached up to swipe all the food off of the shelves. She has been fired from jobs because of her uncontrollable temper; she sometimes ―just can’t be around certain people. Chantel also reports that at times she will go two full days and nights being unable to sleep, and that her mind keeps racing and she can’t ―shut it down. When this happens, she just gets up and does things around the house. Finally, Chantel reports that she cannot hold onto money at all. Whenever she gets a paycheck, she immediately spends it on things that she acknowledges she doesn’t even need. When considering a diagnosis of bipolar disorder, the PMHNP specifically assesses for:
A. Any history of suicidal attempts or serious ideation
B. History and current patterns of substance abuse
C. Concomitant psychotic features such as hallucination or delusion
D. Manic symptoms that are sustained most of the day for at least 2 weeks

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