1130: 25-year-old female reporting to the clinic for a regularly scheduled follow-up. She is being treated for bipolar disorder with lamotrigine and valproic acid for bipolar I disorder. The client indicates that she 'doesn't feel better.' Over the past few weeks, she stated that 'she feels high, but yet feels low.' On assessment, the client is alert and oriented and has a constricted affect. She described her mood as 'whatever'. She denies suicidal ideations and hallucinations. She reports her sleep has been 'terrible' and that she 'cannot turn her mind off when she lays down.'

• Discontinue valproic acid
• Discontinue lamotrigine
• Start lithium 900 mg PO twice a day
• Follow-up visit in 3 weeks