The plan of care for a patient in the manic state of bipolar disorder should include which intervention?

Choice A reason: Delusions of persecution in schizophrenia involve hyperactive dopamine pathways in the mesolimbic system, leading to irrational fears like poisoning. Tasting food directly addresses the delusion by demonstrating safety, potentially reducing anxiety and engaging the patient’s trust, which can modulate amygdala hyperactivity and promote acceptance of nutrition without invasive measures.

Choice B reason: Tube feedings or parenteral nutrition are invasive and may reinforce the patient’s delusional fears of harm, as they bypass voluntary control. Schizophrenia’s dopamine dysregulation heightens suspicion, and forced interventions could exacerbate paranoia by stimulating the amygdala, increasing stress responses and potentially worsening the patient’s mental state and compliance.

Choice C reason: Allowing restaurant delivery does not directly address the poisoning delusion, as external food sources may still be perceived as unsafe due to hyperactive dopamine-driven paranoia in schizophrenia. This option fails to engage the patient’s trust or reduce amygdala-driven fear responses, making it unlikely to resolve the refusal to eat.

Choice D reason: Supervised vending machine access may not alleviate the patient’s delusional belief in poisoning, as the source remains external and unverified. Schizophrenia’s dopamine excess in the mesolimbic pathway sustains mistrust, and this intervention does not directly counter the delusion, potentially leaving amygdala-driven fear responses unaddressed, reducing its effectiveness.

Choice A reason: Strenuous outdoor activities increase dehydration risk with lithium, which has a narrow therapeutic index and affects renal sodium handling. No changes are unsafe, as dehydration elevates lithium levels, risking toxicity via neuronal and renal sodium-potassium ATPase disruption.

Choice B reason: Sunscreen is unrelated to lithium’s mechanism, which stabilizes mood via sodium channel modulation and inositol depletion. Lithium does not cause photosensitivity, and this advice does not address the critical risk of dehydration impacting renal lithium clearance.

Choice C reason: Lithium’s renal excretion depends on hydration, as it disrupts sodium-potassium ATPase, risking toxicity with dehydration. Increased fluid intake during heavy perspiration prevents elevated lithium levels, protecting neuronal and renal function, making this the most appropriate response.

Choice D reason: Reducing fluid intake increases lithium toxicity risk by decreasing renal clearance. Lithium’s effect on sodium-potassium ATPase heightens neuronal and renal sensitivity to dehydration, potentially causing toxic levels, making this advice dangerous and inappropriate for safe lithium use.