What if girl presents with irritability, initial insomnia


Problem: A 14-year-old girl presents with irritability, initial insomnia, and low self-esteem since her partner ended their relationship about 3 weeks ago. She continues to eat well and enjoys her usual activities with friends, including actively planning a trip for spring break. Review of systems is negative for inattention, low energy, mania, psychoses, substance use, and suicidality. She just started school-based therapy and has never been on psychiatric medications. She is accompanied by her mother, who is adamant that the girl should be started on lamotrigine. Her mother has been on multiple trials of psychiatric medications and reports lamotrigine is the only medication that is helpful for her own irritability. Which of the following is the best next step in management? Need Online Tutoring? Cytochrome P450 testing prior to a lamotrigine trial Fluoxetine trial after obtaining informed consent Lamotrigine trial after obtaining informed consent Psychoeducation and continuing school-based therapy

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