Soru

A 26-year-old female graduate student is brought to the emergency department by her roommate. For the past month, the patient has exhibited profound sadness, a 4.5-kg (10-lb) weight loss, and severe psychomotor retardation. She sleeps 14 hours a day and refuses to attend her classes. During the interview, she stares blankly and admits she has been hearing a persistent voice saying she is "a fraud who deserves to die." The roommate reports that two years ago, the patient had a distinct 3-week period where she barely slept, spoke incredibly fast, bought thousands of dollars of unneeded laboratory equipment on credit, and claimed she had independently deciphered the human genome. That prior episode culminated in a 5-day psychiatric hospitalization. Her urine toxicology screen is negative. Which of the following is the most accurate diagnosis and most appropriate initial pharmacotherapy for this patient?