Please address the following: 

Patient is a 47-year-old woman with bipolar disorder and anxiety. She has been stable on a combination of duloxetine and quetiapine for a number of years. She smokes, and has diabetes, hypertension, and hyperlipidemia. She is concerned about her weight and asks whether there are medications that she can take to aid in weight loss. She says that she has been told indirectly, by her friends and family, that she is overweight. She has tried several fad diets without lasting success. She has not been unable to maintain any weight loss for more than a few months. 

She tells you that she watches what she eats and reads the nutritional labels on food packaging but enjoys eating out and often orders take-out meals. She works full time and spends most of her day sitting in an office. She belongs to a fitness club, but her attendance is inconsistent. 

She also confides that she has trouble reaching orgasm regardless of what she tries. 

 

Questions: 

What would be your approach to managing this patients weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

What would be our approach for the sexual side effects she is experiencing? 

If you suggested additional medication, look up your states prescribing laws. Are PMHNPs able to prescribe the medication you recommended?