A 36-year-old woman with no formal psychiatric history is re…

A 36-year-old woman with no formal psychiatric history is referred to you by a dermatologist for an evaluation of her chronically chapped hands.  She says she has been seeing her dermatologist for about 5 years for this problem and treated with a variety of topical agents with limited success.  Over the past 3 weeks, her hands have become worse, to the point where they are always cracked and bleeding.  Reluctantly, she confides in you that has had a fear of germs, but since her colleague has been sick, she has been washing her hands about 40 times a day because she is afraid of contracting the disease.  She refuses to touch anything that might infect her without using a tissue or handkerchief.  She also admits to being very tidy at home and tells you that she spends about 2 ½ hours in the morning getting showered.  She realizes her fears of contamination are irrational, but every time she tries to stop she becomes increasingly anxious.  You discuss which of the following diagnoses with the patient in an effort to determine the best course of treatment?

A 70 year old patient with history of bipolar mood disorder…

A 70 year old patient with history of bipolar mood disorder presents with new onset of psychosis. Current psychotropic agent is lamictal 100mg daily for mood stabilization and patient has been maintained on agent greater than a year. What is the most appropriate initial approach?