,ASSESSMENT:,  This is a 69-year-old Caucasian female with a past medical history of schizoaffective disorder, diabetes, hypothyroidism, osteoarthritis, dyslipidemia, and GERD who presents to the emergency room with complaints of inability to sleep, irritability, elevated mood, and impulsivity over the past 3 days, which she attributes to a recent change in medication after an admission to St. Luke's Hospital during which time the patient was taken off her usual medications of lithium and Zyprexa. 
,ASSESSMENT : , This is a 69 - year - old Caucasian female with a past medical history of schizoaffective disorder , diabetes , hypothyroidism , osteoarthritis , dyslipidemia , and GERD who presents to the emergency room with complaints of inability to sleep , irritability , elevated mood , and impulsivity over the past 3 days , which she attributes to a recent change in medication after an admission to St. Luke 's Hospital during which time the patient was taken off her usual medications of lithium and Zyprexa .