A 22-year-old gravida 1, para 0 Caucasian woman at 8 weeks of gestation is brought to the emergency department by her boyfriend because she has been threatening to commit suicide. He reports that in the past several days she has become increasingly angry, impulsive, and dramatic. She has slept very little in the past week and spent much of today buying an assortment of expensive clothes and shoes on credit. The woman has a long history of poorly controlled bipolar disorder with episodes of psychosis. While a teenager, she twice attempted to commit suicide. She denies taking any medications and insists she is not under the care of a therapist or psychiatrist. In dealing with emergency department personnel, she is highly irritable and combative, resisting attempts to physically examine her. The woman refuses to take any medication by mouth and resists the insertion of an intravenous catheter. At one point she leaps off of the examination table and shouts, "I am God. I can accomplish anything I want, anytime I want, and that includes killing myself right this minute." Which of the following actions would be most beneficial?
A) Hospitalization and forced lithium
B) Hospitalization and forced valproic acid
C) Hospitalization and forced fluoxetine
D) Hospitalization and forced electroconvulsive therapy
E) Discharge home with referral to psychiatrist
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