mrcpsych-0930

You are requested to evaluate a 35-year-old woman who is currently in isolation in a psychiatric intensive care unit.
She has a diagnosis of bipolar affective disorder and has been restarted on 15 mg of aripiprazole and 1000 mg of lithium carbonate since being admitted ten days ago. She has been compliant with her medication regimen.
The nursing staff has informed you that she has been progressively deteriorating and the risks of her manic presentation are becoming challenging to manage. She has not slept for two days, is continuously restless, and has already received 1 mg of lorazepam IM without any improvement.
What would be the next appropriate course of action?