Bipolar Disorders Assignment Essay
Assignment 1- “Captain of the Ship” Project – Bipolar Disorders- BIPOLAR I DISORDER TO SELECT-WK5
Bipolar disorders are severe disorders of mood that include both depressive episodes and expansive, grandiose, or manic episodes. During these times, the person may engage in activities with little awareness of the consequences because of accompanying psychosis. A diagnosis of bipolar disorder includes periods of mania or hypomania and periods of depression where the mood is down, hopeless, and suicidal. The neurovegetative symptoms of bipolar depression can be incapacitating. It is also important to differentiate the psychosis of bipolar disorder from schizophrenia.
In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a bipolar disorder.Bipolar Disorders Assignment Essay
Learning Objectives
Students will:
• Recommend psychopharmacologic treatments based on therapeutic end points for clients with bipolar disorders
• Recommend psychotherapy based on therapeutic end points for clients with bipolar disorders
• Identify medical management needs for clients with bipolar disorders
• Identify community support resources for clients with bipolar disorders
• Recommend follow-up plans for clients with bipolar disorders
QUESTION
To prepare for this Assignment:
• Select an adult or older adult client with a bipolar-I disorder that you have seen in your practicum.
In 3-4 pages, write a treatment plan for your client. In which you do the following:
• Describe the HPI and clinical impression for the client.
• Recommend psychopharmacologic treatments and describe specific and therapeutic end points for your psychopharmacologic agent. (This should relate to HPI and clinical impression.).
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
• Identify medical management needs, including primary care needs, specific to this client.
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.NOTE
1. PROVIDE BRIEF INTRODUCTION
2. ANSWER THE QUESTION WITH THE SUBHEADINGS
3. PROVIDE BRIEF CONCLUSION
4. ALL REFERENCES SHOULD BE 5 YEARS OR LESS AND EVIDENCED BASED
Bipolar 1 Disorder
Bipolar I disorder is a chronic mood disorder characterized by the presence of at least one manic episode and usually recurrent major depressive episodes and often chronic depressive symptoms, (Sadock, 2015). Individuals with bipolar turmoil regularly have cycles of hoisted and discouraged inclination that fit the portrayal of “manic depressive.” People with bipolar disorder are frequently misdiagnosed as having only depression. Bipolar disorder can affect both very young and older persons
There are four kinds of the bipolar disorder; all of them incorporates clear changes in the perspective, empowered, and activity levels. These outlooks reach out from times of to a huge degree up, upbeat, and enabled conduct (manic episode) to incredibly hopeless, down, or miserable periods (depressive episode). Less extraordinary manic periods are known as hypomanic scenes (Bressert, 2018).Bipolar Disorders Assignment Essay
History of present illness (HPI) and Clinical impression
A 38-year-old African American man presented to the primary care clinic to “have some disability papers filled out”. He reports being unable to work for several months because “I am a failure and I don’t have enough energy to get up in the morning”. He reports a long-standing history of sleep problems and now lays awake in bed every day from 4 am until mid-morning. He smokes several sticks of cigarettes throughout the day “to try to get moving”. He has gained weight over few months and now has a body mass index of 28 and daily low back pain. He endorses problems with concentration, decreased interest in previously pleasurable activities, and racing thoughts. He was hospitalized once on a psychiatry ward at the age of 23, “because I smoked a lot of pot, didn’t sleep for few weeks”. Scores 20 out of 27 on the Patient Health Questionnaire-9. He said, ” I have a larger number of individuals in paradise than here.” Reported that he generally has felt forlorn and misconstrued. He experiences issues with connections and had the ability to distinguish any suicide defensive components. Conceded hearing voiced past weeks to hurt self or others and often scans the web for approaches to hurt self. He revealed trouble concentrating, repetitive musings of death and suicide. Shown his outrageous high and extraordinary low emotions
Assessment: Patient is a moderately built African American male. Gait: intact. patient has good eye contact, language: intact. speech is regular in rate and rhythm, Thought process: logical. alert and oriented to time, place, person and situation, lacks concentration and feels suspicious of people and feeling anxious, said that people who don’t talk are plotting against him. Exhibits episodes of extreme happiness, little sleep, lack of energy, restlessness, racing thoughts, irritability suggestive of mania in the past. Mood and affect: flat, admitted no suicidal nor homicidal ideations at present, understand mental health status, and necessity of treatment, able to contract for safety, agreed to call for help or go to the nearest emergency room or call 911.
Medication Order
Will continue to provide for a safe and therapeutic environment as well as encourage for compliance.
Tylenol 500mg q 6hours for mild pain
Motrin 800mg q 6 hours PRN
Quetiapine 200mg q hs
Quetiapine 50mg BID PRN
Divalproex DR 500mg bid
Pantoprazole 40 mg q before breakfast
Nicotine 21mg/24-hour patch 1dose daily
Clinical Impression: Based on the diagnostic criteria in APA (2013), a diagnosis of Bipolar 1 Disorder.Bipolar Disorders Assignment Essay
Psychopharmacology
The patient will be on Depakote and Seroquel. Supplementing Depakote and Seroquel will diminish mania and avert repeats of mania. It enhances negative manifestations, cognitive, affective and aggressive symptoms. It takes around a month and a half for the viability of the medications in the body yet takes around 16-20 weeks for a decent reaction particularly on cognitive indications. The patient should proceed with the treatment until achieving a level of enhancement (Stahl, 2017).
On the other hand, Depakote will help squares voltage-delicate sodium channels and increases brain absorption of gamma-aminobutyric acid (GABA). The point of the treatment is complete abatement of mania manifestations. The treatment will proceed until the point when all manifestations are gone or until the point when enhancement is steady and afterward keep treating inconclusively as long as enhancement perseveres. The patient will be instructed to proceed with treatment inconclusively to keep away from repeat of mania (Stahl, 2017).
Seroquel works by demolishing dopamine two receptors, contracting positive reactions of psychosis and modifying full of feeling side effects. Likewise, works by changing the exercises of dopamine and serotonin in the cerebrum to improve thinking, perspective, and conduct. Impedes serotonin 2A receptors, bringing about enhancement of dopamine discharge in certain brain areas and in this manner diminishing motor reactions and potentially enhancing intellectual and affective manifestations (Stahl, 2017). Psychotic and hyper manifestations may improve in a week; be that as it may, it can take a little while for full results on intellectual, behavior and passionate stabilization (Stahl, 2017).Bipolar Disorders Assignment Essay
Psychotherapy
Psychotherapy is huge for this patient to enable him to heal better. Psychotherapy is an urgent piece of bipolar disorder treatment. The patient was educated that he needs psychotherapy and was inquired as to whether it is alright to incorporate his spouse on the grounds that a family treatment will enable him to recuperate better. Cognitive family behavior treatment will encourage the patient and his accomplice. It investigates the role of the mood disorder in the entire mental prosperity of the patient relationship. It looks at the role of the patient and his accomplice relationship in the safeguarding of the patient’s side effects (Sadock, Sadock, and Ruiz, 2015). The emphasis is on perceiving undesirable, unsafe practices and convictions and swapping them with sound, positive ones. CBT can help recognize what causes the bipolar scenes. Patient and accomplice learn successful strategies to oversee pressure and to adapt to exasperating circumstances.
Medical Management
Quite essential for patient’s primary care physician to be reached about patient new improvement and made mindful that the patient is no protestation with her prescription routine. Tolerant ongoing lab result will be talked about. The patient ought to be educated about the significance of taking his medicine and the side effects. The patient was educated to screen for symptoms, for example, dizziness, perplexity, sleepiness, and trouble focusing yet report the accompanying promptly hives, skin rash, tingling, swelling of the face, lips, or tongue. The patient is educated to restrict or evade liquor consumption while on Depakote (Stahl, 2017).
A community support resources for clients with bipolar disorders will help a lot to this client. Therefore, the Depression and Bipolar Support Alliance site was introduced to the client. This resource gives auspicious data on bipolar turmoil and depicts the conditions is screen by the providers and in addition, recuperation steps and approaches to assist adored one with the diagnosis (DBSA Baltimore County, n.d.).
Follow-up plan and Collaboration
The patient returns in seven days for a follow up, observed to apparently doing outstandingly with his medications. The therapist was follow-up on, to see how well the patient and partner are doing. The therapist was taught to tell the provider if there are any issues. The Therapist and PCP will likewise be educated to screen the patient for self-destructive ideations and depressive manifestations. PCP will in like manner be advised to get up to speed with labs results CBC, Liver function tests, platelet checks, and coagulation test. Plasma drug dimension will help screen viability, consistence and side effects.Bipolar Disorders Assignment Essay
Conclusion
Incredibly, the patient returned following a month was solid. He detailed inclination fine, his plasma report was ordinary. He detailed that his treatment session was enthralling, and he has been doing great with his accomplice and neighbors. He is an astoundingly cheerful individual about existence. He in like manner verbalized that his accomplice is adjusting commendably. The patient is relied upon to continue with the treatment as prescribed and answer to provider in about multi month.
Reference
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Bressert, S. (2018). Introduction to Bipolar Disorder. Psych Central. Retrieved on September 26,
2018, from https://psychcentral.com/disorders/bipolar/introduction-to-bipolar-disorder/
DBSA Baltimore County (n.d.). Depression & Bipolar Support Alliance of Baltimore County.
Retrieved on December 30, 2018. http://www.DBSABaltimoreCounty.com
Nimh.nih.gov. (n.d.). Bipolar Disorder. Retrieved on September 30, 2018.
https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Stahl, S. M. (2017). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (6th ed.).
New York, NY: Cambridge University Press.
Introduction
This paper discusses the management of a client with bipolar I disorder in terms of psychopharmacology and psychotherapy. It also describes the medical management and primary care needs and how best to coordinate with other providers when managing such clients.
HPI and Clinical Impression for the Client
EO was a 22year-old sophomore in a small Midwestern college. She presented at the clinic accompanied by her mother with complaints of insomnia for an entire week and a heightened activity state which she thought was out of control. Her mother mentioned that most of EOs behaviors were primarily characterized by ideas which were not only strange but also grandiose and always took a sexual tone. For instance, the day before, she had proclaimed to her friends that she failed to get her menses since she was of a third gender that was above all the human sexes. When questioned, she clearly explained that she was special in a way that she could still give birth without involving in sexuality.Bipolar Disorders Assignment Essay
EO also had bizarre thinking patterns which had a political dimension. For instance, she strongly believed that her soul had been switched with that of the governor of her state. She also explained how she had developed three governmental theories that only she could use to safeguard the US from destruction with nuclear weapons. Based on this relation, she believed that she was best suited for a position in government. She kept explaining her thoughts and theories to everyone at school, family and even wrote them on the dormitory walls, her notebooks and computer with the fear of forgetfulness and even started to campaign for an elected post in government though there were no elections scheduled at this time. Although she was well known by family and friends to be highly organized and tidy, lately, most of them had expressed a lot of worry and disbelief to find that she had started being disorganized and frantic.
It is important to know that EO grew up in an overprotective environment with parents who were very demanding. Apart from being a passively obedient child, EO never applied makeup as she was forbidden by her mother. She also never discussed issues related to sex while growing. She had a positive family history of mood disorders: her paternal grandfather had at once received electroconvulsive therapy for depression and her maternal aunt was once diagnosed with depression when she was going through menopause. Based on the DSM IV, EO was diagnosed with Bipolar I disorder (Koirala & Anand, 2018).
Recommended Psychopharmacologic Treatments
As the PMHNP, considering EO’s Bipolar I diagnosis, the severity of her symptoms and family history, I would strongly recommend the prescription of an antipsychotic and a mood stabilizer. The best antipsychotics, in this case, could be Seroquel and lithium as the mood stabilizer (Ketter et al., 2016). A lot of preference wouldn’t be given to starting her on large-scale anti-depressants since most scientific studies have demonstrated that for most patients with bipolar I, combining antidepressants to mood stabilizers is very effective as compared to management using only a mood-stabilizer (Ketter et al., 2016). After four weeks if EO fails to show treatment progress, an antidepressant, preferably Prozac will be added to the prescribed drugs.Bipolar Disorders Assignment Essay
Recommended Psychotherapy Choices
The goal of psychotherapy is to increase the patient’s adherence to medications and to offer social, emotional and psychological support apart from linking up the patient with appropriate resources within the community. According to Ye et al. (2016), the most recommended form of therapy for this patient will be group cognitive behavioral therapy. CBT will help the client to change his irrational thoughts and dysfunctional behavioral patterns. Through group interactions, the client will be able to face her fears as compared to practicing avoidance and will develop more effective strategies to maintain calmness and relaxation Ye et al. (2016).
Medical Management Needs, Primary Care Needs and Community Support Resources
It will be necessary to connect with the patient’s PCP as this will promote effective communication to know about the client’s progress. Baseline laboratory investigations will be needed to ascertain whether the patient can efficiently take the prescribed medications. They include liver profile, complete blood count and a kidney function test. It is likely that the medications prescribed will influence some side effects. As recommended by López-Muñoz et al. (2018), she needs to be educated about to ensure compliance with medication. EO will be connected to community support groups such as those which are supported by Mental Health America, as well as Depression and Bipolar Support Alliance (DBSA) (Behler et al., 2017).
Plan for Follow-up and Collaboration with Other Providers
The client’s follow-up visit was scheduled in a week’s time for the start. The purpose of this visit will be to assess the client’s tolerance to the prescribed medications. Major issues that will be assessed include compliance to medications and adjustment of the dosages (Malhi, 2016). Thereafter, other follow-up visits will be done in an interval of 4 weeks. It should also be noted that the client was instructed to begin psychotherapy the same week with medications and weekly attend to other sessions. It will be necessary to maintain communication with the client’s therapist and PCP for continuous monitoring. Bipolar Disorders Assignment Essay
Conclusion
The client’s prognosis was unremarkable. She managed to regain her social and functional status and to maintain previous relationships that existed with friends and family. In clinical practice, bipolar disorders present a lot of challenges when it comes to diagnosis and management such that, misdiagnosis or mismanagement can easily result in poor prognosis and mental health outcomes. Good treatment outcomes are also associated with a strong and long term therapeutic relationship that is characterized by openness and constant communication.
References
Behler, J., Daniels, A., Scott, J., & Mehl-Madrona, L. (2017). Depression/Bipolar Peer Support Groups: Perceptions of Group Members about Effectiveness and Differences from Other Mental Health Services. The Qualitative Report, 22(1), 213-236.
Ketter, T. A., Miller, S., Dell’Osso, B., & Wang, P. W. (2016). Treatment of bipolar disorder: Review of evidence regarding quetiapine and lithium. Journal of Affective Disorders, 191, 256-273.
Koirala, P., & Anand, A. (2018). Diagnosing and treating bipolar disorder in primary care. Cleveland Clinic journal of medicine, 85(8), 601-608.
López-Muñoz, F., Shen, W., D’Ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of bipolar disorder. International journal of molecular sciences, 19(7), 2143.
Malhi, G. S. (2016). Bipolar disorders: key clinical considerations. The Lancet, 387(10027), 1492-1494.
Ye, B. Y., Jiang, Z. Y., Li, X., Cao, B., Cao, L. P., Lin, Y., & Miao, G. D. (2016). The effectiveness of cognitive behavioral therapy in treating bipolar disorder: An updated meta‐analysis with randomized controlled trials. Psychiatry and clinical neurosciences, 70(8), 351-361.Bipolar Disorders Assignment Essay