Bipolar Disorder

1

ASSIGNMENT 1 3

Assignment 1: –Bipolar Disorders

–Bipolar Disorders

The HPI and Clinical Impression

Juliet 35-years old female complains of insomnia. She typically does not nap. “I have not slept for a couple of weeks.” Juliet has been hospitalized severally in the past. First, she was hospitalized in her early twenties due to a mood disturbance with some psychotic characteristics. Currently, she is receiving outpatient treatment for bipolar disorder. Juliet has a history of medication non-compliance, which is making the treatment ineffective. Consequently, she has made suicidal threats severally.

She appears distracted, irritable, intrusive, and she articulates her poorly. Additionally, her speech is rapid, pressured, constant, confused and loud due to racing thought patterns. She was unable to recognize her unusual behavior. Besides, her judgment seems to be poor. She also experiences paranoia and fear. She believes that she has done something terrible, which might result in harm. Nonetheless, she does not portray any signs of anxiety. She portrays some oppositional behavior throughout the examination process. The present health history and clinical presentation indicate that she is suffering from Bipolar I Disorder (mania and depression).

Psychopharmacologic Treatments

I prescribed lithium 600mg by mouth twice a day to the patient. According to Swartz & Swanson, (2014), lithium is effective in regulating mood swings and minimizing the chances of attempting suicide. Additionally, I recommended psychiatric hospitalization to monitor her condition closely, thus minimizing potential danger to causing harm to herself or others. Less intensive treatment would not be effective since it has failed in the past. This therapy will minimize suicidal thoughts. Recommend Psychotherapy

Psychotherapy is appropriate to complement medications used in the treatment of this condition. The use of pharmacotherapy as the treatment for bipolar disorder only provides the patients with partial relief. Moreover, pharmacologic treatment as the only option has been associated with high rates of recurrence, low rates of remission, psychosocial impairment, and residual symptoms (Swartz & Swanson, 2014). In this case, I would recommend individual cognitive therapy as a psychotherapeutic intervention. This type of cognitive therapy (CT) for bipolar disorder is a skills-based treatment, which assists individuals to recognize maladaptive thoughts and modify the connection between these thoughts and moods (Swartz & Swanson, 2014). The goal of psychotherapeutic approach is that, the patient will learn to modify negative thoughts automatically using thought records, activity planning, and mood journals. Furthermore, she will learn how to intersect sequences of mania and depression as well as eliminate inaccurate thinking rationales. Therefore, this psychotherapy will enable Juliet to recovery from depressive episodes faster and prevent her from experiencing new mood episodes, thus reducing suicidal thoughts. Also, this therapy will minimize her distractive, irritable, and intrusive behavior, thus improving her quality of life. Medical Management Needs

The patient has various medical management needs, including primary care needs. First, Juliet needs to be hospitalized in the healthcare facility and assigned to a family caregiver. Doing so will enable the healthcare provider to monitor her progress and response to the treatment. Additionally, it will minimize the chances of medication non-compliance, which was reported in her past incidents. Non-adherence to medication is among the primary cause of relapse in bipolar disorder. Additionally, she requires to be administered with Lithium. According to Shah et al Grover (2017), Lithium is an effective mood stabilizer in bipolar disorder; it prevents suicide among bipolar disorder patients. Besides, this patient requires tricyclic, which is an antidepressant to assist in the management of depression. However, this drug is not supposed to be used along with a mood stabilizer (Lithium) since it is likely to trigger a manic episode. Finally, the patient requires Benzodiazepines, which improve sleep and lowers the level of anxiety. Community Support Resources and Community Agencies

According to Waxmonsky et al (2014), patients with bipolar disorder incur relatively high health care costs compared to other mental illnesses. Consequently, community support resources and community agencies are coming up to provide bipolar patients with the required support. These organizations provide patients with a wide range of services. First, they provide information about symptoms of the condition, how it is diagnosed, and available treatment options (Dunleavy, 2018). Besides, they provide patients with financial support since the condition hinders them from engaging in income-generating activities. Finally, the organizations provide coping mechanisms, advocacy, and psychological support to the patients and their family members. In most cases, Bipolar disorder not only affects an individual but also their loved ones (Dunleavy, 2018). Therefore, these organizations provide patients and their family members with a good support system, thus enabling them to overcome the situation.

A Plan for Follow-Up Care

Upon being discharged from the healthcare facility, a 60-day follow-up visit is recommended for the patient. Initially, Juliet should be accompanied by a family member to the healthcare facility after every 3 days for the first two weeks. Later the frequency will change to every 5 days for the next month and finally after every 7 days for the remaining period. This follow-up plan will allow the psychiatrist to monitor her progress and how she is responding to the treatment. Additionally, follow-up care will allow the specialist to change her medications if need be, thus enhancing her recovery process.

References

Swartz, A, H & Swanson, J. (2014). Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence. Am Psychiatr Publ, 12(3): 251–266. doi:10.1176/appi.focus.12.3.251.

Shah, N., Grover, S., & Rao, G. P. (2017). Clinical practice guidelines for management of bipolar disorder. Indian journal of psychiatry, 59(Suppl 1), S51.

Waxmonsky, J., Kilbourne, A. M., Goodrich, D. E., Nord, K. M., Lai, Z., Laird, C., ... & Bauer, M. S. (2014). Enhanced fidelity to treatment for bipolar disorder: results from a randomized controlled implementation trial. Psychiatric Services, 65(1), 81-90.

Dunleavy, P, B. (2018). Bipolar Disorder Resources: Finding the Help You Need. Everyday Health. Retrieved from https://www.everydayhealth.com/bipolar-disorder/guide/resources/