W7 Bipolar Case Study
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BIPOLAR CASE STUDY
Ivan Oliva
Regis College
Course Number: Course Name
Instructor’s Name Nicole Walters
Assignment Due Date 10-15-21
Week 7 Discussion 1: Bipolar Case Study
Identification of target symptoms/problems
1. What information, if any, would you like to know that was not included in the case?
The provider in the case study has explored most of the information, including the patient’s symptoms, past medication, family history, etc. However, one of the areas that I would explore that was not included in the case study is the environmental factors. It is crucial to examine whether the patient had experienced some disturbing events in his surrounding that could have resulted in the depressive and manic symptoms. Another critical thing that I would inquire about is the significant changes in the patient's life, i.e., whether he has gone through a divorce.
2. Which psychiatric symptoms are a treatment priority for this case?
Some psychiatry symptoms that are a priority in this case study include; manic symptoms such as high energy, reduced need for sleep, and the loss of touch with reality. According to the case study, the patient sent different letters to different individuals, including the Pope and Tony Blair. He also talks about having a reduced need for sleep over the last few days. The patient has also lost touch with reality; he believes that God is speaking to him. On the other side, I would prioritize the depressive symptoms, including loss of energy during the interview, hopelessness, and sadness.
3. What are the non-pharmacologic issues in this case (problems/complaints that cannot be addressed by medication)?
Some of the non-pharmacologic issues in the case study that the medication cannot address are anger issues, change of emotion, and thoughts. The patient exhibits anger issues on several occasions. First, after being irritated by his mate, Dave, the patient becomes angry. He also becomes angry because the previous G.P. cannot address his problems. Besides, he is irritated when the provider tells him that he does not seem to be well. Medications cannot effectively address such issues; only psychotherapies such as CBT can address them best.
Medication Choice 1
4. List one medication that would be appropriate for this case. Include the name and starting dose.
The medication that would best help the patient manage his symptoms is the atypical antipsychotics, Quetiapine (Seroquel). Dosage; I.R. 50 mg 1 Tab PO BID; adjust the dose according to response, maximum 800 mg/day (Ketter et al., 2016).
5. Describe your clinical decision-making. What is your rationale for choosing this medication? Also, include the mechanism of action for this medication choice and the neurotransmitters and areas of the brain on which the medication is proposed to act.
Quetiapine would best address the symptoms exhibited in the case study because it re-balances the dopamine and serotonin in an individual’s brain; thus, improving thinking, mood, and behavior. Quetiapine is a second-generation antipsychotic with a high affinity for D2, 5-HT2A, H1, alpha 1, and 5-HT1A receptors (Abdyrakhmanova et al., 2021). In its mechanism of action, this medication reduces dopaminergic neurotransmission in the mesolimbic pathways; thus, eliminating the manic and depressive symptoms in a patient. If the patient in the case study takes this medication, he is likely to manage the severity of his manic and depressive symptoms.
6. What laboratory testing/monitoring is needed for safely prescribing this medication?
Various laboratory tests needed before administering this medication are as follows. One of the tests is fasting blood lipid testing; this is monitored at the start and periodically during the treatment to examine the amount of cholesterol in the patient’s blood (Vatsalya et al., 2016). Another test required is the Body Mass Index (BMI); this measures the patient's weight and whether it is suitable for the medication. And the last lab test is a complete blood count (CBC) to evaluate the cells circulating in the patient’s blood.
7. Are there any contraindications or safety issues associated with this medication?
Quetiapine has various contraindications or safety issues. One of them is that individuals with low thyroid hormone levels should not take the medication because it might lower metabolism in an individual; thus, causing weight gain or feeling tired. Another safety concern is that the medication should not be administered to individuals with low magnesium and potassium levels in the blood (Kim et al., 2016). Quetiapine's administration on individuals with low magnesium or potassium levels in the blood might lead to sedation, weight gain, or postural hypotension. And the last contraindication is that the medication should not be administered to individuals with high blood pressure because it might further complicate the situation, leading to death.
Non pharmacologic Interventions
8. What non-pharmacologic interventions do you recommend? Do you recommend including but not limited to psychotherapy, complementary and holistic therapies?
One of the non-pharmacological interventions that I would recommend to the patient is Cognitive Behavioral Therapy (CBT). CBT works by changing the patient’s patterns of thoughts, thus, addressing the manic and the depressive symptoms (Ellard et al., 2018). CBT helps the patient recognize the warning signs of a mood change, thus, helping them change the unhealthy patterns. Another strategy that can be used in the case study to manage the symptoms is reflexology. This technique focuses on applying pressure to the foot, which eventually brings relaxation and a healing effect on the mind. As a result, the patient efficiently manages the depressive and manic symptoms. And the last strategy is meditation; this helps individuals disengage from the stressful and anxious thoughts; thus, better controlling their moods.
Safety Risk Assessment
9. What are the safety concerns, if any, associated with this case? How will you address safety?
The safety concern associated with this case is getting rid of the drugs. The patient in the case study does not believe that he is suffering from any mental issues; therefore, he is likely to get rid of any medication prescribed to him by the provider. Such a safety concern can be addressed by connecting the patient to family and close relatives to minimize the severity of the symptoms.
10. When would you follow up with this patient?
The first follow-up will take place in 7 days, then in two weeks as per the patient’s progress.
References
Ellard, K. K., Gosai, A. G., Bernstein, E. E., Kaur, N., Sylvia, L. G., Camprodon, J. A., ... & Deckersbach, T. (2018). Intrinsic functional neurocircuitry associated with treatment response to transdiagnostic CBT in bipolar disorder with anxiety. Journal of affective disorders, 238, 383-391.
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.
Kim, A., Lim, K. S., Lee, H., Chung, H., Yoon, S. H., Yu, K. S., ... & Chung, J. Y. (2016). A thorough Q.T. study to evaluate the QTc prolongation potential of two neuropsychiatric drugs, quetiapine, and escitalopram, in healthy volunteers. International clinical psychopharmacology, 31(4), 210-217.
Vatsalya, V., Pandey, A., Schwandt, M. L., Cave, M. C., Barve, S. S., Ramchandani, V. A., & McClain, C. J. (2016). Safety assessment of liver injury with quetiapine fumarate X.R. management in very heavy drinking alcohol-dependent patients. Clinical drug investigation, 36(11), 935-944.
