CAPTAIN OF THE SHIP BIPOLAR DISORDER 1

CAPTAIN OF THE SHIP BIPOLAR DISORDER 1

CAPTAIN OF THE SHIP BIPOLAR DISORDER 4

Captain of the Ship: Bipolar Disorder

1 Captain of the Ship: Bipolar Disorder Bipolar disorder is a common mental illness that is considered severe and unrelenting ( Sadock, Sadock, &Ruiz, 2016). The condition is described as the alternating pattern of bouts of depression and elevation emotion and irritability categorized as mania. The learner will utilize this assignment to discuss the clinical impression of a client presenting with this illness. The paper will discuss psychopharmacological treatments and psychotherapy options along with medical needs, resources, and plan for the patient.

History of Present illness

D.H. 1 is a 26-year-old female African American client seen in the clinic accompanied by a friend. She is being examined the following discharge after two weeks stay in inpatient. Today her mood is calm, she dressed appropriately, and conversation is appropriate to the subject topic. When asked to describe symptoms she experienced, which lead to her placement in inpatient care, she describes symptoms of an elevated mood, which resulted in impulsive decision making, accompanied by the reduced need for sleep, swift pressured speech, and grandiose ideas. Her roommate reports the patient saying she “felt like flying.” Her symptoms lasted for more than a week and have came increasingly abnormal. The client is increasingly distractible, more social than usual, and is participating in more hazardous like conduct, especially while out with friends last weekend. Activities her friend describes included client walking out in the street during traffic, instigating fights with those who she is unfamiliar with, and drinking irresponsibly. The client mentions exciting sexual advances from men she did not know, and when asked about resting or calming down response, “Why would I think about sleep when I can party?” There is no apparent precipitant for the symptoms the client presents with. They appear to be gradual over weeks and occur episodically. The client does have a history of depressive episodes and possible moments of elevated mood; however, the subthreshold for manic diagnosis. Moreover, in the clinic, today client state that medication she was prescribed Abilify and lithium have stabled her. D.H. 1 describes no depressive episode today.

Clinical Impression

1 The clinical impression for the client is bipolar one disorder, most recent episode manic, as evidenced by the DSM-V criteria. One of the characterizing features of this diagnosis is the presence of a manic episode that lasts for a week and causes impairment to work, social, and roles of responsibility (APA, 2013). Furthermore, in manic diagnosis episodes, the clinician should rule out behaviors related to a medical condition, substance abuse, or drug interaction (2013 ).

When listening to the client describe her disturbed mood, it meets criteria because she describes moments of racing thoughts, reduction of sleep, distractibility, and pleasurable experiences from events with severe outcomes (2013). Also, the DSM-V notes for mood disturbances that are hazardous in a way which can result in the exposure of harm the client or others, which was evident in this client by her walking in the street in traffic and engaging in risqué sexual activity with strangers (Caponigro et al., 2012).

Psychopharmacology

1 The symptom that is the most profound for the client at this time is the mood disturbance; therefore, the use of mood stabilizers would be considered the most effective. A good choice of therapy would be lithium because of its robust effects on treating and preventing both mania and depression (Saddock et al., 2016). It also is one of the two medications which an anti-suicidal impact, which is most helpful for clients like D.H., who has a history of multiple major depressive episodes. The goal of therapy would be to continue the lithium to achieve stabilization of the client’s mood disturbances.

Psychotherapy Choices and Goals

Psychotherapy options that would be effective for this client would include individual-based cognitive behavioral therapy, which could be provided within the same clinic at the availability of the patient. The goal of cognitive-behavioral therapy would be to overcome the disorganizing effect of the mood disturbances while confronting debilitating delusions, ideas, and attitudes with reality-based interpretations. Through the implementation of skills like activity scheduling, the endpoint intervention is to assist the client in dealing with the negative thought patterns that may be associated with her disorganized behaviors related to mania and depressive episodes. Therapy allows the client to practice positive behaviors and coping (Miklowitz & Chung, 2016). The use of family therapy can also be useful for the client. In this setting, the expectations and assumptions surrounding mental illness can be challenged, and more focused, goal-oriented behaviors can be established not only for the patient but also for the family members involved in her care. By implementing family-focused therapy, the clinician highlights the emotional and communication stressors that exist amongst the family of those living with bipolar disorder (Swartz & Swanson, 2014).

Medical Management

1 The medical management of the client would be to address side effects that may be associated with lithium directly. While this medication is considered a great choice of treatment, it does present with a significant side effect profile. Labs that the clinician should consider include CMP, BMP, Calcium, serum sodium, pregnancy test, creatinine, and thyroid test (Saddock et al., 2016). Routine lithium levels will be necessary to avoid toxicity. In efforts to maintain quality of life, aspects such as sleeping patterns, appetite, and recreational activities should be monitored in routine check-ups.

Community Resources

1 Resources available for the client include both local and national entities. Nationally, organizations such as the American Psychiatric Association and the National Institute of Mental Illness have a hotline that is open twenty-four-seven for assistance. Locally, the behavioral health hospital for the Smith County of Texas has a hotline. As a clinician, we can refer this client for integrative outpatient services, which are held in the East Texas area weekdays from eight to five in the afternoon.

Plan for Follow Up and Conclusion

The follow up for this client will occur a month after the appointment. The client will be asked to contact the clinic a week after starting medications to assess for side effects. Also given instructions to contact the clinic in the event of questions or emergency. The PMHNP will also collaborate with the psychiatrist to determine the client’s continued progress and to plan for the appropriate plan of care. With the initial presentation being Bipolar type one, the client will require a combination of psychotherapy and medication treatment. Furthermore, utilizing community resource efforts and maintenance.

References

1 American Psychiatric Association. (2013). 1 Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Caponigro, J. 1 M., Lee, E. H., Johnson, S. L., & Kring, A. M. (2012). Bipolar disorder: 1 A guide for the newly diagnosed. New Harbinger Publications.

Miklowitz, D. 1 J., & Chung, B. (2016). 1 Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research. Family Process, 55(3), 483–499. https://doi.org/10.1111/famp.12237

Sadock, B., Sadock, V. A., & Ruiz, P. (2016). 1 Kaplan & Sadock’s concise textbook of clinical psychiatry. Lippincott Williams & Wilkins.

Swartz, H. 1 A., & Swanson, J. (2014). 1 Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence. Focus (American Psychiatric Publishing), 12(3), 251–266. https://doi.org/10.1176/appi.focus.12.3.251