“Captain of the Ship” Bipolar Disorders
“Captain of the Ship” Bipolar Disorders
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
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Select an adult or older adult client with a bipolar 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 “Captain of the Ship” Bipolar Disorders.
Recommend a plan for follow-up intensity and frequency and collaboration with other providers
“Captain of the Ship” Bipolar Disorders
Bipolar disorder us a mental disorder characterized by extreme mood swings that encompass mania/hypomania (high moods) and depression (low mood). During hypomania/manic episode, the person is full of energy while during the depressive episode, the person feels sad and loses interest in most activities (McCormick et al, 2016). This paper will analyze a client with bipolar disorder and discuss the appropriate treatment options for the client.
HPI and Clinical Impression for the Client
The client Mr. M a 32-year-old male presented complaining of symptoms such as difficulty in concentrations, loss of appetite, sadness, irritability, sleep disturbances, lack of energy and lack of interest in most activities. The client reported that in spite of taking lamotrigine 100 mg/day and moclobemide 600 mg/day, the symptoms had persisted. The client further reported that sometimes he was full of energy, overly sociable, aggressive, talkative, sleep for only 2 hours at night, and would take risky decisions, which was unlike him “Captain of the Ship” Bipolar Disorders.
From the above data, the client experiences hypomanic episodes and depressive episodes and hence the diagnosis is bipolar II disorder. The DSM-5 criteria stipulate that depressive episodes are characterized by symptoms such as fatigue, sadness, lack of interest, appetite and weight changes, as well as suicidal thoughts. Hypomania episode is characterized by risky behaviors, high energy levels, reduced need to sleep, delusions, and feeling euphoric (Muneer, 2016). The client presented with hypomanic and depressive symptoms and this justifies the diagnosis of bipolar II disorder “Captain of the Ship” Bipolar Disorders.
Lithium 300 mg 3 times a day: Lithium will be prescribed as the mood stabilizer. Shah et al, (2017) explain that the efficacy of lithium in the treatment and prevention of hypomania and mania episodes. The medication is also effective in improving suicidal thoughts in people with bipolar disorder.
Lurasidone 20 mg PO qDay: Lurasidone will target the bipolar depressive symptoms. The medication is approved by the FDA in treating bipolar depressive symptoms, either as a monotherapy or in combination with lithium (Bawa & Scarff, 2015). Moreover, the medication is associated with few side effects and therefore the client is not likely to experience metabolic symptoms such as weight gain “Captain of the Ship” Bipolar Disorders.
Cognitive-behavioral therapy (CBT): CBT is the psychotherapy choice for the client. CBT targets the maladaptive thinking patterns and the dysfunctional beliefs that lead to the hypomanic and depressive symptoms for the client (Geddes & David, 2013). As a result, the negative/maladaptive thinking pattern will be transformed into more a positive thinking pattern and this will help eliminate the negative feeling and improve the symptoms of bipolar and normal functioning for the client (Geddes & David, 2013).
Medical Management Needs
The client and his immediate family members will require education regarding the client’s condition to enable them to understand his condition and handle him better. They will also be educated about the possible triggers for depressive and hypomanic symptoms and how to avoid the triggers. There will also be a need to encourage the client to adhere to the prescribed treatment. (Kilbourne et al, 2013). Moreover, bipolar is characterized by suicidal thoughts and therefore it will be necessary to monitor the client closely. It will also be important to educate the client about the importance of maintaining regular schedules when it comes to activities of daily living such as sleep. More importantly, one of the prescribed medications (lithium) is associated with toxicity and side effect and therefore the client will be educated about the side effect and possible toxicity. The client will also be monitored and assessed closely to avoid any possible toxicity (Kilbourne et al, 2013) “Captain of the Ship” Bipolar Disorders.
Community Support Resources
The client will be linked to the locally available support groups so that he can meet and socialize with individuals undergoing similar mental health problems. This will motivate the client to cope with his conditions and adhere to the prescribed treatment. The client will also be provided with educative resources such as booklets and magazines about his condition so that he can gain information about how to avoid triggers and manage the symptoms (Culpepper, 2014).
The treatment plan and the client’s progress and response to the prescribed treatment will be reviewed after four weeks. The psychiatrist in collaboration with the PMHNP will assess the client and prescribe treatment according to his progress, tolerance, and response to the treatment. The PMHNP will also educate the client and administer the medications as well (Culpepper, 2014). A social worker will have the role of monitoring the progress of the client while at home.
The diagnosis for this client is bipolar II disorder as per the hypomanic and depressive symptoms. The prescribed medications include lithium as the mood stabilizer and lurasidone to treat the depressive symptoms. The psychotherapy choice for the client is cognitive behavioral therapy in order to change the maladaptive thinking pattern into a more positive thinking pattern. The medical management needs include monitoring the client for suicide and treatment adherence, as well as educating the client about the possible triggers and symptom management. The client will be linked with the local support groups and given reading resources about the condition “Captain of the Ship” Bipolar Disorders.
Bawa R & Scarff. (2015). Lurasidone: A New Treatment Option for Bipolar Depression—A Review. Innov Clin Neurosci, 12(1-2), 21–23.
Culpepper L. (2014). The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care. Prim Care Companion CNS Disord, 16(3): PCC.13r01609.
Geddes & David M. (2013). Treatment of bipolar disorder. Lancet, 381(9878).
Kilbourne A, David G, Allison N & Miller C. (2013). Integrating Bipolar Disorder Management in Primary Care. Curr Psychiatry Rep, 214(6), 687–695 “Captain of the Ship” Bipolar Disorders.
McCormick U, Murray B & McNew B. (2015). Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses. J Am Assoc Nurse Pract, 27(9), 530–542.
Muneer A. (2016). The Neurobiology of Bipolar Disorder: An Integrated Approach. Chonnam Med J, 52(1), 18–37.
Shah N, Grover S & Rao P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian J Psychiatry, 59(1), S51–S66 “Captain of the Ship” Bipolar Disorders.
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