Bipolar Disorder: Captain of the Ship

• 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 with use of APA 7th format and references no further than 2015.

• 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.

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Bipolar Disorder: Captain of the Ship

Introduction

Bipolar disorders are characterized by abnormal changes in activity and energy levels, mood changes, and changes in the ability to carry out usual daily activities. People with bipolar manifest symptoms such as abnormal and extreme emotions, sleep problems, abnormal behaviors, and changes in energy levels. The mood changes in bipolar include manic, depressive, and hypomanic episodes (McCormick et al., 2015). This paper will discuss the HIP and clinical impression for the client, the appropriate treatments, and identify the medical management needs for the client.

HPI and Clinical Impression

The client is a 33-year-old male who presented for evaluation after a violent episode at his workplace. According to the client, he has had difficult relationships since her college days and his academic performance deteriorated so much. He could drink a lot of alcohol to mask his emotions. He also reported that since his college days, he has been experiencing episodes of sadness and mania, as well as symptoms such as irritability and aggression. The client further reported that he also experiences alternate episodes of persecutory ideas and depression. The wife reported that the client often manifests delusions by believing that his family and friends are always plotting evil against him. The client has been taking clorazepate 10 mg/day and sertraline 100 mg/day for the depressive symptoms. The client reported that for the last one month he has been experiencing sadness, insomnia, crying spells, sadness, aggression, irritability, and increased activity levels. The wife reported that sometimes the client exhibits psychotic symptoms. Bipolar 1 disorder is typified by episodes of depressive symptoms and manic symptoms (McCormick et al., 2015). As a result, the diagnosis for this client is type 1 bipolar disorder.

Psychopharmacologic Treatments

Lithium: Lithium will be prescribed as the mood stabilizer for the client. The medication was selected due to its efficacy in treating and improving both depressive and manic symptoms in individuals with bipolar disorder (Masi et al., 2018).

Risperidone: This is an atypical antipsychotic that functions by balancing the level of dopamine and serotonin in the brain in order to improve the mood, behavior, and thinking as well (López-Muñoz et al., 2018). Risperidone with thus helping in improving the thinking pattern, mood, and behavior for this client and at the same time treat the psychotic symptoms such as delusions and persecutory ideas. Risperidone is effective in improving manic episodes because the medication has anti-manic properties (López-Muñoz et al., 2018). The drug also treats psychotic symptoms.

Psychotherapy Treatments

Cognitive-behavioral therapy (CBT): CBT will be used to augment the pharmacological treatment for this client. Evidence shows that CBT is effective in improving manic and depressive symptoms, decreasing relapse rates, and improving the psychological functioning of individuals with bipolar disorder (Chiang et al., 2017). Additionally, CBT will equip the client with skills to help him identify triggers for mood changes and skills to manage the symptoms appropriately. Chiang et al (2017) further add that CBT is effective in improving the quality of life and interpersonal relationships in people with bipolar disorder.

Medical Management Needs

The client manifests psychotic symptoms such as delusions and persecutory ideas. He also had a violent episode at his place of work. The client also has symptoms of mania. It is thus important to monitor the client closely to make sure he will not engage in risky and dangerous activities. Since mania symptoms impair judgment, it is important to ensure that the client adheres to the prescribed treatment regimen (Switsers et al., 2018).

Community Support Resources

The appropriate community resources for this client include referring him to a local support group to ensure that the client gets the appropriate emotional and moral support to deal with the diagnosis and motivate him to adhere to the treatment regimen. This is because the local support group will have members with similar mental issues. It will also be important to refer him to a local agency that offers social services. The agency will help in monitoring the client while at home. He will also be given reading resources that will educate him about bipolar disorder, how to identify the triggers, and manage the symptoms (Kavitha et al., 2018). The client reported that he was having problems with finances and thus he will be linked with an agency that can provide free treatment.

Follow-Up Plan

The client will be instructed to come for review after four weeks to examine the response to treatment if he will tolerate the medications by assessing for any side effects and examine his adherence to the prescribed treatment regimen. Members of the multidisciplinary team who will be involved during the treatment of this client include a PMHNP, psychiatrist, and a social worker.

Conclusion

The diagnosis for this client is type 1 bipolar disorder as manifested by manic and depressive symptoms. The medications will include risperidone and lithium, where lithium will be utilized as a mood stabilizer and risperidone to treat both psychotic and mania symptoms. CBT will be used as psychotherapy treatment. The client will be monitored closely due to the psychotic symptoms. The client will be referred to a local support group for moral support; an agency that can assist in financing his treatment; and reading resources. The client will be advised to visit the clinic for review after four weeks and a PMHNP, psychiatrist, and a social worker will be involved in the treatment of this client.

References

Chiang K, Tsai J, Liu D, Lin C, Chiu H, Chou K. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PLoS One, 12(5), e0176849.

Kavitha R, Kamalam S & Ravi R. (2018). Functional Ability of Clients with Bipolar Disorders in Tertiary Hospital, Puducherry. Int J Community Based Nurs Midwifery, 6(1), 21–28.

López-Muñoz F, Shen W, Pilar D, Romero A & Alamo C. (2018). A History of the Pharmacological Treatment of Bipolar Disorder. Int J Mol Sci, 19(7), 2143.

Masi G, Milone A, Giulia S, Mucci M, Bruni G, Stefano B & Pisano S. (2018). Lithium treatment in bipolar adolescents: a follow-up naturalistic study. Neuropsychiatr Dis Treat, 1(14), 2749–2753.

McCormick, U., Murray, B., & McNew, B. (2015). Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses. Journal of the American Association of Nurse Practitioners, 27(9), 530–542. https://doi.org/10.1002/2327-6924.12275.

Switsers L, Dauwe A, Hilde V, Koen L & Oldenburg J. (2018). Users’ Perspectives on mHealth Self-Management of Bipolar Disorder: Qualitative Focus Group Study. JMIR Mhealth Uhealth, 6(5): e108.