Bipolar Case Study Assignment essay

Bipolar Case Study Assignment

Bipolar Case Study
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Bipolar Case Study Assignment

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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?

Bipolar Case Study Assignment

For this patient, I would inquire about the status of his relationships if any. I would inquire whether he is or has been in an intimate relationship in the past. Based on his presenting symptoms and behaviors, there is likelihood that he has trouble forming relationships or maintaining them. Thus, a response indicating a past relationship that has recently had troubles would affirm a significantly compromised social life (Jarvis, 2019). It would also be important to inquire whether the patient lives alone or lives with his family members. The inquiry would seek to know whether the patient can identify any recent instances where he has had trouble with the family members and the cause of the trouble. Further, I would inquire about the patient’s spending behaviors in the recent past. Patients with manic symptoms usually demonstrate excessive and uncontrolled spending while also having regrets about those behaviors later. Inquiring about the patient’s sexual life would also be important. Patients with manic symptoms demonstrate an excessive urge for sex. The inquiry on intimacy and sex would also identify whether the patient has been practicing safe sex and whether he felt any sense of shame or guilt following any said sexual escapades. It would also be important to inquire from the patient on their feeding patterns as well as whether they have had any signs of weight loss. Considering the patient’s notable behaviors of disorganized behavior and hyperactivity, there is a chance they cannot sustain a consistent feeding pattern. Weight loss would be an indication of poor nutritional patterns probably influenced by poor feeding habits (Jarvis, 2019).

Bipolar Case Study Assignment

2. Which psychiatric symptoms are treatment priorities for this case?

The priority symptom for treatment in John’s case is sleep. The patient admits to not having had sufficient sleep because apparently, he “does not need it” and has “enthusiasm from God”. Sleep deprivation tends to elevate manic symptoms and would allow relaxation of the patient to enable better decision-making. The second priority is delusion and confusion. The patient cannot sustain a coherent and logical conversation thus making it difficult to communicate their needs from a subjective position (Rathee, 2019). Resolving these delusions will gradually help in minimizing the feelings of grandiosity and create a sense of reality for the patient. With reality dawning on the patient, it will be possible to collaboratively manage their condition including identification of the trigger factors and methods for resolving them (AHRQ, 2014).

3. What are the non-pharmacologic issues in this case (problems/complaints that cannot be addressed by medication)?

A major problem for John is medication adherence and nutritional issues. Based on his disorganized thoughts, it is highly likely that John cannot sustain a regular pattern including on medication. The disorganized behaviors will also affect his nutritional patterns especially in keeping a regular pattern. A third issue is John’s workplace issues. There is a risk that the patient has not been delivering well at work and has had run-ins with colleagues which explains why Dave –his mate – once told him he was “bonkers’. These issues may require a support person to help John manage his medications, maintain a regular feeding pattern, and communicate at his workplace on his current health issues (Sani et al., 2017).

Medication Choice 1
4. List one medication that would be appropriate for this case. Include the name and starting dose.

Lithium extended release 900mg twice daily (morning and nighttime) (Malhi et al., 2013)

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 on.

Typically, a Lithium dosage of 300mg twice daily immediate release would be considered appropriate for a patient with bipolar disorder (Malhi et al., 2013). However, in this case, the patient manifests manic symptoms that tend to occur throughout the day and also disrupting his sleeping patterns. In such circumstances, an extended-release dosage would be more important. The extended release has prolonged effects and will help resolve the possible issues with medication adherence that would occur with 300mg thrice daily (Malhi et al., 2013). Lithium acts by regulating the excitatory factors dopamine and glutamate. In patients with bipolar disorder, the GABA levels and their neurotransmission are usually diminished (Malhi et al., 2013). GABA is the inhibitory factor responsible for regulating glutamate and dopamine. Lithium, therefore, causes elevations in GABA levels while also activating the GABA receptor. These outcomes cause a decrease in glutamate and dopamine levels while also causing down-regulation of the NMDA receptors further enhancing neurotransmission inhibition. The levels of dopamine and glutamate are therefore sustained at desired low levels to inhibit excitatory outcomes (Malhi et al., 2013).

Bipolar Case Study Assignment

6. What laboratory testing/monitoring is needed for safely prescribing this medication?

Serum level testing should be conducted at regular intervals. The recommendation is to test the serum levels just before the next dosage is taken. The serum levels determine the need for dosage modification (Malhi et al., 2013).

7. Are there any contraindications or safety issues associated with this medication?

Lithium demonstrates significant contraindications with antihypertensive medications such as hydrochlorothiazide. The medication also contraindicates with non-steroidal anti-inflammatory drugs (NSAIDs) drugs such as naproxen and ibuprofen. Equally, Lithium should not be administered in patients with hypertension, renal failure, unmanaged hyperthyroidism, as well as those diagnosed with Addison’s disease (Sani et al., 2017).

Non pharmacologic Interventions
8. What non-pharmacologic interventions do you recommend? Including but not limited to psychotherapy, complementary and holistic therapies?

For John, cognitive-behavioral therapy (CBT) and interpersonal therapy will be a priority. For CBT, the intention is to help John change his thought process that depicts grandiosity, delusion, and disorganization. CBT will gradually help John to develop a sense of reality, logic, and rationality in his decision-making (AHRQ, 2014). The significance of interpersonal therapy is to enhance John’s social skills and ability to form and sustain relationships. The feelings of grandiosity seem to be compromising John’s social life especially by causing rifts with his social circles most of whom he considers less clever. More importantly, it would be useful to integrate a support person for John especially a family member (AHRQ, 2014). John’s delusions and current manic symptoms may be enhanced by a probably isolated life. He is experiencing a state of continued destruction of his social circles occasioned by the feelings of grandiosity which do not seem to augur well with friends or people in his circle. With a support person, John can find someone to open up to and collaboratively identify the impact of his delusion on his social and occupational functioning. The support person will allow John to communicate without feeling judged or shameful. This instance of opening up is significant in the design of viable interventions including identification of the trigger factors (AHRQ, 2014).

Safety Risk Assessment
9. What are the safety concerns, if any, associated with this case? How will you address safety?

Agitation/irritability: The patient demonstrates signs of irritability and aggression especially when involved in an inquiry-like conversation. These feelings are exacerbated by situations that he perceives to be challenging his grandiosity. These behaviors are likely to trigger conflicts with people around him whether at work or in the workplace. Such conflicts could likely lead to physical confrontations that would lead to injuries or other adverse outcomes. The best strategy to assure his safety is to involve the support person to communicate to people at home or in the workplace about his current health issue (Rathee, 2019).

Risk for self-harm: John demonstrates significant racing thoughts that are usually accompanied by irrational decision-making. For an individual who demonstrates irritability at the smallest confrontation or challenge, he could easily experience overwhelming frustrations that can trigger negative thoughts such as suicide and other self-harm behaviors. The strategy is to limit John’s movements including a possible bed rest for at least one week. In a controlled indoor environment, John is less likely to experience triggers for possible frustrations that can elicit self-harm thoughts (AHRQ, 2014).

10. When would you follow up with this patient?

John’s follow-up will be in four weeks. In the first two weeks of Lithium use, the patient usually demonstrates reasonable changes in behavior towards the desired direction. However, optimal benefits are attained in week three and even further towards week four. Importantly, the outcomes/benefits are dependent on the patient’s ability to demonstrate medication adherence through the period of medication (Baldessarini et al., 2019)

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