Bipolar Disorder Case
Describe the HPI and clinical impression for the client
A patient HJ a female 25-year-old Latino, had previously come to the clinic with clinical presentations, alternating between extremely low mood and manic states. The condition has been around for about a year; she has been on medication but has not realized resolution. She raised concern over the inability to express herself and unable to bridge social interactions. At times in the course of the interview, she cried and then remain calm at another moment.
Psychopharmacologic treatments and Specific and therapeutic endpoints for your psychopharmacologic agent.
Psychopharmacology is supposed to put the depression and mania under control and prevent possible relapse while stabilizing the mood. In the first instance, the first medication should be a stabilizing agent, and the agent would manage the mood swings. Lithium is the one highly preferred for the management of mood in the patients. The drug does not only stabilizes the mood but also able to prevent the occurrence of suicide by the patient (Simonetti et al., 2020). Before starting lithium therapy, it is essential to assess the patient for potential renal dysfunction, cardiac function abnormalities, and thyroid dysfunction.
On the other hand, quetiapine has also been used where lithium does not attain the required effects. Quetiapine is preferred for the mixed manias, but lithium is mainly used for the euphoric states of bipolar disorder. Quetiapine also helps with some particularly troubling symptoms, like insomnia and anxiety (Shah, Grover, & Rao, 2017). Lamotrigine is also considered effective in mood stabilization for depression in bipolar disorder, although it is not helpful for mania. Other medications are associated with side effects like fatigue, weight gain, long-term medical risks, and sexual dysfunction. However, lamotrigine has been associated with being well-tolerated and associated with fewer side effects. The only concern for lamotrigine is the risk of Stevens-Johnson syndrome.
The baseline for treatment in bipolar is to make sure, in the end, the patient has control over the clinical manifestations and therefore allows them to control their lifestyles. The therapy should also enable the patient to prevent the occurrence of complications. The end goal for this client would be to make sure future relapses do not occur, and the patient does not suffer the occurrence of unmanageable adverse effects.
Psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your preferences.
Psychotherapy, including cognitive-behavioral therapy and interpersonal therapy, are useful in the management of psychotherapy. In cognitive-behavioral therapy, the therapist would examine the thoughts that would affect the patient’s emotions and later on learn how to manage the negative patterns of thinking and later on transform the behaviors into positive ways of learning (Chiang et al., 2017). In bipolar disorder, the patient would manage the symptoms and avoid any encounters that would trigger the disease and therefore solve problems.
In interpersonal therapy, the focus is on issues that would help the patients improve how they relate with other people in their lives. Through solving the interpersonal problems, the therapy would help reduce the stresses they face in life because stress has been considered to trigger bipolar disorder (Crowe, Inder, Swartz, Murray, & Porter, 2020). The relationship-oriented approach is likely to reduce the cycling of the mood.
Family-focused therapy is also important since living with people affected by bipolar is challenging. Family therapy would be important to educate the family members of the therapy and how to cope with the symptoms and improve communication. The therapy would help restore a very healthy and even supportive environment for the patient (Miklowitz & Chung, 2016). Further, family therapy is also meant to provide the patient with a conducive environment that would enable healing.
Identify medical management needs, including primary care needs, specific to this client.
The primary care needs take into account the comorbid conditions and other risk factors, and the therapist should make sure they improve the care in the primary care settings. In the primary care setting, the teams would seek to establish the patient’s diagnosis using set criteria, provide interventions, and determine possible side effects. There is also a need for panel management, which would allow improvement and chronic care management for those at very high risk.
Identify community support resources (housing, socioeconomic needs, etc.) and community agencies available to assist the client.
During the disease’s active phases, it sometimes presents with the patient being unable to cope with life. Specifically, the patient should be attached to social workers who would frequently make follow ups and ensure the patient can maintain a state of remission. Social workers also assess and then report whenever potential complications occur. Social support schemes are also important, provided by the governments would give support and assistance to the patients who cannot cater to their own needs. It is also crucial to link patients to support groups that would provide the patients with company and warmth, enabling them to understand their condition is curable and can easily be managed.
References
Chiang, K.-J., Tsai, J.-C., Liu, D., Lin, C.-H., Chiu, H.-L., & Chou, K.-R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PLOS ONE, 12(5), e0176849. https://doi.org/10.1371/journal.pone.0176849
Crowe, M., Inder, M., Swartz, H. A., Murray, G., & Porter, R. (2020). Social rhythm therapy—A potentially translatable psychosocial intervention for bipolar disorder. Bipolar Disorders, 22(2), 121–127. https://doi.org/10.1111/bdi.12840
Miklowitz, D. J., & Chung, B. (2016). 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
Shah, N., Grover, S., & Rao, G. (2017, January 1). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian Journal of Psychiatry, Vol. 59, pp. S51–S66. https://doi.org/10.4103/0019-5545.196974
Simonetti, A., Koukopoulos, A. E., Kotzalidis, G. D., Janiri, D., De Chiara, L., Janiri, L., & Sani, G. (2020). Stabilization beyond mood: Stabilizing patients with bipolar disorder in the various phases of life. Frontiers in Psychiatry, Vol. 11. https://doi.org/10.3389/fpsyt.2020.00247