The bipolar disorder, which was initially identified as manic depression, refers to a mental health problem that results in severe mood swings that are characterized by emotional highs and lows such as mania and depression respectively. McCormick et.al (2015) states, BD typically begins in adolescence or early adulthood and can have life-long adverse effects on the patient's mental and physical health, educational and occupational functioning, and interpersonal relationships. It is also as a mental problem that mostly affects individuals moods to the extreme. When one becomes depressed, he or she exhibits periods of hopelessness and losing interest in activities that bring about relaxation or pleasure. When the mood changes to mania, an individual experiences unusual irritability, energy, and euphoria. The mood swings are perceived to affect the behavior, thought process, energy, sleeping patterns, daily activities, and judgments of an individual (Australian & New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Bipolar Disorder, 2016).
Hypothetical case study
Anne, who is 59 years of age and from the Latina community, reports having a bipolar II disorder with a medical history of fifteen years. Bipolar II disorder, in this case, is a type of bipolar disorder that includes frequent patterns of hypomanic and depressive episodes. However, it does not include the elevated manic episodes (Craddock & Sklar, 2013). Currently, she takes 30mg/d of citalopram as recommended by her therapist. Anne frequently complains of having depressed moods in which her therapist gives her referrals for the electroconvulsive therapy and psychiatric hospitalization. When admitted, Anne presents the reports that her moods have completely deteriorated in the past two months after taking a trip to Cabo. Also, she underwent a negative experience with a security guard at the airport whereby he did not allow her to pass because of her poodle which she had carried with her. The argument resulted in her missing the flight. She exhibits challenges in maintaining concentration, lack of energy, poor appetite, hopelessness and inefficient memory. She tends to wander off when being talked to even during therapy whereby she just stares at her therapy while her mind is focused on other things. She also reports experiencing panic attacks in addition to abnormal noxious scents, discomfort on her right side, and frequent falls. The falls, in this case, is attributed to body weakness and her inability to maintain balance. Anne explains that, when taking a shower or doing laundry, she often experiences foul odors but unaware of where the odors emanate. She also reports of experiencing headaches that emanate from the back side of the head or rather the occipital area. About six years ago, Anne underwent hospitalization as a result of a depressive episode but without exhibiting any psychotic features. According to the diagnosis, she was suffering from generalized anxiety disorder in which her physician prescribed her with 1.5mg/d of clonazepam. She experienced a manic episode about two years ago that included high levels impulsivity, excess energy, increased productivity, and the necessity for sleep in addition to myriad ideas in her mind that gave her plenty of headaches. Annes medical history is associated with arthritis, prolonged low back pain, diabetes mellitus which is noninsulin dependent and hyperlipidemia. Her medical prescriptions include; 50 mg/d of losartan, 20 mg/d of rosuvastatin, and 30 mg/d of pioglitazone. She had a spinal fusion of L4-S1 about a year ago. Anne has not experienced seizures of brain damage as per her medical history. Her mother also suffers from bipolar disorder but bipolar I while her brother, who is her twin, suffers from severe anxiety. Her father died in an accident when both Anne and her brother were still in high school.
According to the diagnosis at the time of Annes admission for the electroconvulsive therapy and psychiatric hospitalization, her heart rate reads 72 beats per minutes, her blood pressure reads 126/66 mm Hg, her temperature reads 36 degrees Celsius while her respiratory rate reads fifteen breaths per minute. According to the results of her neurologic tests, Anne exhibits a right facial droop that has an unclear duration. When inquired about the droop, she explains that she has not paid much attention on her appearance of late and hence unaware of the droop. Her motor strength is also weak whereby she experienced weakness on her left side. Her friend who is with her during the admission notices an unusual look in Annes admission photo but not certain on when she began exhibiting that look. The physician assigned to her care notices that Anne frequently leans on her left side and prefers using the wheelchair for her movements rather than walking. During her stay in the hospital, Anne exhibits difficulty when walking and also when eating whereby she is unable to use the utensils adequately. She does not accept that she has motor challenges and often asks people to leave her room when eating.
A collaborative formulation
Anne works with a therapist and a personal physician who are aware of her condition. It is important to note that collaboration or rather collaborative efforts that include team-based care are increasingly associated with adequate management of bipolar disorder. The idea is to ensure that the invoked parties are in line with the treatment progress of a patient. Annes therapist frequently interacts with her physician especially during checkups when Anne visits either of them. Both the therapist and the physician share their diagnosis with Anne. The associated view is that, by discussing the diagnosis with a patient, a substantive foundation is established regarding treatment. Often, most individuals who are diagnosed with the condition find it difficult to accept the condition or rather accept the changes taking place in their body. This explains why Anne is offended when questioned about her dropping face and her inability to adequately handle her utensils when eating. McCormick et.al (2015) state, The initial diagnosis is frequently provisional and requires additional observations or confirmatory historical information. It can also be expected that patients will show resistance to the diagnosis, possibly because of the social stigma of having a mental illness. To assist a patient, there is the need for a collaborative effort that includes motivational interviewing during therapy. The method is perceived to strengthen the patients feelings and thoughts such that they concentrate on getting well. It puts into view persistence and patience that enables patients to accept that they have the condition and hence take individual responsibility to manage it with the help of medical professionals. It can be perceived that through the consultations among the therapist, the physician and Anne, and using motivational interviewing when conducting assessments and informing Anne on her diagnosis, a person-centered approach is established whereby all focus is put on Anne getting the best treatment.
Details of a care/intervention plan and a rationale for the actions that were taken
It is important to note that intervention plans operate with the goal of managing or eliminating a condition. The intervention plan used in treating Anne is adequately illustrated in Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders by Malhi et.al (2015) that puts into view the goals and treatment interventions. The goal of the treatment was to eliminate depression such that Anne experiences full recovery after the treatment and acquire resilience. The first step made by the therapist and the associated physicians was to attempt and cease the sources that resulted in low moods, integrate a sleeping hygiene, integrate adequate lifestyle adaptations such as eating a healthy diet and engaging in exercise and eliminate any incidence of substance abuse if applicable in her case. The second step involved using combining both psychological therapy and pharmacotherapy as the treatment methods. Psychological treatment comes into perspective as it allows the improvement of social functioning. It also assists in decreasing mood symptoms and fluctuations, enabling the development of coping mechanisms, improving communication with the family members and enabling compliance with medication (Vancampfort et.al, 2015). Pharmacotherapy comes into perspective whereby it represses the occurrence of depressive episodes. Quetiapine was used as her first line medical treatment to assist in symptomatic improvements. It is perceived that the drug works well for patients with bipolar disorder when compared to employing lithium, placebo or paroxetine, and lithium. The associated view was to use the drug until Anne showed signs that she was improving. The therapy used for treating Anne was interpersonal psychotherapy whereby focus was put on her feelings and the development of her self-esteem. In a study done by Geddes & Miklowitz (2013), the scholars state, patients who received interpersonal and social rhythm therapy in the acute phase had longer times to recurrence and better vocational functioning in the maintenance phase than did patients who received clinical management during the acute phase (Geddes & Miklowitz, 2013). Therefore, interpersonal psychotherapy was perceived to be efficient because of its long-term effects. Each session integrated motivational interviewing to support her during the treatment in which she willingly collaborated with the patients.
Outcome of care
Anne showed significant improvements during the treatment whereby she openly communicated about her feelings and easily interacted with the professionals attending to her needs. However, there were periods when she exhibited depressive symptoms but, through the patient-centered approach, they were controlled to ensure that the goal of the treatment is achieved. Her complaints regarding pain in her back, frequent headaches and general body weakness also decreased. She engaged in frequent exercises, and her facial expression began to regain firmness. After the treatment, Anne still meets with her therapist to ensure that the condition is under control.
A critical reflection on your assessment
From an individual perspective, adequate intervention strategies are relevant in dealing with patients suffering from bipolar. It is factual that treatment of the disorder focuses on stabilization whereby the intended goal is to bring about a stable mood for a patient experiencing mania or depressive episodes. Also, during maintenance, the goal includes improving the social functioning and decreasing the subthreshold signs. Another important perspective is on maintaining a patient-centered approach during treatment to ensure that the needs of the patient are fully met. As stated earlier, collaboration makes it possible for the medical professionals to share information and be updated on the treatment progress of a patient, also, informing the patient about his or her diagnosis. It can be perceived, In Annas that what could have been improved in the care is family or social support whereby her family or friends could be included during therapy. The idea is to develop an emotional support system when out of medical care to decrease the chances of experiencing either a depressive of a manic episode.
Australian, R., & New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Bipolar Disorder. (2016). Australian and New Zealand clinical practice guidelines for the treatment of bipolar disorder. Australian & New Zealand Journal of Psychiatry.
Craddock, N., & Sklar, P. (2013). Geneti...
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