Bipolar Disorder, Case Study Example

Question 1

The diagnosis is bipolar 1 disorder because based on DMS-5 criteria, the patient had a mania episode manic due to the rapid cycling and mixed features. The diagnosis is based on the features that Ingram presented of mania being expansive, irritable and elevated. She is tearful, irritable, have insomnia, manic and depressive mood swings (Carvalho et al., 2020). There is a history of the increasing treatment of recurrent major bouts of depression without success. Based on the presentation, Ingram has a rapid, pressured speech and is difficult to interpret due to incoherence. Her behavior of creating a get-rich-quick investment blog which is against the rules of the company. The act proves poor judgment as she could have lost her job. Hence, she is not goal-oriented.

Hyper alertness, insomnia, dysphoria, careless appearance, outfit, and anger are more presentations to qualify for bipolar disorder. Ingram also presents delusions of grandeur as she believes that she can uniquely predict the stock exchange market by herself. She has unconfused and glazed eyes with a classic manic related to bipolar disorder. The husband states that there was a history of at least six episodes in the previous few years, which confirms the rapid cycling (Carvalho et al., 2020). The dismissive attitude and alcoholic father prove the coming up with bipolar disorder as the diagnosis, although it can be confused to unipolar. The symptoms may be directive of depression as it never totally disappears when treated, but most are more specific to bipolar disorder (Warwick et al., 2019).

Question 2: A

Bipolar disorder needs a broad approach in its management involving a multisystem approach depending on the approach, which can be bipolar mania or bipolar depression. For Ingram, this is a manic episode of bipolar disorder. Several pharmacological drugs can be used for this patient, including lithium, Olanzapine, and Valium (Lopez et al., 2018). Lithium, a mood stabilizer, is the first-line drug for this presentation. The drug is prescribed as it controls the highs and lows of bipolar disorder. They manage both depression and mania of bipolar disorder. Valproic acid, Depakote, carbamazepine and lamotrigine can be used in place of lithium (Lopez et al., 2018). Olanzapine is an antipsychotic that can be administered to this patient. The drug has been proven effective in such cases, especially if the patient had been treated for depression before, as in this scenario (Baldessarini et al., 2019). Quetiapine, risperidone, ziprasidone and lurasidone can be used as antipsychotics.

Fluoxetine is a combination of antipsychotics and antidepressants exerting both effects. For bipolar patients like Ingram, the combination of fluoxetine and Olanzapine produce better effects than when prescribed alone. Antianxiety medications are also of great impact to Ingram, bringing the need for Valium benzo diazepam (Baldessarini et al., 2019). The drug improves sleep having in mind the patient experiences insomnia. Based on how the patient presents, the above drugs would effectively manage the symptoms as she is experiencing bipolar mania.

Question 2: B

Decision on medication depends on the presentation of bipolar disorder. If the drugs prescribed fail to work, there is always a chance to change medication. For this case, the above prescription was chosen over other medications due to its effectiveness in bipolar disorder mania (Amodeo et al., 2017). Centrally to bipolar depression, for Ingram, antipsychotics are advised compared to antidepressants. The patient’s presentation does not qualify for any symptom of depression, so fluoxetine should be stopped as it is an antidepressant that will worsen the mania situation (Parker et al., 2017). Unless fluoxetine is combined with Olanzapine, it should be avoided. Bupropion is prescribed for bipolar patients but not for all cases because it is an antidepressant hence good for bipolar depression (Parker et al., 2017). The antidepressants may exacerbate the patient to a manic episode or increase the mixed symptoms.

Question 3

The medications am prescribing for the patient are lithium, Olanzapine and Valium. Lithium or lithium carbonate is the generic name, and the brand names are Eskalith, Lithobid. The drug is classified as a mood stabilizer used for bipolar disorder agents and specifically an antimanic agent. The mechanism of action of lithium is that it works by decreasing abnormal and exaggerated brain activity (Kessing et al., 2018). It does this by decreasing the norepinephrine release and increasing serotonin synthesis, which leads to mood stabilization and lowering of the highs. The dose of lithium is 1800mg daily, taken orally for individuals twelve years and above.  A patient taking lithium should expect the following side effects: diarrhea, metallic taste in the mouth, dry lips, sickly feeling, and excessive urination associated with extreme thirst (Kessing et al., 2018). Non-adherence is a common issue in lithium taking which mostly ends in discontinuation of the medication; this depends on the attitude and knowledge of the bipolar disorder patients.

Olanzapine is a generic name that has brand names like Zyprexa and Zyprexa zydis. The drug is an antipsychotic and, specifically, an atypical antipsychotic agent used for manic episodes and schizophrenia (Uguz et al., 2021). The mode of action of Olanzapine is that it works by blocking several neurotransmitter receptors in the brain (Uguz et al., 2021). The goal is to reduce the brain’s activity and bind with histamine H-1, muscarinic, alpha-1 and serotonin type 2 receptors responsible for an active brain. It blocks dopamine from coming to contact with synaptic receptors for potential action. The drug is administered from 10 to 15 milligrams daily orally.  Dizziness, depression, weakness, insomnia, restlessness, constipation and unusual behavior are the common side effects of Olanzapine (Uguz et al., 2021). Olanzapine is contraindicated in patients with known hypersensitivity to the drug. It may also elevate diabetes mellitus lead to low white blood count, and cause liver dysfunction. Once the drug is taken, the individual starts to feel more relaxed and calmer, and it is advisable to be taken at night, especially during bedtime, as it has sleepy effects.

Lastly, I would prescribe Valium for the patient. The drug’s generic name is Diazepam, and the brand names are Valium, diastat AcuDial and Diastat. The drug is antianxiety, also called anxiolytic, specifically benzo diazepam (Joseph et al., 2020). It can also act as a skeletal muscle relaxant, a sedative and an anticonvulsant. Valium facilitates the action of gamma-aminobutyric acid, which is a neurotransmitter with an inhibitory effect in the central nervous system, this being its mechanism of action (Joseph et al., 2020). The inhibiting of GABA causes blockage of certain signals in the brain, causing a calming effect hence relieving anxiety, fear, tension, and stress. Diazepam is administered in 2mg, 5mg, and 10 mg orally twice or four times a day. The dose should not exceed 30mg within eight hours. Being an anxiolytic, the common side effects of Valium are dizziness, drowsiness, dry lips, constipation, headache and a feeling of tiredness and weakness (Joseph et al., 2020). Patients with alcohol intoxication, drug abusers, depressed individuals, and patients with myasthenia gravis are contraindicated in taking Diazepam.

Question 4: A

Bipolar disorder can be approached in a non-pharmacological way and be managed as it is chronic and recurrent with often episodes. The disorder involves energy, mood, and activity levels involving extreme highs and extreme lows. Cognitive behavioral therapy, Lifestyle changes, and counseling are some of the non-pharmacological approaches that can be applied for bipolar disorder patients (Amodeo et al., 2017). The interventions will enable the patient to manage their symptoms and improve their life quality overall. In cases of comorbidities, cognitive and behavioral therapy can be applied.

Lifestyle changes can be one of the pharmacological interventions that can be applied to manage bipolar disorder. Sleep is one of the lifestyle aspects. Based on the episode, depressive symptom tends to cause excessive sleep and less sleep for mania episodes. Training the patient to have enough sleep will impact mood changes which will e of positive effect on maintaining the levels of highs and lows (Fornaro et al., 2020). The patient can be educated on sleeping in a comfortable room, going to bed early and regularly, eating fewer meals before sleep and limiting alcohol intake to control their sleep pattern.

Diet is one of the lifestyles considerations that bipolar disorder patients should be enlightened on. A healthy diet reduces the occurrence of mania and depressive attacks. A healthy diet lowers the rate of complications of the diseases and emergency of other chronic and metabolic illnesses like hypertension. Eating disorders are also more likely to occur in this patient, like binge eating, especially in depressive episodes. The need to eat regularly, have a well-balanced diet, and have a meal plan is important to maintain a good lifestyle (Fornaro et al., 2020). Exercise is another lifestyle change that can have a positive effect on the management of the bipolar disorder. Physical activity has proven to affect improving mood in a depressive state. Exercise is believed to activate the body and brain, counteracting the depressive state (Fornaro et al., 2020).

Counseling is important to educate on practicing moderation as the patients are susceptible to addictive behaviors. The addiction mostly involves drugs and alcohol. Lack of moderation and satisfaction tends to drive them to risky behaviors. Counseling on risky behaviors, awareness need for seeking help, and having positive friends can greatly impact the management of the disorder (Bauer et al., 2018). Lastly, cognitive behavioral therapy can effectively treat bipolar disorder, especially if focused on what affects the patients. This involves changing the perception of the patients on how they act and behave. With this, depression and mania can be managed.

Question 4: B

The above non-pharmacological interventions are effective in managing bipolar disorders compared to other interventions. Genetic predisposing may not be tamed, so it can not apply as non-pharmacological management. For other diseases, the genetics can be altered but on this, having a first-degree relative with bipolar predisposes one to acquire it. Lifestyles that expose one to high-stress levels like death and chronic illnesses may not be well controlled to achieve a non-pharmacological intervention (Bauer et al., 2018). A lifestyle-free form drug will be effective compared to others who advise intake of drugs to relieve stress.

Question 5

To come up with a mental diagnosis, several aspects must be considered and looked into in detail. For this patient, coming up with the diagnosis involved several skills of comprehensive history taking, physical exam, classification of symptoms and a psychological evaluation. On history taking skill, taking a comprehensive history was effective in understanding the occurrence of symptoms, their behaviors and when they occur as different mental problems present differently. History taking was also important to know the duration of the symptoms for the right diagnosis (Bauer et al., 2018).

The second skill was a physical exam. Patients with mental conditions may have difficulty following up for medical treatment. A thorough physical exam will elicit medical conditions present and understand the physical status of the patient. Using the diagnostic and statistical manual mental disorders, the next skill is to group symptoms to diagnose. For this patient, the diagnosis is categorized as a mood disorder and based on the patient presenting complaints. The mood is largely affected by other factors. Although some mental conditions may present in the same way, classification of the symptoms effectively comes up with the right diagnosis (Bauer et al., 2018). The last skill is a psychological evaluation. This diagnosis is the exact brain status, which includes the brain processes, behaviors, patterns, memory, and response. The process involves questioning the individual about their behaviors and activities to come up with a diagnosis.

Treatment skills include assessing the degree of symptoms to know which to start with. For Ingram, the mood was greatly affected by knowing that we give mood stabilizers first. The next skill is the dysfunction caused by the mental illness to determine the management to be provided. Danger assessment is another skill that needs to eliminate the danger as the first approach to managing (Brown, 2019). Several social workers are involved in the achievement of total management of mental illnesses. For Ingram, several social workers can be put on board to assess mental illness, diagnose mental conditions, treat, prevent and control the behavior and emotional states (Brown, 2019). Those involved may include counselors, psychiatrists, spouses, physicians, nurses, and psychologists.

References

Amodeo, G., Fagiolini, A., Sachs, G., & Erfurth, A. (2017). Older and newer strategies for the pharmacological management of agitation in patients with bipolar disorder or schizophrenia. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 16(8), 885-890.

Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of an adult bipolar disorder. Molecular psychiatry, 24(2), 198-217.

Bauer, M. S., Krawczyk, L., Tuozzo, K., Frigand, C., Holmes, S., Miller, C. J., … & Godleski, L. (2018). Implementing and sustaining team-based telecare for bipolar disorder: lessons learned from a model-guided, mixed-methods analysis. Telemedicine and e-Health, 24(1), 45-53.

Brown, T. (2019). Social work roles and healthcare settings. Handbook of health social work, 21-37.

Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66.

Fornaro, M., Carvalho, A. F., Fusco, A., Anastasia, A., Solmi, M., Berk, M., … & de Bartolomeis, A. (2020). The concept and management of acute episodes of treatment-resistant bipolar disorder: A systematic review and exploratory meta-analysis of randomized controlled trials. Journal of affective disorders, 276, 970-983.

Joseph, A., Moriceau, S., Sica, V., Anagnostopoulos, G., Pol, J., Martins, I., … & Kroemer, G. (2020). Metabolic and psychiatric effects of acyl-coenzyme A binding protein (ACBP)/diazepam binding inhibitor (DBI). Cell death & disease, 11(7), 1-10.

Kessing, L. V., Bauer, M., Nolen, W. A., Severus, E., Goodwin, G. M., & Geddes, J. (2018). Effectiveness of maintenance therapy of lithium vs. other mood stabilizers in monotherapy and combinations: a systematic review of observational studies. Bipolar disorders, 20(5), 419-431.

López-Muñoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of bipolar disorder. International journal of molecular sciences, 19(7), 2143.

Parker, G. B., Graham, R. K., & Tavella, G. (2017). Is there consensus across international evidence?based guidelines for the management of bipolar disorder?. Acta Psychiatrica Scandinavica, 135(6), 515-526.

Uguz, F., & Kirkas, A. (2021). Olanzapine and quetiapine in preventing a new mood episode in women with bipolar disorder during the postpartum period: a retrospective cohort study. Brazilian Journal of Psychiatry.

Warwick, H., Mansell, W., Porter, C., & Tai, S. (2019). ‘What people diagnosed with bipolar disorder experience as distressing’: a meta-synthesis of qualitative research. Journal of affective disorders, 248, 108-130.