Bipolar Disorder 8 Captain Of The Ship: Bipolar Disorder ✓ Solved

bipolar disorder 8 Captain of the Ship: Bipolar Disorder The

The following case study details the treatment approach for a 35-year-old Caucasian male who presented to the clinic for help with his mood disorder. The assessment and intake supported the diagnosis of bipolar disorder, subtype II. The following analysis presents the details related to both pharmacology and psychotherapy, as well as information related to medical management, community support resources, and appropriate follow-up.

Chief Complaint

The client came to the clinic reporting that he “could no longer deal with his up-and-down mood swings and that he was at the end of his rope."

History of Presenting Problem

This client stated that he has had mood swings for as long as he could remember, and that right now he was in the “up” phase of this alternating mood pendulum. From an inspection of the genogram that the client provided, there was a noticeable inheritance pattern of the bipolar disorder. Notably, this client had evidence of bipolar disorder on both maternal and paternal sides of his genogram. Research has shown that bipolar disorder has a high heritability rate. Kern (2014) reported on the concordance rates of twins with bipolar disorder, stating the rate was from 60-80%. In other studies, the heritability of bipolar is demonstrated albeit at lower rates (Maier et al., 2005).

Diagnostic Criteria and Current Medications

The DSM-V characterizes bipolar II disorder as one in which individuals experience a period of at least 4 days of hypomanic symptoms. Additional symptoms to support this diagnosis were the client’s admission that he was taking on several projects at work simultaneously; sleeping little; experiencing racing thoughts; and feeling invincible. The intake showed the client’s extremely fast talking, switching subjects haphazardly, and admission of both depressive and hypomanic episodes, all of which point to a diagnosis of bipolar II (296.89 F31.81) (APA, 2013).

This client denied taking any medications, either over the counter or from a doctor. Although he claimed he was in good health, he reported that he frequently got headaches, described as annoying rather than problematic, relieved by Motrin or Tylenol.

Relevant History

The client reported that his mood swings began when he was in his early 20s. He believed they were normal as he witnessed other family members suffering from similar mood swings. He appeared healthy, was well-dressed, and was oriented x4. Earning a good living as a financial consultant, he enjoyed his work but sought help because he could not manage the revolving mood swings anymore.

Diagnostic Impression

The client’s symptomatology and relevant history align with a diagnosis of bipolar disorder, subtype II. This disorder runs along a continuum from mild to severe, characterized by major depressive phases alternating with hypomanic phases (Antokhin et al., 2010; APA, 2013). The DSM-V states that the bipolar II diagnosis is confirmed by experiencing at least one episode of major depression and at least one hypomanic episode.

Psychopharmacology and Treatment Options

Both subtypes of bipolar disorder can severely debilitate individuals. This client faced regular sleep disturbances and an overwhelming appetite for increased responsibilities, causing significant emotional distress (Sadock et al., 2014). The typical treatment for bipolar patients, targeted at mood stabilization, is lithium therapy (Stahl, 2013). Based on the information for this case, a regimen of 600mg of a lithium salt TID would be initiated.

Regular blood monitoring is essential during lithium therapy to maintain target blood serum levels (1-1.5mEq/L) (Sadock et al., 2014). Supplemental pharmacology might include venlafaxine (an antidepressant) and olanzapine (an antipsychotic) to address psychotic episodes, confirming non-overprescription until lithium's effectiveness is confirmed.

Therapeutic Endpoint

The therapeutic endpoint would be improvement in the client’s mood swings over the ensuing weeks following pharmacological intervention. Cognitive Behavioral Therapy (CBT) is recommended weekly as the gold standard for psychotherapy. Numerous studies support CBT’s effectiveness in bipolar cases (Jones et al., 2012; Sadock et al., 2014). Gabbard (2014) highlighted that regular CBT therapy could provide relief from the symptoms of bipolar disorder.

Medical Management and Follow-Up

It's critical to monitor lithium levels regularly, as toxicity can occur above 2.5mEq/L (Sadock et al., 2014). The client will undergo routine blood draws to maintain safety. Furthermore, routine preventive care such as vaccinations will be emphasized, and the client will be informed of the side effects associated with pharmacology. Notably, lithium can cause diarrhea, muscle fatigue, and a shaky gait (Stahl, 2013), requiring immediate reporting to healthcare services for any severe reactions.

Support Resources

The National Alliance on Mental Illness (NAMI) offers a broad range of social support services, including a suicide hotline and resources for finding mental health specialists. Additionally, the Depression and Bipolar Support Alliance (DBSA) provides extensive information regarding bipolar and related mood disorders (DBSA, 2020). The FAIR START program, managed by Stanford Medical School, assists individuals with bipolar disorder in obtaining proper evaluations and treatment (FAIRSTART, 2019).

References

• American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). APA.
• Antokhin, E., Bardyurkina, V., Budza, V., Kryukova, E., & Baldina, O. (2010). Bipolar depression of the II type: Psychopathology, therapy. European Psychiatry, 25.
• Depression and Bipolar Support Alliance (DBSA). (2020).
• FAIR START. (2019). From affective illness to recovery: Student access to rapid treatment. Stanford Medicine.
• Gabbard, G. O. (2014). Gabbard's treatment of psychiatric disorders (5th ed.). American Psychiatric Publications.
• Jones, S., Mulligan, L. D., Law, H., Dunn, G., Welford, M., Smith, G., & Morrison, A. P. (2012). A randomized controlled trial of recovery-focused CBT for individuals with early bipolar disorder. BMC Psychiatry, 12: 204.
• Kern, B. (2014). Genetics of bipolar disorder. Applied Clinical Genetics, 7: 33-42.
• Maier, W., Höfgen, B., Zobel, A., & Rietschel, M. (2005). Genetic models of schizophrenia and bipolar disorder: Overlapping inheritance or discrete genotypes? European Archives of Psychiatry and Clinical Neuroscience, 255(3), 159–166.
• Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.
• Samalin, L., de Chazeron, I., Vieta, E., Bellivier, F., & Llorca, P. (2016). Residual symptoms and specific functional impairments in euthymic patients with bipolar disorder. Bipolar Disorders, 18(2), 164–173.
• Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
• Ward, I. (2017). Pharmacologic options for bipolar disorder. Clinical Advisor, 20(3), 17–25.