MRU PMHNP Clinical Write-Up Student Name: Write-Up # Typhon

MRU PMHNP Clinical Write-Up Student Name: Write Up # Typhon Case

This assignment requires a comprehensive psychiatric evaluation and treatment plan for a patient with bipolar disorder. The core tasks include documenting the patient's presenting complaints, psychiatric history, mental status exam, medication regimen, diagnosis, treatment considerations, and future plans. The report must be written in a structured, formal, and academically appropriate manner, adhering to clinical documentation standards.

Paper For Above instruction

Introduction

The following clinical write-up presents a detailed psychiatric assessment and treatment plan for a patient diagnosed with Bipolar I Disorder. The case underscores the importance of a thorough biopsychosocial evaluation, accurate diagnosis aligned with DSM-5 criteria, and tailored pharmacological and psychosocial interventions. This comprehensive review emphasizes the role of advanced practice psychiatric-mental health nurses (PMHNPs) in managing complex mood disorders through evidence-based practices.

Chief Complaint and Presenting Symptoms

The patient, Sarah, reports presenting for a "routine follow-up to ensure my bipolar disorder remains stable." Her primary concern is maintaining mood stability, with no current symptoms of depression or mania. She describes her mood as euthymic, with past episodes of severe depression and mania effectively managed with medication. She experiences occasional anxiety, especially during high-stress periods, which she manages with clonazepam as needed. Her sleep hygiene is good, with no current sleep disturbances. Her mental health history indicates a longstanding pattern of mood episodes, with onset at age 19, involving manic episodes, followed by depressive episodes. She denies suicidal or homicidal ideations, hallucinations, paranoia, self-harm, or substance misuse at this time.

Psychiatric History and Past Treatments

Sarah's mood symptoms began at 19 with a manic episode, leading to a diagnosis of Bipolar I Disorder. She reports no significant environmental triggers or family history of bipolar disorder. Her previous treatments include lithium, quetiapine, and clonazepam, which have been effective. She discontinued valproate due to intolerable side effects. The absence of recent treatment modifications suggests good medication adherence and symptom control.

Personal and Social History

Sarah is a university student pursuing a degree in psychology. She is single and has no children or significant work history. Her legal history is unremarkable. She reports social alcohol consumption without signs of abuse and denies illicit drug use or tobacco/vape/marijuana use. Her social environment appears supportive with stable personal circumstances.

Medical and Psychiatric Examination

Her physical appearance is appropriate, with good grooming and posture. Behaviorally, her psychomotor activity, eye contact, and responses are normal. She is cooperative, alert, and fully oriented, with a mood that she describes as "stable and good." Affect is congruent with her mood, and her thought processes are logical, goal-directed, and coherent. She denies perceptual disturbances, delusions, or paranoid ideation. Cognitive functioning appears intact, and insight into her condition is good. Judgment is appropriate, with responsible and safe behavior documented during interactions.

Medication Regimen and Education

• Lithium: 900 mg/day. It stabilizes mood by balancing neurotransmitters. Side effects include mild tremors and increased thirst. Patients should adhere to regular blood tests to monitor lithium levels. It is FDA-approved for bipolar disorder and classified as a mood stabilizer.
• Quetiapine: 200 mg/day. An atypical antipsychotic that helps regulate mood, with side effects including sedation and weight gain. Patients are advised to take it at bedtime to minimize drowsiness. It is FDA-approved for bipolar disorder.
• Clonazepam: 0.5 mg as needed for anxiety. A benzodiazepine that reduces anxiety with potential for dependency and drowsiness. It should be used sparingly and only as needed, with awareness of its risk profile.

Diagnosis and DSM-5 Criteria

The patient's diagnosis is Bipolar I Disorder (ICD-10 F31.0), consistent with DSM-5 criteria:

• At least one manic episode lasting at least one week, characterized by elevated or irritable mood, increased activity, and impaired social or occupational functioning.
• Past depressive episodes with symptoms of hopelessness, fatigue, and anhedonia.
• Current stability on pharmacotherapy indicates effective symptom management.

The patient’s history of manic episodes with subsequent euthymic periods following medication adherence supports this diagnosis.

Prognosis and Treatment Plan

Sarah demonstrates good insight and adherence, contributing to her favorable prognosis. Continued pharmacotherapy with lithium and quetiapine, along with ongoing psychotherapy, is recommended. Weekly cognitive-behavioral therapy (CBT) and monthly family therapy are targeted to reinforce relapse prevention and coping skills. Engagement in mental health advocacy is encouraged to promote resilience and social support.

Follow-up and Future Considerations

She is scheduled for a follow-up appointment in three months to monitor mood stability, medication side effects, and any emerging symptoms. Adjustments will be made based on her clinical response, side effects, and psychosocial needs.

Discussion and Role of the PMHNP

The role of the psychiatric-mental health nurse practitioner is critical in managing bipolar disorder through comprehensive assessment, personalized treatment, patient education, and coordination of care. Evidence-based pharmacotherapy, combined with psychotherapy, helps optimize patient outcomes. Regular monitoring of medication effects, side effects, and psychosocial factors ensures a holistic approach to mood stabilization.

The case underscores the importance of patient-centered care, with emphasis on education, adherence, and early intervention for emerging symptoms. The PMHNP’s expertise in medication management, psychotherapy, and health promotion plays a vital role in enhancing quality of life for individuals with bipolar disorder.

Conclusion

In conclusion, this case exemplifies effective clinical management of Bipolar I Disorder, emphasizing the significance of accurate diagnosis, medication adherence, psychosocial support, and ongoing evaluation. The collaborative approach aims to sustain mood stability, prevent relapse, and promote holistic wellness, demonstrating the vital contribution of advanced practice psychiatric nurses in mental health care.

References

• O’Donnell, L., & Miklowitz, D. (2020). Current state of evidence-based psychotherapies for bipolar disorder. Bipolar Disorder, 22(7), 496-510.
• Strakowski, S. M., Almeida, J. R., & DelBello, M. P. (2020). Psychopharmacological treatments for bipolar disorder. Bipolar Disorder, 22(7), 511-528.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
• Ketter, T. A. (2017). Pharmacological management of bipolar disorder. Psychiatric Clinics of North America, 40(3), 439-456.
• Geddes, J. R., & Miklowitz, D. J. (2017). Treatment of bipolar disorder. The Lancet, 382(9904), 1672-1682.
• Yatham, L. N., et al. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of bipolar disorder. Bipolar Disorders, 20(2), 97-170.
• Malhi, G. S., & Outhred, T. (2019). Bipolar disorder. The Lancet, 393(10189), 1869-1882.
• Grunze, H., et al. (2020). The treatment of bipolar disorder—An update. Bipolar Disorders, 22(7), 523-540.
• DelBello, M. P., & Strakowski, S. M. (2021). Pharmacotherapies for bipolar disorder. Psychiatric Clinics of North America, 44(2), 265-281.
• Miklowitz, D. J., & Johnson, S. L. (2019). Prevention of bipolar disorder. Current Psychiatry Reports, 21(9), 1-10.