This Bipolar Disorder Sample Essay – Captain of the Ship Project assignment discusses the management of a client with bipolar I disorder in terms of psychopharmacology and psychotherapy. It also describes the medical management and primary care needs and how best to coordinate with other providers when managing such clients.
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HPI and Clinical Impression for the Client
EO was a 22year-old African American female client who came to the clinic accompanied by her mother with complaints of insomnia for an entire week and a heightened activity state which she thought was out of control. The client is a college sophomore student. The client’s mother mentioned that most of the client’s behaviors were primarily characterized by ideas which were not only strange but also grandiose as the client thinks she is most important to be recognized by everyone in the entire school irrespective of her poor background. The client had proclaimed to her friends that she owns a business given to her by her father and does not need to go to school Bipolar Disorder Sample Essay – Captain of the Ship Project. However, the client is sometimes noted to be begging for money. When questioned, EO clearly explained that she was unique in a way that she could still lend her colleagues cash from her business.
EO also had bizarre thinking patterns which had a political dimension. The client strongly believed that her soul had been switched with that of the governor of her state. She also explained how she had developed three governmental theories that only she could use to safeguard the US from destruction with nuclear weapons. The client also reported that she believed that she was best suited for a position in government. The client mother also stated that the client kept explaining her thoughts and theories to everyone at school, family and even wrote them on the dormitory walls, her notebooks and computer with the fear of forgetfulness and also started to campaign for an elected post in government though there were no elections scheduled at this time. Although she was well known by family and friends to be highly organized and tidy, lately, most of them had expressed a lot of worry and disbelief to find that she had started being disorganized and frantic. The client was very talkative and quickly changing the subject during the interview and in a loud tone of voice without realizing, of which she has to be redirected to speak calmly in a low tone. The client mother also reported that the client was noted not to be sleeping well and will argue and have elevated moods swings and angry at most times, thereby affecting her not to focus on her academic studies. These behavior patterns especially with the manic episode and others above had be going on for the past two months.
It is imperative to know that the client grew up in an overprotective environment with very demanding parents. Apart from being a passively obedient child, EO never applied makeup as her mother forbade her. The client was also noted to have an angry mood when young at the age of 10 years and will fight with his mother. The client had a positive family history of mood disorders. The client’s paternal grandfather had at once received electroconvulsive therapy for depression and her maternal aunt was once diagnosed with depression when she was going through menopause
Objective: Mental Status Examination
The client is a moderately built African American female. Gait is intact and has fair eye contact. Language is intact. Speech is pressured in rate and rhythm, and fast pace. The thought process is logical, slightly goal-directed and tangential. Association is loose, alert and oriented to person, place, time and situation. Concentration is poor. Mood and affect is expansive elation and irritation and anger at times when confronted. Affect is full of a range of expression and talkativeness, euphoria, and intolerance to criticism. Insight and judgment are guarded (American Psychiatric Association. 2013).
Diagnosis
The client experience if manic episode lasted for at least one week with the strange mood of persistently elevated, expansive and irritable mood. It was noted above that the manic client behavior and other behavior dysfunction was sufficiently severe to cause extreme impairment in her social functioning. The client shows grandiosity, with poor concentration, distractibility, psychomotor agitation and lack of sleep. Based on the DSM –IV criteria, the client behavior symptoms above fall under Bipolar I disorder (Koirala & Anand, 2018).
Recommended Psychopharmacologic Treatments
Considering the client’s (EO) Bipolar I diagnosis, the severity of her symptoms and family history, I, as a PMHNP, would strongly recommend the prescription of an antipsychotic and a mood stabilizer. The best two drugs to prescribe for the client, in this case, would be Seroquel and lithium as the mood stabilizer. Lithium is a mood stabilizer which works by altering the sodium transport in nerve and muscles, and it also influences the reuptake of norepinephrine and serotonin. Lithium will, therefore, help to subside the client’s manic symptoms and it might take one to three weeks for a therapeutic effect. The Seroquel will also assist in the psychotic symptoms to calm the patient (Ketter, Miller, Dell’Osso & Wang, 2016).
On the other hand, if the initial planned psychopharmacologic treatment above fails, then an antidepressant will be introduced. A lot of preference would not be given to starting the client on large-scale antidepressants since most scientific studies have demonstrated that for most patients with bipolar I, combining antidepressants to mood stabilizers is very effective as compared to management using only a mood stabilizer. However, practitioners have to be cautious when augmenting lithium with antidepressant as antidepressants can destabilize the client’s mood as well as the induction of rapid cycling or suicidal ideation After four weeks if EO fails to show treatment progress, an antidepressant, preferably SSRI (Prozac) will be added to the prescribed drugs (Stahl, 2014b).
Recommended Psychotherapy Choices
The objective of psychotherapy is to increase the patient’s adherence to medications and to offer social, emotional and psychological support apart from linking up the patient with appropriate resources within the community. The most suggested form of therapy for this patient will be group cognitive behavioral therapy (CBT). CBT will help the client to change her irrational thoughts and dysfunctional behavioral patterns. Through group interactions, the client will be able to face her fears as compared to practicing avoidance and will develop more effective strategies to maintain calmness and relaxation (Ye et al., 2016).
Medical Management Needs, Primary Care Needs and Community Support Resources
It will be necessary to connect with the patient’s primary care physician (PCP) as this will promote effective communication to know about the client’s progress. Baseline laboratory investigations will be needed to ascertain whether the patient can efficiently take the prescribed medications. They include liver profile, complete blood count and a kidney function test. It is likely that the drugs prescribed will influence some side effects. As recommended by Francisco López-Muñoz et al. (2018), the client needs to be educated about to ensure compliance with medication. The client will also be connected to community support groups such as those which are supported by Mental Health America, as well as Depression and Bipolar Support Alliance (DBSA) (Behler, Daniels, Scott & Mehl-Madrona, 2017).
Plan for Follow-up and Collaboration with Other Providers
The client’s follow-up visit will be scheduled in a week for a start. The purpose of this follow up appointment will be to assess the client’s tolerance to the prescribed medications. The significant issues that will be assessed include compliance to medications and adjustment of the dosages. After that, the next follow-up visits will be scheduled for four weeks. It is essential to note that the client will be instructed to begin psychotherapy the same week with medications and weekly attend to other sessions. It will be necessary to maintain communication with the client’s therapist and PCP for continuous monitoring (Malhi, 2016).
Conclusion
The client’s prognosis was unremarkable. The client has managed to regain her social and functional status and to maintain previous relationships that existed with friends and family at this time. In clinical practice, bipolar disorders present a lot of challenges when it comes to diagnosis and management such that, misdiagnosis or mismanagement can easily result in poor prognosis and mental health outcomes. Good treatment outcomes are also associated with a strong and long term therapeutic relationship that is characterized by openness and constant communication (Sadock, Sadock & Ruiz, 2014).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washin gton, DC: Author
Behler, J., Daniels, A., Scott, J., & Mehl-Madrona, L. (2017). Depression/Bipolar Peer Support Groups: Perceptions of Group Members about Effectiveness and Differences from Other Mental Health Services.
Qualitative Report
,
22
(1), 213. Retrieved from
https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=120800845&site=eds-live&scope=site
Ketter, T. A., Miller, S., Dell’Osso, B., & Wang, P. W. (2016). Treatment of bipolar disorder: Review of evidence regarding quetiapine and lithium.
Journal Of Affective Disorders
,
191
, 256–273. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2015.11.002Koirala, P., & Anand, A. (2018). Diagnosing and treating bipolar disorder in primary care.
Cleveland Clinic journal of medicine
,
85
(8), 601-608.
Francisco López-Muñoz, Winston W. Shen, Pilar D’Ocon, Alejandro Romero, & Cecilio Álamo. (2018). A History of the Pharmacological Treatment of Bipolar Disorder.
International Journal of Molecular Sciences
, (7), 2143. https://doi-org.ezp.waldenulibrary.org/10.3390/ijms19072143.
Malhi, G. S. (2016). Bipolar disorders: key clinical considerations.
The Lancet
, (10027), 1492. https://doi-org.ezp.waldenulibrary.org/10.1016/S0140-6736(15)01045-4.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer
Stahl, S. M. (2014b).
The prescriber’s guide
(5th ed.). New York, NY: Cambridge University
Press
Ye, B. Y., Jiang, Z. Y., Li, X., Cao, B., Cao, L. P., Lin, Y., & Miao, G. D. (2016). The effectiveness of cognitive behavioral therapy in treating bipolar disorder: An updated meta‐analysis with randomized controlled trials.
Psychiatry and clinical neurosciences
,
70
(8), 351-361.
Assignment 1-WK7
Captain of the Ship Project – Obsessive-Compulsive Disorders
In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with an obsessive-compulsive disorder.
Learning Objectives
Students will:
• Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with obsessive-compulsive disorders
• Recommend psychotherapy based on therapeutic endpoints for clients with obsessive-compulsive disorders
• Identify medical management needs for clients with obsessive-compulsive disorders
• Identify community support resources for clients with obsessive-compulsive disorders
• Recommend follow-up plans for clients with depression disorders
QUESTION
To prepare for this Assignment:
• Select an adult or older adult client with an obsessive-compulsive disorder you have seen in your practicum.
In 3–4 pages, write a treatment plan for your client in which you do the following:
• Describe the HPI and clinical impression for the client.
• Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
• Identify medical management needs, including primary care needs, specific to this client
(NOTE IF IIT IS A FELAEE BEARING CHILD CHECK FOR PREGNANACY TEST BEFORE ORDERING ANY DRUG )
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
Learning Resources
Required Readings
American Nurses Association. (2014).
Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)
. Washington, DC: Author.
Standard 14 “Professional Practice Evaluation” (pages 80-81)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 10, “Obsessive-Compulsive and Related Disorders” (pp. 418–436)
Gabbard, G. O. (2014).
Gabbard’s treatment of psychiatric disorders
(5th ed.). Washington, DC: American Psychiatric Publications.
Chapter 21, “Obsessive-Compulsive Disorder”
Note:
You will access this textbook from the Walden Library databases.
American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author Bipolar Disorder Sample Essay – Captain of the Ship Project.
“Obsessive-Compulsive and Related Disorders”
Note:
You will access this book from the Walden Library databases.
Stahl, S. M. (2014).
Prescriber’s Guide: Stahl’s Essential Psychopharmacology
(5th ed.). New York, NY: Cambridge University Press.
Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://stahlonline.cambridge.org/
To access information on specific medications, click on
The Prescriber’s Guide, 5th Ed
. tab on the Stahl Online website and select the appropriate medication.
Obsessive-compulsive disorder
citalopram
clomipramine
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine
vilazodone
Thompson-Hollands, J., Edson, A., Tompson, M. C., & Comer, J. S. (2014). Family involvement in the psychological treatment of obsessive-compulsive disorder: A meta-analysis.
Journal of Family Psychology, 28
(3), 287–298. doi:10.1037/a0036709
Note:
You will access this article from the Walden Library databases.
Required Media
Bruce, T. & Jongsma, A. (Producers). (n.d.)
Evidence-based treatment planning for obsessive compulsive disorder
[Video file]. Mill Valley, CA: Psychotherapy.net.
Note:
The approximate length of this media piece is 64 minutes. You will access this video from the Walden Library databases Bipolar Disorder Sample Essay – Captain of the Ship Project.
Optional Resources
Himle, J. A., Chatters, L. M., Taylor, R. J., & Nguyen, A. (2013). The relationship between obsessive-compulsive disorder and religious faith: Clinical characteristics and implications for treatment.
Spirituality in Clinical Practice, 1
(S), 53–70. doi:10.1037/2326-4500.1.S.53
Wheaton, M. G., Rosenfield, D., Foa, E. B., & Simpson, H. B. (2015). Augmenting serotonin reuptake inhibitors in obsessive–compulsive disorder:
What moderates improvement? Journal of Consulting and Clinical Psychology, 83
(5), 926–937. doi:10.1037/ccp0000025
This assignment discusses the management of a client with bipolar I disorder in terms of psychopharmacology and psychotherapy. It also describes the medical management and primary care needs and how best to coordinate with other providers when managing such clients. Bipolar Disorder Sample Essay – Captain of the Ship Project.
HPI and Clinical Impression for the Client
EO was a 22year-old African American female client who came to the clinic accompanied by her mother with complaints of insomnia for an entire week and a heightened activity state which she thought was out of control. The client is a college sophomore student. The client’s mother mentioned that most of the client’s behaviors were primarily characterized by ideas which were not only strange but also grandiose as the client thinks she is most important to be recognized by everyone in the entire school irrespective of her poor background. The client had proclaimed to her friends that she owns a business given to her by her father and does not need to go to school. However, the client is sometimes noted to be begging for money. When questioned, EO clearly explained that she was unique in a way that she could still lend her colleagues cash from her business.
EO also had bizarre thinking patterns which had a political dimension. The client strongly believed that her soul had been switched with that of the governor of her state. She also explained how she had developed three governmental theories that only she could use to safeguard the US from destruction with nuclear weapons. The client also reported that she believed that she was best suited for a position in government. The client mother also stated that the client kept explaining her thoughts and theories to everyone at school, family and even wrote them on the dormitory walls, her notebooks and computer with the fear of forgetfulness and also started to campaign for an elected post in government though there were no elections scheduled at this time. Although she was well known by family and friends to be highly organized and tidy, lately, most of them had expressed a lot of worry and disbelief to find that she had started being disorganized and frantic. The client was very talkative and quickly changing the subject during the interview and in a loud tone of voice without realizing, of which she has to be redirected to speak calmly in a low tone. The client mother also reported that the client was noted not to be sleeping well and will argue and have elevated moods swings and angry at most times, thereby affecting her not to focus on her academic studies. These behavior patterns especially with the manic episode and others above had be going on for the past two months.
It is imperative to know that the client grew up in an overprotective environment with very demanding parents. Apart from being a passively obedient child, EO never applied makeup as her mother forbade her. The client was also noted to have an angry mood when young at the age of 10 years and will fight with his mother. The client had a positive family history of mood disorders. The client’s paternal grandfather had at once received electroconvulsive therapy for depression and her maternal aunt was once diagnosed with depression when she was going through menopause
Objective: Mental Status Examination
The client is a moderately built African American female. Gait is intact and has fair eye contact. Language is intact. Speech is pressured in rate and rhythm, and fast pace. The thought process is logical, slightly goal-directed and tangential. Association is loose, alert and oriented to person, place, time and situation. Concentration is poor. Mood and affect is expansive elation and irritation and anger at times when confronted. Affect is full of a range of expression and talkativeness, euphoria, and intolerance to criticism. Insight and judgment are guarded (American Psychiatric Association. 2013) Bipolar Disorder Sample Essay – Captain of the Ship Project.
Diagnosis
The client experience if manic episode lasted for at least one week with the strange mood of persistently elevated, expansive and irritable mood. It was noted above that the manic client behavior and other behavior dysfunction was sufficiently severe to cause extreme impairment in her social functioning. The client shows grandiosity, with poor concentration, distractibility, psychomotor agitation and lack of sleep. Based on the DSM –IV criteria, the client behavior symptoms above fall under Bipolar I disorder (Koirala & Anand, 2018).
Recommended Psychopharmacologic Treatments
Considering the client’s (EO) Bipolar I diagnosis, the severity of her symptoms and family history, I, as a PMHNP, would strongly recommend the prescription of an antipsychotic and a mood stabilizer. The best two drugs to prescribe for the client, in this case, would be Seroquel and lithium as the mood stabilizer. Lithium is a mood stabilizer which works by altering the sodium transport in nerve and muscles, and it also influences the reuptake of norepinephrine and serotonin. Lithium will, therefore, help to subside the client’s manic symptoms and it might take one to three weeks for a therapeutic effect. The Seroquel will also assist in the psychotic symptoms to calm the patient (Ketter, Miller, Dell’Osso & Wang, 2016) Bipolar Disorder Sample Essay – Captain of the Ship Project.
On the other hand, if the initial planned psychopharmacologic treatment above fails, then an antidepressant will be introduced. A lot of preference would not be given to starting the client on large-scale antidepressants since most scientific studies have demonstrated that for most patients with bipolar I, combining antidepressants to mood stabilizers is very effective as compared to management using only a mood stabilizer. However, practitioners have to be cautious when augmenting lithium with antidepressant as antidepressants can destabilize the client’s mood as well as the induction of rapid cycling or suicidal ideation After four weeks if EO fails to show treatment progress, an antidepressant, preferably SSRI (Prozac) will be added to the prescribed drugs (Stahl, 2014b).
Recommended Psychotherapy Choices
The objective of psychotherapy is to increase the patient’s adherence to medications and to offer social, emotional and psychological support apart from linking up the patient with appropriate resources within the community. The most suggested form of therapy for this patient will be group cognitive behavioral therapy (CBT). CBT will help the client to change her irrational thoughts and dysfunctional behavioral patterns. Through group interactions, the client will be able to face her fears as compared to practicing avoidance and will develop more effective strategies to maintain calmness and relaxation (Ye et al., 2016). Bipolar Disorder Sample Essay – Captain of the Ship Project.
Medical Management Needs, Primary Care Needs and Community Support Resources
It will be necessary to connect with the patient’s primary care physician (PCP) as this will promote effective communication to know about the client’s progress. Baseline laboratory investigations will be needed to ascertain whether the patient can efficiently take the prescribed medications. They include liver profile, complete blood count and a kidney function test. It is likely that the drugs prescribed will influence some side effects. As recommended by Francisco López-Muñoz et al. (2018), the client needs to be educated about to ensure compliance with medication. The client will also be connected to community support groups such as those which are supported by Mental Health America, as well as Depression and Bipolar Support Alliance (DBSA) (Behler, Daniels, Scott & Mehl-Madrona, 2017). Bipolar Disorder Sample Essay – Captain of the Ship Project.
Plan for Follow-up and Collaboration with Other Providers
The client’s follow-up visit will be scheduled in a week for a start. The purpose of this follow up appointment will be to assess the client’s tolerance to the prescribed medications. The significant issues that will be assessed include compliance to medications and adjustment of the dosages. After that, the next follow-up visits will be scheduled for four weeks. It is essential to note that the client will be instructed to begin psychotherapy the same week with medications and weekly attend to other sessions. It will be necessary to maintain communication with the client’s therapist and PCP for continuous monitoring (Malhi, 2016) Bipolar Disorder Sample Essay – Captain of the Ship Project.
Conclusion
The client’s prognosis was unremarkable. The client has managed to regain her social and functional status and to maintain previous relationships that existed with friends and family at this time. In clinical practice, bipolar disorders present a lot of challenges when it comes to diagnosis and management such that, misdiagnosis or mismanagement can easily result in poor prognosis and mental health outcomes. Good treatment outcomes are also associated with a strong and long term therapeutic relationship that is characterized by openness and constant communication (Sadock, Sadock & Ruiz, 2014).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washin gton, DC: Author
Behler, J., Daniels, A., Scott, J., & Mehl-Madrona, L. (2017). Depression/Bipolar Peer Support Groups: Perceptions of Group Members about Effectiveness and Differences from Other Mental Health Services.
Qualitative Report
,
22
(1), 213. Retrieved from
https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=120800845&site=eds-live&scope=site
Ketter, T. A., Miller, S., Dell’Osso, B., & Wang, P. W. (2016). Treatment of bipolar disorder: Review of evidence regarding quetiapine and lithium.
Journal Of Affective Disorders
,
191
, 256–273. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2015.11.002Koirala, P., & Anand, A. (2018). Diagnosing and treating bipolar disorder in primary care.
Cleveland Clinic journal of medicine
,
85
(8), 601-608. Bipolar Disorder Sample Essay – Captain of the Ship Project.
Francisco López-Muñoz, Winston W. Shen, Pilar D’Ocon, Alejandro Romero, & Cecilio Álamo. (2018). A History of the Pharmacological Treatment of Bipolar Disorder.
International Journal of Molecular Sciences
, (7), 2143. https://doi-org.ezp.waldenulibrary.org/10.3390/ijms19072143.
Malhi, G. S. (2016). Bipolar disorders: key clinical considerations.
The Lancet
, (10027), 1492. https://doi-org.ezp.waldenulibrary.org/10.1016/S0140-6736(15)01045-4.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer
Stahl, S. M. (2014b).
The prescriber’s guide
(5th ed.). New York, NY: Cambridge University
Press
Ye, B. Y., Jiang, Z. Y., Li, X., Cao, B., Cao, L. P., Lin, Y., & Miao, G. D. (2016). The effectiveness of cognitive behavioral therapy in treating bipolar disorder: An updated meta‐analysis with randomized controlled trials.
Psychiatry and clinical neurosciences
,
70
(8), 351-361. Bipolar Disorder Sample Essay – Captain of the Ship Project.