A Glance at the Treatment of Bipolar I Disorder

A Glance at the Treatment of Bipolar I Disorder

Bipolar disorder is among the primary infinite health challenges affecting humanity today. The disease is a global social issue. Its prevalence across the globe varies from 0.3 to 1.2% by country. Categorically, approximately 46 million across the world had bipolar disorder as of 2019, with females and men making up 52% and 48% of the figure, respectively (Swartz & Swanson, 2019). Thus, critical about bipolar disorder is its prevention, control, and treatment. Through a case study of Angie, a bipolar disorder from a practicum, the current project examines how bipolar I disorder can be treated successfully.

The Case Study

In her early 50s, Angie, a married woman, has a long history of both hypomanic and depressive episodes. She has also had variable diagnoses across the years, including borderline personality disorder, borderline personality disorder, major depression, and lately bipolar I disorder. An HPI and clinical assessment of her symptoms designate that she had compound incidents of depression in her adolescent years, after which hypomanic incidences developed. Her vigorous interpersonal conflict, substance use, alcoholism, and hyper-sexuality during her hypomanic episodes led to the makeshift borderline diagnosis. However, in the context of her full history, bipolar disorder came out as the most fitting diagnosis. She claims that she is not in any relationship now and laments of feelings of alienation from her family. She also complains of fatigue, low or lack of motivation accompanied by loss of interest in daily activities. She also reports excessive anger, irritability, unwanted thoughts, and delusion, as well as sleep complications. For around a year now, Angie has been taking mood stabilizers, but she continues exhibiting depression symptoms, though at low levels. She has gone off medications in the past several times. However, evidently regretting, she now says she “tired of being in trouble all the time” and is ready for a long-term solution to her issues, and she is calling for individual psychotherapy.

Therapy

Bipolar disorder can be treated in a number of ways. Its principal treatment options include medication and psychotherapy. Various factors dictate the appropriateness of these options to a patient. For Angie, the fact mood stabilizers acted to lower her depression episodes before she went off the medication, implies that the use of medications is highly likely to be effective; hence, succeed in treating her. Though pharmacotherapy is the spine of bipolar disorder’s treatment, medication offers patients only fractional reprieve, according to Reynolds (2011). Swartz and Swanson (2019) also observed that dependence on pharmacologic interventions alone in treating bipolar disease is associated with low remission rates, high recurrence rates, as well as residual symptoms. For this reason, for excellent results, a combination of psychopharmacologic intervention and psychotherapy is usually advised for bipolar treatment. For Angie, psychopharmacologic treatment and individual psychotherapy are considered.

Psychopharmacologic Treatment

Psychopharmacological treatment falls under psychopharmacological. This field engrosses the extensive use of drugs in managing and treating mental disorders. Because of mixed episodes and extreme manic episodes, any form of monotherapy will not suit Angy. As such, a combination of psychopharmacological therapy of mood stabilizers and antipsychotic agents is recommended as the first-line treatment. A combination therapy, particularly in clients with manic episodes, is rampant in clinical practice today because of its high success rate of 85% with a whopping 90% of hospitalized manic in-patients treated with a combination of mood stabilizers and atypical antipsychotics (Redfield Jamison, n.d.).

Any of Lithium, valproic acid, or carbamazepine or their combination will be used as mood stabilizers. Afar their therapeutic effects in treating acute manic incidents, these drugs also effective prophylaxis against future episodes and are also adjunctive antidepressant medications, according to Ward (2017). While critical extracellular effects are yet to be excluded, existing evidence depicts that the medications’ remedially pertinent targets are in the cell’s inland, as suggests Reynolds (2011). In this way, mood stabilizers’ functional mechanism is founded on modulating the enzyme activities, arachidonic acid turnover, and ion channels, as well as the G protein-coupled receptors and intracellular pathways engrossed in synaptic plasticity and neuroprotection. The medication will begin low then increased as appropriate.

For Angie, the projected psychopharmacologic endpoints for these mood stabilizers will encompass:

• Recovery from her hypomanic and depressive episodes
• Recession of motivation and interest in activities; she will be able to intermingle and enter relationships comfortably again
• Decline in anger and irritability
• Debility in unwanted thought, delusion, and sleep complications

With their prophylaxis properties, the medication will also

• Prevent Angie from such conditions in the future.

Individual Psychotherapy

The first criterion of selection of this psychotherapy intervention is that it was proposed by Angie herself, which implies that she will be comfortable with it; hence, cooperative. Secondly, it suits her situation, particularly because of her old age. In mental health, Marsee and Gross (2013) affirm that the elderly and women usually require special and customized care. Thus, family and group psychotherapies may not be effective. In this relation, Individual cognitive or cognitive-behavioral therapy (CBT), the primary version of this type of psychotherapy, will be considered for Angie.

Through a combination of mood diaries and thought records, as well as activity scheduling, this CBT will see Angie learn how to modify automatic negative thoughts, remove distorted thinking, and interrupt of mania and depression cycles as suggests (Redfield Jamison, n.d.). Accordingly, therapeutic endpoints will include:

• Recession of wrong thoughts and delusion
• Restoration of motivation and interests in activities such as relationships
• Decline of anger and irritability
• Returning of normal sleep patterns

Medical Management Needs

When caring for the elderly, safety is a principal concern in nursing. Thus, for Angie, the first medication management needs will include monitoring of safe therapeutic serum levels and intensive care of the symptoms of side effects’ symptoms. Lithium, for example, is associated with electrolyte imbalances and dehydration, among other adverse effects, which will require primary care management for Angie’s situation. Suicide is another need. According to Bjorklund et al. (2016), approximately 10% to 15% of individuals with bipolar disorder commit suicide. Thus, Angie’s practitioner will have to be aware of her suicide risk.

Community Support Resources

Mentally ill persons, especially the elderly like Angie, have endless socio-economic needs, including proper housing. Luckily, they have various community support resources, the majority of which are provided by community agencies. In the US, for patients like Angie, Mental Health America (MHA), and International Society for Bipolar Disorders (ISBD) are among the leading of these agencies (American Nurses Association, 2014). MHA offers free or affordable housing to persons of mental illnesses in the US, depending on their socio-economic status, while ISBD deals with education and research in bipolar diseases.

The Treatment Follow-Up Plan

There will be a fall-up plan on a weekly basis. Both Angie’s physician and psychiatric will visit her at her home to monitor her for signs of psychosis, anger, any self-harmful behaviors, and mood swings. The frequency and intensity of the checks will reduce to once in 2 weeks and once a month, respectively, as she stabilizes. After she fully recovers, the follow-up plan will then stop. Many people have recovered from this disease, and it is highly anticipated that Angie will as well.

References

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

Bjorklund, L., Mors, O., Ostergaard, S. D., Horsdal, H. T., Gasse, C., Mors, O., Ostergaard, S. D., … Ostergaard, S. D. (April 01, 2016). Trends in the psychopharmacological treatment of bipolar disorder: A nationwide register-based study. Acta Neuropsychiatrica, 28, 2, 75-84.

Marsee, K., & Gross, A. F. (2013). Bipolar disorder or something else? Current Psychiatry, 12(2), 43–49. Retrieved from http://www.mdedge.com/currentpsychiatry/article/66320/bipolar-disorder/bipolar-disorder-or-something-else

Miller, L. J., Ghadiali, N. Y., Larusso, E. M., Wahlen, K. J., Avni-Barron, O., Mittal, L., & Greene, J. A. (2015). Bipolar disorder in women. Health Care for Women International, 36(4), 475–498. doi:10.1080/07399332.2014.962138

Redfield Jamison, K. (Producer). (n.d.). Assessment & psychological treatment of bipolar disorder [Video file]. Mill Valley, CA: Psychotherapy.net.

Reynolds, G. P. (January 01, 2011). Receptor mechanisms of antipsychotic drug action in bipolar disorder – focus on asenapine. Therapeutic Advances in Psychopharmacology, 1, 6, 197-204.

Swartz, H. A., & Swanson, J. (January 01, 2019). Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence. Focus American Psychiatric Publishing Inc.-, 12, 3, 251-266.

Ward, I. (2017). Pharmacologic options for bipolar disorder. Clinical Advisor, 20(3), 17–25.