Patient Evaluation
The patient is a 37-year-old female. She says that she only visited the mental clinic after persistent arguments with her husband, in which the husband insisted that she has to seek help from a psychiatrist. The patient insists that she does not need help, as her condition is just temporary and will soon resolve. As the evaluation proceeds, the patient admits that she has had mental problems before and has seen a psychiatrist twice. She has previously been on lithium therapy. She has however been in good condition for 13 years, until four weeks ago when she started experiencing frequent mood swings. She says that her mood often alternates between euphoria and irritability. She sometimes feels so depressed that she cries. She says that this may often happen about three or four times a week, during which she cries for approximately 30 minutes.
The patient admits that at times, she becomes verbally aggressive with family members and neighbors. She, however, insists that she only becomes verbally aggressive but not physically aggressive. She poses no harm to herself or those around her. Her daily work rate has significantly reduced in the past four weeks, which she attributes to her overall reduced concentration and lack of interest in what she does. Besides the reduced concentration, she also suffers periods of indecisiveness, racing thoughts, increased anxiety, agitation, overtalking, and excessive cleaning behavior. Her eating habit is poor, manifested by a pervasive eating disturbance which has resulted in a weight loss of 12 lbs. in a fortnight. Furthermore, she has severe insomnia and finds it very difficult to sleep. When she eventually manages to fall asleep, she intermittently wakes up during her sleep. The patient admits to a history of alcohol abuse, but she points out that she has not used alcohol for the last five years. She denies having suicidal thoughts or any symptoms of obsessive-compulsive disorder. She also denies hallucinations, delusions, or prior attempted suicide.
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Diagnosis
On the basis of this evaluation, the patient is diagnosed with bipolar disorder. The condition affects a person’s moods and causes the moods to swing from one extreme (depression) to another (mania) (Barlow, 2014). Unlike normal mood swings, bipolar disorder often lasts for several weeks or even longer. The condition may recur if it had previously been resolved and the patient had been normal for some time (Beidel, & Frueh, 2018).
Treatment
Medication
Mood stabilizers are the medications of choice for treating the patient. The patient is given lithium (Lithoid) drugs. According to Alda, (2015) lithium is indicated for the manic episodes of the disorder, which are more severe than depression disorders. The dosage and frequency of lithium administration will change depending on the concentrations of the drug in the blood; this will help to prevent lithium toxicity. Close monitoring of the patient is therefore required during the treatment period to determine prognosis and ascertain the risk of toxicity (Alda, 2015).
Psychotherapy
Cognitive behavioral therapy (CBT) is important in the management of patients with bipolar disorder (Frank et al., 2015). The therapy involves a one-on-one interactive session with a therapist. During these sessions, the patient gets to be helped in the management of their behavior, perceptions, and thoughts. At times, the sessions might be held in groups in which the therapist helps several people with bipolar disorder collectively. The therapy helps the patient to learn important coping mechanisms.
Lifestyle Advice
This therapy often works in combination with medication or psychotherapy. The patient is advised on how to partake their daily activities and other important activities that aid in prognosis and prevention of relapse of the disorder (Frank et al., 2015). The patient is given a regular exercise schedule, as well as advice on improving their sleeping habits and diet. The patient also has to plan a list of activities that they enjoy doing; this helps in building their concentration and enhances a sense of fulfillment.
References
Alda, M. (2015). Lithium in the treatment of bipolar disorder: pharmacology and pharmacogenetics. Molecular psychiatry , 20 (6), 661.
Barlow, D. H. (Ed.). (2014). The Oxford Handbook of Clinical Psychology: Updated Edition . Oxford University Press.
Beidel, D. C., & Frueh, B. C. (Eds.). (2018). Adult psychopathology and diagnosis . John Wiley & Sons.
Frank, E., Peters, A., Sylvia, L. G., da Silva Magalhaes, P. V., Miklowitz, D. J., Otto, M. W., ... & Deckersbach, T. (2015, January). The role of age at onset, course of illness and sleep in response to psychotherapy in bipolar disorder. In ISBD 2015: Proceedings of the 17th Conference of the International Society for Bipolar Disorders (pp. 1-1). Wiley.
