JJC Health & Medical Bipolar Disorder II The Case of Eve Questions

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JJC Health & Medical Bipolar Disorder II The Case of Eve Questions

Description

Nursing homework help

 

Questions

Make a diagnosis (and mention possible diagnoses/diagnoses to rule out), and explain the rationale for the diagnosis.

What are the points in favor of a bipolar II diagnosis?

  1. What might account for the failure to respond to any of the prior treatments?
  2. Given the diagnosis you have made, describe your medication treatment strategies. Discuss not only initial choices of medications but also your next-step strategy and why you’ve chosen it. (In doing so, be sure to provide a rationale for your choices.) What questions should be addressed about the class of medications that is chosen (e.g., mood stabilizers)?
  3. Include a brief discussion of how you will integrate legal and ethical considerations of diagnosis, treatment, and consultation with medical professionals in light of the role and activities of the DEA.

 

Case Study 2 Instructions

Make sure to fully respond to each question and to use the rubric to guide your writing (the rubric is used to determine your grade). Your assignments should be written in accordance with APA 6th edition guidelines and contain two professional sources (your text-book may count as one of your resources). Although there is no minimum page length requirement for this assignment, you will likely write a minimum of four pages to full address all of the prompts. Case Scenario The Case of Eve Eve is a thirty-two-year-old woman who comes to the therapist for treatment of depression. Her current symptoms include the following: depressed mood, apathy, anhedonia, hypersomnia, significant daytime fatigue, suicidal ideations, and low frustration tolerance. She has experienced five prior episodes of depression. The symptom picture was much the same during each episode, though in this most recent episode she reports that her suicidal thoughts have increased. She also is increasingly pessimistic about psychiatric treatment being helpful for her. Eve’s first episode occurred at the age of twenty-one and the second at age twenty-five. During these first two episodes of depression, each of which lasted approximately eight to nine months, she was functional but seriously depressed. She did not seek treatment; apparently in both cases she eventually experienced spontaneous remissions. In the next episode (her third, at age 27), she did see a psychotherapist and reports that it was somewhat helpful, but the treatment (psychotherapy alone) did not resolve her depression. Again she eventually recovered after twelve months. Again, it was likely a spontaneous remission. Episode number four (age 29): Eve was treated by her primary care physician with Zoloft. She started this medication at a dose of 50 mg qd and she did tolerate it. After one month on this dose the dose was increased at first to 100 mg and then to 150 mg. After 3 months during which she did not show any improvement she was switched to Wellbutrin. Again she started with a low dose and was eventually increased to a dose of 300 mg qd. On both the Zoloft and the Wellbutrin, there was no significant improvement, but she remembers that she did experience increased irritability. Since the medication was not effective, she simply stopped taking it (four months into treatment). Eve continued to be depressed but somehow tolerated it and never talked to her doctor about it again. By twelve months her depression lifted. Episode number five (age 30): This time Eve saw a psychiatrist and was tried on a number of different drugs: Effexor (up to 300 mg); Wellbutrin added to Effexor (doses in the therapeutic range). On Wellbutrin and Effexor she showed a 10% reduction in symptoms on the Hamilton Depression Rating Scale, but her slight improvement was accompanied by increased irritability, and that was the reason she stopped this medication combination after six weeks. The next medication she was prescribed was Remeron (which she stopped after five days due to excessive daytime sedation). Next she was tried on Effexor and lithium (she discontinued the lithium after three weeks due to sedation and nausea). Before stopping she had attained a blood level of 0.6 and no noticeable improvement. Finally, she was prescribed Cymbalta; again, not successful. Her psychiatrist diagnosed her as having treatment-resistant major depression without psychotic symptoms. She now seeks treatment for her sixth episode of depression, which began three months ago and has gotten increasingly more severe. Eve denies any history of psychotic symptoms, mania or hypomania, suicide attempts, or significant abuse of alcohol or other recreational drugs. She does drink four cups of coffee a day, attempting to stay alert and combat her constant fatigue. She takes a low dose of Inderal to treat a “mild case of hypertension.” She was started on this medication about three months prior to her current episode of depression. She says that she has no other medical problems. In her first episode the break-up of a romantic relationship seems to have triggered the depressive episode. This was the case again in her second episode. However, in all later episodes there were no noticeable psychosocial stressors occurring prior to the depression. The depressions seemed to “come out of the blue.” She is currently married, in a stable and supportive relationship with her husband, and works as a university librarian. Family history is significant. Her maternal grandmother (someone she never met) had had a number of psychiatric hospitalizations and she killed herself when she was twenty-nine years old. One cousin has had a “nervous breakdown.” Eve does not know any details about this. A great aunt was a severe alcoholic, and mother suffers from moderately severe chronic depression. Eve says that now she feels desperate and is plagued by recurring and intense suicidal impulses. Directions: Please respond to the following questions. All papers should be written in APA format. Questions 1. Make a diagnosis (and mention possible diagnoses/diagnoses to rule out), and explain the rationale for the diagnosis. 2. What are the points in favor of a bipolar II diagnosis? 3.What might account for the failure to respond to any of the prior treatments? 4. Given the diagnosis you have made, describe your medication treatment strategies. Discuss not only initial choices of medications but also your next-step strategy and why you’ve chosen it. (In doing so, be sure to provide a rationale for your choices.) What questions should be addressed about the class of medications that is chosen (e.g., mood stabilizers)? ▪ ▪ ▪ This assignment is worth 100 points. All assignments should be written in APA format. Please include a title page, the body of your paper, and a reference page. All papers should include an introduction and conclusion. Submit the assignment by 11:59 CST on Day 7 of the week. Assignment Rubric Criteria Question 1: 15 pts a. Make a diagnosis (and mention possible diagnoses/diagnoses to rule out), b. Explain the rationale for the diagnosis. Question 2: 15 pts a. What are the points in favor of a bipolar II diagnosis? Question 3: 15pts a. What might account for the failure to respond to any of the prior treatments? Well Developed (A to High A) 15 points The correct diagnosis was clearly identified. Possible diagnoses to rule out were identified. Rationale for diagnosis was explained and pointed to the diagnosis. 15 points Hypomanic episode and depressive episodes are identified and not explained by ruling out disorders. Clinical distress is present. No manic episodes identified. 15 points Previous treatments are all identified and discussed. Rationale for treatment is multifactorial and direct links applied to previous treatments. Developed (B to Low A) 13-14 points The correct diagnosis was clearly identified. Diagnoses to rule out were identified Rationale for diagnosis was explained. Emerging (C to Low B) 11-12 points A diagnosis was identified. Diagnoses to rule out may or may not have been present. Rationale for diagnosis was present. Undeveloped (Less than a C) 0-10 points A diagnosis was present but diagnoses to rule out may or may not have been present. Diagnostic rationale may not point to diagnosis or is missing. 13-14 points 11-12 points 0-10 points Hypomanic episode and Hypomanic episode and Hypomanic episode and depressive episodes are depressive episodes are depressive episodes are identified and not explained identified. Clinical distress vaguely identified or by ruling out disorders. is present. missing. Clinical Clinical distress is present. distress may or may not be noted. 13-14 points Previous treatments are all identified and discussed. Rationale is present with direct links applied to previous treatments. 11-12 points Some previous treatments are identified and discussed. Rationale for treatment failure is discussed. 0-10 points Some previous treatments are discussed. Rationale for treatment failure may or may not be present. Question 4: 30 pts a. Given the diagnosis you have made, describe your medication treatment strategies. Discuss not only initial choices of medications but also your next-step strategy and why you’ve chosen it. (In doing so, be sure to provide a rationale for your choices.) b. What questions should be addressed about the class of medications that is chosen (e.g., mood stabilizers)? Writing Mechanics and APA Format: 15 points Sources: 10 points Total: 100 points 29-30 points Diagnosis is stated and medication treatment strategies are fully discussed. Medications are identified and rationale for next-step use presented and linked to therapeutic interventions. At least five medication questions are thoroughly addressed. 15 points No more than three grammatical, spelling, punctuation, and/or APA errors. Clarity of paper not influenced by errors. 25-28 points Diagnosis is stated and medication treatment strategies are discussed. Medications and rationale for next-step use presented with suggestions for accompanying therapeutic interventions. Two to four medication questions are thoroughly addressed. 13-14 points More than three grammatical, spelling, punctuation, or APA errors. Clarity of paper was not strongly influenced by the errors. 10 points 9 points 2 professional sources or 1-2 professional sources are more are used throughout used to adequately support the paper as appropriate ideas and are documented in to thoroughly support the reference list. ideas, and are documented in the references list. 22-24 points Diagnosis and medication treatment strategies are incompletely addressed. Rationale for next-step use is incomplete and may not be associated with any suggestions for therapeutic interventions. One or more medication questions are incompletely addressed. 11-12 points More than three grammatical, spelling, punctuation, or APA errors that had a negative influence on the clarity of the paper. 7 points 1 professional source is used to partially support ideas and is documented in the reference list. 0-21 points Medication treatment strategies are present. Rationale for next-step use is vague or is missing. Accompanying therapeutic interventions may or may not be present. Medication questions are incomplete or absent. 0-10 points More than three grammatical, spelling, punctuation, or APA errors that had a strong negative influence on the clarity of the paper. 0-6 points 1 source or less was used. Ideas were insufficiently supported. Running head: BIPOLAR DISORDER II -THE CASE OF EVE Title of your paper Your name Your institution BIPOLAR DISORDER II – THE CASE OF EVE 1 Running head: BIPOLAR DISORDER II -THE CASE OF EVE 2 ABSTRACT Bipolar disorder is a psychological health condition that causes abnormally high and in some cases, low tempers. It affects an individual’s energy levels and their capacity to function in daily life. There are several categories of bipolar disorder, the most common being bipolar I and bipolar II. Bipolar disorder I and Bipolar disorder II are often differentiated by the intensity of the maniac period. Bipolar disorder I is often so intense that some individuals get hospitalized during the maniac periods. Bipolar disorder II is characterized by high moods and energy levels which interfere with work and socializing. The symptoms of bipolar disorder II include; – Impaired decision making – The tendency towards reckless behavior such as drinking and using drugs – An increase in energy or feeling more agitated – Inability to sleep leading to fatigue during the day The risk factors are thought to be of a genetic component as having a first-degree relative with bipolar disorder II increases ones’ ability to be diagnosed with the same condition. Often bipolar disorder II is misdiagnosed because its symptoms of hypomanic periods are mild hence it comes out as a major depressive disorder. Diagnosis of bipolar disorder II starts by carrying out a physical exam of a blood test to rule out bodily causes such as hormonal imbalance. A psychiatric evaluation is then prescribed to the patient to test what might be the cause. After diagnosis and the test becomes positive on bipolar disorder II, the patient is then treated with a combination of medication and psychotherapy. Medications include antidepressants, antipsychotics and mood stabilizers. Psychotherapy involves counselling to help the patient get through their emotional problems and other life issues. Running head: BIPOLAR DISORDER II -THE CASE OF EVE 3 DIAGNOSES Bipolar disorder II is often misdiagnosed which delays initiation of appropriate therapy; a misdiagnosis may further worsen prognosis. The main distinguishing features of bipolar disorder II include; earlier age of onset, presence of psychotic features, antidepressant-induced switching, and a family history of bipolar disorder. According to Eve’s symptoms, the therapist reviewed her medical history and symptoms. Eve had been having depression which became severe over time. The therapist’s evaluation focused on her thoughts, feelings, and behaviors. According to the therapist’s observations, Eve’s current symptoms depict those of a person suffering from bipolar II disorder. Her symptoms include; depressed mood, apathy, anhedonia, hypersomnia, significant day fatigue, suicidal ideations, and low frustration tolerance. The other thing besides her symptoms is her family history which is also significant. By comparing Eve’s symptoms to her grandmother’s, cousin and aunt who have all undergone various forms of depression, this might also add up to her state as well which reveals the presence of the disease in the family history. She has had suicidal thoughts while in the past her grandmother took away her life. Her great aunt was an alcoholic as Eve is currently and her mother suffers from moderately severe chronic depression. Eve is in denial of her other symptoms, especially during manic periods according to the criteria for bipolar disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). POINTS IN FAVOUR OF BIPOLAR II DIAGNOSES The main symptoms of bipolar disorder II are mania, hypomania, and depression. Eve is a thirty-two-year-old woman who comes to the therapist for the treatment of depression. During a mania period, one can experience anger, restlessness or irritability, difficulty in Running head: BIPOLAR DISORDER II -THE CASE OF EVE 4 concentrating and making decisions, and racing thoughts. Hypomania can interfere with a persons’ quality of life. Depression is also a sign of bipolar disorder and it includes having suicidal thoughts, sadness, and changes in appetite. Approximately 2.8 percent of adults in the United States experience bipolar disorder in a given year, according to the National Institute of Mental Health (NIMH). An estimated 4.4 percent of people experience bipolar disorder at some point in their lives. Eve’s symptoms included depressed mood, apathy, anhedonia, hypersomnia, significant daytime fatigue, suicidal ideations, and low frustration tolerance. She also experienced five prior episodes of depression. The symptom picture was much the same during each episode and worsened eventually. She became increasingly pessimistic about the psychiatric treatment being helpful for her. REASONS WHICH ACCOUNT FOR EVE’S FAILURE TO RESPOND TO ANY OF THE PRIOR TREATMENTS. Failure to respond to bipolar disorder II treatment could have different reasons. Patients with severe symptoms often remain symptomatic even after treatments. In order to curb recurrence, doctors should strive to find the right combination of therapies for their patients and encourage them to stick to the treatment plans. Eve has been in denial of using small or moderate amounts of alcohol or recreational drugs. Her continued use of the substance has interfered with the therapeutic effects of prescribed bipolar medications. Her concurrent use of some psychiatric antidepressants e.g the four cups of coffee which she takes and mood-destabilizing medications i.e Inderal should be discontinued to determine whether they are opposing the therapeutic effects of antimanic agents. Irregular medication compliance can counteract or offset the positive effects of prescribed medications. Eve’s Running head: BIPOLAR DISORDER II -THE CASE OF EVE 5 volitional unhealthy lifestyle behaviors can also contribute to the prognosis of bipolar disorder. MEDICATION TREATMENT STRATEGIES. Pharmacological treatment for people with Bipolar disorder II was developed by an international task force of the World Federation of Societies of Biological Psychiatry (WFSBP). According to their study, manic symptoms in bipolar mixed states appeared receptive to treatment with numerous unusual antipsychotics, the best proof resting with olanzapine. For depressive symptoms, the addition of ziprasidone to treatment was beneficial however; the indication found it much more limited than for the treatment of manic symptoms. Besides olanzapine and quetiapine, valproate and lithium should also be considered for repetitive preclusion. Eve’s bipolar II disorder treatment should typically consist of medications, psychotherapy, and lifestyle changes. As bipolar disorder is a long-term condition, treatment will be long-lasting. The treatments should include lithium, which is highly effective at controlling particularly high mood swings. Carbamazepine, which is an antiseizure drug, larmotrigine, which is approved by the FDA for bipolar disorders. Valporate, which in high doses controls agitation due to sedation. Eve should practice frequent exercises and the stability of regular routines, such as healthy eating habits and good sleep hygiene to enhance her treatment outcomes. Her prescription should include mood stabilizers, such as lithium, for bipolar disorder. I would also prescribe a combination of antipsychotic drugs for manic episodes and antidepressants for depression. This will help reduce depression while stabilizing mood. It is vital to keep on taking medications even throughout periods of stable mood to avoid relapse. Persistence in making lifestyle changes to manage her symptoms and will help Running head: BIPOLAR DISORDER II -THE CASE OF EVE stabilize her moods. The helpful changes include avoiding alcohol and drugs, attending a support group for people with mood-related disorders and practice mindfulness and meditation. References 6 Running head: BIPOLAR DISORDER II -THE CASE OF EVE 7 Sugarman, M. A. (2016). Are antidepressants and psychotherapy equally effective in treating depression? A critical commentary. Journal of Mental Health 25(6). 475-478. doi: 10.3109/09638237.2016.1139071 Haller, M., Myers, S., McKnight, A., Angkaw, A. C., Norman, S. B. (2016). Predicting engagement in psychotherapy, pharmacotherapy, or both psychotherapy and pharmacotherapy among returning veterans seeking PTSD treatment. Psychological Services 13(4). 341-348. doi: 10.1037/ser0000093