NURS6670 Week 7 Examine Case Study: A young Woman with Depression
NURS6670 Week 7 Examine Case Study: A young Woman with Depression
Bipolar 1 case Study Sample Paper
Introduction
Bipolar is a chronic psychiatric diagnosis characterised by alternative episodes of depression with mania or hypomania. Mania is a mood elevation characterised by excessive energy to overwork and perform. The number of recurrent episodes in each phase as well as the duration varies between patients. Bipolar disorders are classified into three categories, namely Bipolar 1, 2 and cyclothymic disorder (Yatham et al, 2018 NURS6670 Week 7 Examine Case Study: A young Woman with Depression). Type 1 bipolar presents with a major depressive episode and complete manic episodes, while type 2 has only hypomanic level of excitement. The depressive phase is however chronic. Cyclothymic causes mild episodes of hypomania and depression and is less severe than bipolar 1 and 2.
Decision 1
Probable diagnosis for the patient is depressive phase of bipolar I. Major depressive episode in Bipolar 1 is attributable to persistent changes functionality, characterised by changes in mood and loss of interest in pleasure and five additional symptoms. These could be suicidal thoughts, inappropriate guilt, psychomotor agitation, weight loss or gain and insomnia (Bobo, 2017 NURS6670 Week 7 Examine Case Study: A young Woman with Depression). Stefanie reports to have experienced depressed episodes in which she feels empty and sad. She also endorses feelings of fatigue and reduced ability to concentrate. She has also lived with this for long, hence aligned to fit the diagnosis of major depressive disorder upon admission. Her self-reported mood is sad with an affect consistent with dysphoria. She also has difficulty in sleeping. This diagnosis corresponds to Stefanie’s current medical history, and also relates with her past medical history of disturbed sleep, reduced concentration alternating with episodes of bursting energy to address piled-up responsibilities after days of sleep. Depression diagnosis could define her current mood but is overlapped by bipolar mood disorder due to bursts of energy and activity.
Decision 2
Episodes of mania and depression among bipolar patients have different triggers, among them family conflicts, turbulent relationships and significant life events and disturbed sleep/wake cycle. This makes it ineffective to manage using only pharmacological means. Regular psychotherapy sessions alongside medication management has showed better recovery and reduced episode relapse. Effective methods of psychotherapy include cognitive behaviour, family-focused therapy (FFT) and group psychoeducation. FFT is inclusive of the patient, relatives, friends and partner, in caring for the patient (Miklowitz et al, 2020 NURS6670 Week 7 Examine Case Study: A young Woman with Depression). The sessions focus on preparing the caregivers to identify early signs, identify triggers and promptly support the patient in self-care. Further sessions focus on communication skills, problem solving skills and conflict resolving skills. Cognitive behavioural therapy addresses the client’s thoughts, feelings and behaviours and their relationship. It also teaches the clients to rehearse and apply adaptive behaviours to address environment triggers and negative thinking patterns. It also enforces the clients to identify with rewarding behaviours especially when depressed, which are not overstretched. Application of both CBT and FFT prepares the client and his environment for further prevention of triggers and reduced occurrence of relapses.
Decision 3
Maniac episodes are considered medical emergencies due to their severity. Emergency medications are used to stabilize the moods and reverse the psychotic features. Olanzapine 5mg BD is the recommended as first line drug, combined with a mood stabilizer for patients with severe psychotic features. Stefanie presents with mild manic symptoms, besides being a new case. As such, the intervening practitioner should initiate her on Olanzapine as a monotherapy, which can be adjusted based on mood changes (Gitlin, 2018). The clinician will regulate dosage adjustment during follow-up visits to maintain optimal effectiveness. Fluoxetine is the most recommended antidepressant for bipolar depression, in combination with only olanzapine. Fluoxetine is a selective serotonin reuptake inhibitor often used to uplift mood status such as in depression and bulimia. The recommended start dose is 20mg in adults, with gradual increase, to a maximum of 60mg a day. With the absence of signs of self-injury and suicide, a low dosage of fluoxetine is recommended to reduce chances of hyper toxicity. NURS6670 Week 7 Examine Case Study: A young Woman with Depression
Additional tests
Stefanie would benefit from a follow-up head CT. The test seeks to identify signs of head injury, atrophy or oedema that would disrupt release of the mood hormones, or their uptake on the postsynaptic membrane. Confusion, visualised brain atrophy and reduced brain activity are among the evident signs of head injury. The test will help to rule out any possible damage to the brain that could be missed, hence causing chronic damages. Thyroid function test will also help assess production of thyroid hormones that regulate moods, hence possible cause of depression and/or mania. This can be corrected by stimulating optimal thyroid functions.
Conclusion
Bipolar I is characterised by hypomanic episodes with major depression. Hypomania presents with high level of energy to work and act, while depressive phases equally hit in. Depressive symptoms will fulfil the depressive disorders criteria of DSM V, of which it could be less intense. Effective management of Bipolar I should include psychotherapy and psychopharmacology for optimal success. A combined therapy of olanzapine and fluoxetine is evidently effective as first line treatment therapy. The doses are adjusted during follow up to achieve the desired therapeutic effects. Cognitive behavioural therapy and family-focused therapy are both effective in instilling adaptive behaviours for the client. NURS6670 Week 7 Examine Case Study: A young Woman with Depression
NURS6670 Week 7 Examine Case Study: A young Woman with Depression References
- Gitlin, M.J (2018). Antidepressants in bipolar depression: an enduring controversy. International Journal of Bipolar Disorders, 6, 25. https://doi.org/10.1186/s40345-018-0133-9
- Bobo, W. V. (2017). The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update. Mayo Clinic Proceedings, 92(10), 1532-1551. doi: 10.1016/j.mayocp.2017.06.022.
- Miklowitz, D. J., Schneck, C. D., Walshaw, P. D., Sigh, M. K., Sullivan, A. E., Suddath, R. L., Borlik, M. F., Sugar, C. A., & Chang, K.D. (2020). Effects of Family-Focused Therapy vs Enhanced Usual Care for Symptomatic Youths at High Risk for Bipolar Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 77(5), 455–463. doi:10.1001/jamapsychiatry.2019.4520. NURS6670 Week 7 Examine Case Study: A young Woman with Depression
- Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., Alda, M., MacQueen, G., Milev, R. V., Ravindran, A., O’Donovan, C., McIntosh, D., Lam, R. W., Vazquez, G., Kapczinski, F., … Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97–170. https://doi.org/10.1111/bdi.12609
NURS6670 Week 7 Examine Case Study: A young Woman with Depression Instructions
| NOTE: Please includes introduction and conclusions Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical, as well as mental factors that might impact the client’s diagnosis and treatment. NURS6670 Week 7 Examine Case Study: A young Woman with Depression At each Decision Point stop to complete the following: Decision #1: Differential Diagnosis Which Decision did you select? Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision #2: Treatment Plan for Psychotherapy Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision #3: Treatment Plan for Psychopharmacology Why did you select this Decision? Support your response with evidence and references to the Learning Resources. NURS6670 Week 7 Examine Case Study: A young Woman with Depression What were you hoping to achieve by making this Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients and their family. A young woman with Depression SUBJECTIVE Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep. NURS6670 Week 7 Examine Case Study: A young Woman with Depression You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks. Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels “depressed”—but then states: “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!” NURS6670 Week 7 Examine Case Study: A young Woman with Depression OBJECTIVE Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits. MENTAL STATUS EXAM Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented. NURS6670 Week 7 Examine Case Study: A young Woman with Depression At this point, please discuss any additional diagnostic tests you would perform on Stefanie. Decision Point One Bipolar I, current phase, depressed | |
| Comments / Note |
NURS 6670 Week 8 Assignment
Explain the diagnostic criteria for delirium.
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder thus deliriums\’.
Identify the risks of different types of therapy and explain how the benefits of the therapy that might be achieved might outweigh the risks.
Support your rationale with references to the Learning Resources or other academic resource
NURS 6670 Week 9 Assignment
A 63 year-old male Caucasian, homeless ,with no jobs , retired from the military, has been diagnosed with Schizophrenia and PTSD.
CC: He states, “During the night, I hear voices in my head, constantly yelling and telling me to do things like jumping my window. I see shadows dancing across the wall and .
Lately whenever somebody comes near me, I fear for my life and my heart rate starts to increase and I start getting paranoid.” NURS6670 Week 7 Examine Case Study: A young Woman with Depression
The patient is experiencing the symptoms of hallucinations and voices from his Schizophrenia which is also causing his anxiety to occur and become paranoid around people.
Medication: Buspirone 10mg PO Daily for anxiety.
Olanzapine 10mg PO Daily for his Schizophrenia
Informed consent explained and signed by patient
Pt is alert and oriented x4,
Denies any street drug taken
Denies any alcohol use
Denies any allergy to medications or food
No side effects of any taken medications presently
Sleeps Pattern :Not sleeping well during the night or day, paces around in her room sometimes reading.
Food she stated she cannot eat well now Has gain 1 lb. after her last visit with her psychiatrist Is not pregnant Very compliance with taken medications taken
No suicidal ideations Hearing of voices or seeing any images Sees her regular therapist weekly Goes for individual therapy Family therapy SI/HI/AVH. NURS6670 Week 7 Examine Case Study: A young Woman with Depression
Clinical Impression: Based on the diagnostic criteria in APA (2013) Diagnosed: Schizoaffective disorder (ICD-10: F25.9),
Psychopharmacology of the patient’s symptoms cause a significant impairment in function or agitation, irritable treatment is based on patients’ signs and symptoms presented, client cannot sleep always on the edge ,easily irritated ,dissociate herself from friends and family and has decrease in her appetite.
Medication Management :Increase buspirone 15mg PO Daily continue to for month.
Olanzapine 15mg po for a month .
Decreases all active activities before bedtime ,getting her family involve especially.
Sees her regular therapist weekly Goes for individual therapy Family therapy monthly Family and client educated about her illness to watch for any suicidal ideations .
Advise given to husband not arguing with client. Read or dim lights or noise around her sleeping room Patient to see her PCP for regular checkup and labs Return for evaluation in a month time. NURS6670 Week 7 Examine Case Study: A young Woman with Depression
Questions
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.
•
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. NURS6670 Week 7 Examine Case Study: A young Woman with Depression
•
•
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
NURS 6670 6670 Week 10 Schizophrenia Case
CASE
Charlie A 49 years-old male AA, is a homeless man had never been in a relationship, works at a local grocery store as a stocker, has been diagnosed with schizophrenia, complains of hearing voices even while at work which distracts her from what she needs to do, she also states that she feels hopeless in some situations which cause her to be anti-social. NURS6670 Week 7 Examine Case Study: A young Woman with Depression
Medication:
Olanzapine-15mg PO Daily
Seroquel-200mg at night
At each Decision Point, stop to complete the following:
Decision #1: Differential Diagnosis
Which Decision did you select?
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
Decision #2: Treatment Plan for Psychotherapy
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different? NURS6670 Week 7 Examine Case Study: A young Woman with Depression
Decision #3: Treatment Plan for Psychopharmacology
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients and their family.
Week 10 Discussion – Sleep/Wake Disorders
topic :Insomnia
- Explain the diagnostic criteria for your assigned sleep/wake disorder.
• Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder.
• Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why. NURS6670 Week 7 Examine Case Study: A young Woman with Depression
• Support your rationale with references to the Learning Resources or other academic resources.
NURS 6670 6670 Week 11
To prepare for this Discussion:
TOPIC IS GENDER DYSPHORIA
Select a gender dysphoria, that interests you.
Review the Learning Resources.
By Day 3
Post:
Explain the diagnostic criteria for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected. NURS6670 Week 7 Examine Case Study: A young Woman with Depression
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.
Support your rationale with references to the Learning Resources or other academic resource.