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1 PPT Bipolar 2 PPT Tourettes Syndrome
Bipolar Disorder II
Yanetsi Alayon
Junior M. Peralta
St. Thomas University
NUR 530 Psychopathology
Dr. Seraphin
September 22nd, 2022
Fictitious Patient Case Study
JM is a Hispanic Mexican woman aged 67 years. She has a long history of hypomanic episodes and depression.
For the past 5 years, JM has had variable diagnoses of borderline personality, and major depression.
Most recently she was diagnosed with Bipolar Disorder II.
For the past week, the patient has been experiencing expansive, elevated, and irritable mood that has been present mostly during the day, more severe in the morning, and occurs almost every day.
Although bipolar disorder affects people from different races equally, there is a high incidence of the condition among the Hispanic and Latino population.
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A review of his symptoms points out that she indeed has had numerous episodes of depression which began about 5 years ago, but more clear hypomanic episodes emerged about a month ago.
Her preeminent personal conflict, and hyper-sexuality during hypomanic episodes resulted in the provisional diagnosis of borderline personality.
Based on the full history of the patient, it is suspected that the patient is having bipolar disorder type 2.
“Since my husband’s death, 5 years ago, I have felt very alienated and lonely,” patient stated.
For the past year, JM has been taking mood stabilizers but continues having lower-level symptoms of depression. Mood stabilizers taken: valproic acid 250 milligrams (mg) 2 times a day.
The condition is normally characterized with depression. The depressive episodes last for about a week. Therefore, symptoms of bipolar disorder are closely related with those of depression. The symptoms often last for days, weeks, months or years.
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Allergies
Having a history of asthma, the patient is allergic to pollen and cold
Aspirin
Non-steroidal anti-inflammatory drugs, such as ibuprofen, and naproxen.
The patient is also allergic to a class of medication known as beta blockers.
There is a close association between allergies and mental illness. For instance, Asthma increases the risk of bipolar disorder, depression and anxiety.
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Physical findings and Psychiatric findings
The patient admits feeling depressed and having a diminished interest in almost all activities.
The patient denies an increase in appetite though there is not weight gain.
Excessive guilt
Psychomotor agitation
JM admits feeling a diminished need for sleep
There is clear evidence of distractibility
The patient admits to having suicidal thoughts.
Hypomania is characterized by irritable mood
Vital Signs
BP: 127/82 mmHg.- the condition is associated with a higher risk of cardiovascular death and high blood pressure.
Heart rate (pulse): 88 bpm.
Respiratory rate: 26 breaths per minute.
Temperature: 37 °C
Weight: 92 Kg
Height: 6 feet
BMI: 25
Mild headache.
No labs/diagnostic tests were reviewed.
Bipolar patients are at a greater risk of hypertension and other cardiometabolic ailments and a higher pulse rate.
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Family history
Bipolar disorder has a genetic component, the disorder often runs in families.
Genetic disorders (Asthma, Diabetes Mellitus) Mother and sister
Mood disorder – (Major Depressive Disorder) Grandfather
Bipolar Disorder II – Sister and his father
Suicidal attempts – Brother
General patient information
No history of tobacco use
Drug use: mood stabilizers
History of alcohol use
Current Employed as Receptionist
Previously employed as Cashier
Heterosexual, sexually active, uses
condoms, and rents an apartment
shared with a colleague.
Bipolar disorder is largely inheritable. A family history of the condition increases the risk. For instance, if one of the parent had the condition, there is a greater likelihood of one getting the condition. The effect of the father is greater. Equally, a history of drug abuse increase the risk by 48% (Miklowitz et al., 2021).
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Mental Status Check
Appearance: pale
Attitude/Behavior: restless
Mood: high and low moods
Affect: a feeling of hopelessness
Speech: disordered speech
Thought process: racing thoughts
Thought content/ perception: very forgetful
Cognition: psychomotor retardation
Insight: less extreme
Judgment: poor judgment
Principal diagnosis based on DSM5
Based on the DSM5, Bipolar Disorder is a condition that is characterized by mood fluctuations in an individual mood, energy, and ability to function.
Bipolar Disorder II comprises hypomanic and depressive episodes which alternate and are usually less stark and do not prevent function.
JM has the condition because he experiences alternate periods of high and low moods, delusions, over activity, euphoria, and sometimes a feeling of hopelessness(Carvalho et al., 2020).
A feeling of irritable, elevated, and expansive, mood change lasted for more than a week.
The patient has lost interest in most of the daily activities and feels a sense of worthlessness and fatigue in performing the day-to-day activities.
Other diagnoses addressed during the visit include borderline personality and major depression.
Major depression is a major symptom of bipolar disorder.
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Differential Diagnoses
Major depressive disorder- is a mental illness that is characterized by a person having a pervasive low mood for about two weeks, low self-esteem, and
loss of interest in normally enjoyable activities. The condition affects how a person thinks feels and performs daily tasks. it can also affect a person’s appetite, sleeping habits, and appetite.
Bipolar I Disorder- refers to manic episodes that occur for about 7 days.
The manic episodes are so severe making a person requires immediate medical care.
The common symptoms of this condition include interest loss, a feeling of worthlessness, guilt, self-doubt, and lacking energy.
No diagnostic testing or screening tool clinically required at this time.
Pharmacologic and Non-Pharmacological Treatment
Cognitive-behavioral therapy provides the healthiest and most efficient alternative based on relapse prevention.
It helps in improving the depression symptoms, the mania severity, and psychosocial functioning.
Mood stabilizers are typically needed for stabilizing the mood-stabilizing medication to control hypomanic episodes(Miller et al., 2020). In this case, JM takes valproic acid 250 milligrams (mg) 2 times a day.
Patients can effectively manage the condition by sticking to a consistent routine and taking the medication as prescribed.
The patient needs to monitor her mood. Keep track of the mood daily, counting factors such as medication, sleep, and events that affect mood.
Developing a schedule is essential for stabilizing the mood. Organizing and sticking to a schedule help to
attain a form of maintaining stability.
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Definition of the disease or disorder
Bipolar Disorder II is a mental illness characterized by hypomanic and depressive episodes.
The condition causes thrilling mood swings including high and low emotions.
An individual with Bipolar Disorder II often feels depressed, hopeless, sad, and loses interest in everyday activities. These mood swings usually affect a person's
sleep, judgment, energy, behavior, activity, and the cognition.
Though the condition is lifelong, it can be managed by controlling a person's mood swings and symptoms through a treatment plan.
Epidemiology, incidence, and prevalence of the disease or disorder
It is estimated that approximately 7 million people globally have Bipolar Disorder (BD) II. The United States has the highest rate of nearly 4.4%, and the lowest rate in India at 0.1%. The condition is more frequent among women living alone and individuals from low socioeconomic levels (Miklowitz et al., 2021).
Incidence of BD II is also influenced by gender and ethnicity.
The earliest signs of a person with this condition manifest in the early twenties. There is evidence of higher rates of the condition among low-income families, and unmarried and unemployed groups, though the social disturbance that occurs due to stark mental illness cannot be ruled out (Miklowitz et al., 2021).
Pathogenesis
Bipolar Disorder II is genetic and normally occurs
due to the shared susceptibility genes. The condition is considered by dysregulation in the serotonin and dopamine systems.
BD 2 disorder is related to preeminent activity in the amygdala, an important brain structure involved in recognizing the implication of emotionally pertinent stimuli of both positive and negative valence(Millgram et al., 2021).
Equally, bipolar disorder occurs due to chemical imbalances in the brain.
The chemicals are involved in controlling the brain's functions.
Some of these chemicals are neurotransmitters. Organic lesions related to manic syndromes include some brain areas that moderate neurovegetative activities such as emotion, sleep, appetite, and energy.
Further limiting stress whenever possible also helps; this means not taking too many commitments at the same time. Spirituality help one to deal with stress by providing one with a sense of purpose, peace, and forgiveness.
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Recommendations
Psychotherapy is the most effective treatment for Bipolar Disorder II. Some of the medications are mood-stabilizing and antidepressant.
Medications are focused on preventing relapse.
Individuals suffering from manic episodes are frequently directed to continue to take mood stabilizers to control bipolar disorder (Gordovez & McMahon, 2020).
This typically comprises a single mood stabilizing medication such as valproate and lithium.
Psychotherapy comprises individual counseling, self-management practices education, and family therapy.
Referrals
Mental health counselor or Psychiatrist.
Therapy is intended to help the patient stick with y the medicine, which can reduce the risk of reversion and the necessity for hospitalization.
Self-management is aimed at encouraging the patient to build better relationships with others.
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References
Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66. https://doi.org/10.1056/NEJMra1906193
Gordovez, F. J. A., & McMahon, F. J. (2020). The genetics of bipolar disorder. Molecular Psychiatry, 25(3), 544-559. https://doi.org/10.1038/s41380-019-0634-7
Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J., McLaren, R., Geddes, J. R., & Cipriani, A. (2021). Adjunctive psychotherapy for bipolar disorder: A systematic review and component network meta-analysis. JAMA Psychiatry, 78(2), 141-150. https://doi.org/10.1001/jamapsychiatry.2020.2993
Miller, J. N., & Black, D. W. (2020). Bipolar disorder and suicide: A review. Current Psychiatry Reports, 22(2), 1-10. https://doi.org/10.1007/s11920-020-1130-0
Millgram, Y., Gruber, J., Villanueva, C. M., Rapoport, A., & Tamir, M. (2021). Motivations for emotions in bipolar disorder. Clinical Psychological Science, 9(4), 666-685. https://doi.org/10.1177/2167702620979583
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