Bipolar Disorder and Abnormal Involuntary Movements - Report Example

Bipolar Disorder Name: Course Professor’s name University name City, State Date of submission Professional Report: Name: Abbey Nelson DOB: 1994 Contact details: Background Abbey was a psychiatric patient even prior her first birth with depression in adolescence. She developed the bipolar disorder after the birth of her first child at 19 years. She was put on treatment and reported a good response but with non-compliance to medication. Abbey was hence referred for follow-up and is currently on a community order treatment. She is here expected to 3take her medication. Personal and social history Achievements/strengths: none Support network (including informal networks and other services involved): Dropped out of support group Housing: NSW housing Employment: Unemployed Education: N/A Mental Health: Has a history of depression in adolescence and her mother is mentally ill. Other health issues: None Substance use (if appropriate): Cannabis, speed and alcohol Social work assessment: No compliance Social work plan (recommendations, timeframes, who is responsible) SOCIAL WORKPLAN BROAD OBJECTIVE: case management for an involuntary bipolar patient TIME: 1 Hour VENUE: Harper valley case management offices Time Specific objective Case manager’ activity Abbey’s activity Evaluation Recommendations 15 minutes Create a rapport Introduce oneself as her case manager Introduce herself as Abbey How willing the patient is willing to take part in treatment. A therapy-patient relationship based on respect, honesty, trust and facts. 15 minutes Define bipolar disorder Bipolar disorder is a mood disorder where a patient has on and off episodes of mania and depression. Mania is the mental illness clinically related with frenzied activity, difficulty with sleep, pressured speech, impulsive spending, impulsive sexual activity and hallucinations among others. The patient is usually very happy, excitable and energetic. Depression is a mental illness clinically identified with low energy, difficulty with sleep, slow activity, feeling guilty, loss of interest in usual activities and suicidal tendencies among others. The patient usually reports sad, hopeless and feeling worthless. Demonstrate her understanding and ask questions in relation to bipolar disorder and her care. An understanding of her condition will help her come in terms with it making her agree to take part in her management. Identify the triggers and learn how to control them to minimize symptoms. 15 minutes Classification of bipolar disorder There are four types of bipolar disorder namely: bipolar disorder type 1, bipolar disorder type 2, hypomania and a bipolar disorder that is unspecified. Make a clear listing of her symptoms. Prescribe treatment in line with the classification. The list will help determine her classification. 15 minutes Phases of bipolar disorder There are three phases of bipolar disorder. The first phase is the acute phase where the patient portrays symptoms with acute manic behaviors, risk of injury and is sexually preoccupied. The second phase is the continuation phase where the normal functioning is restored. The patient has a chance for self awareness and able to manage symptoms and practices drug adherence. The third phase is the maintenance phase and at this point the patient may have the assumption they are well and may discontinue treatment. In this phase, an emphasis on drug importance and compliance is necessary. Identify which phase she lie and take part in her management to aim higher. Evaluate her drug compliance Educate Abbey on the warning symptoms of bipolar that include trouble sleeping, increased agitation, aggression, alcohol and substance use, hallucinations, pressured speech and social withdrawal. 25 minutes Pharmacotherapy of bipolar disorder The goals of treatment are bringing back the patient’s psychosocial function, prevent mood episodes relapses and alleviating acute mood symptoms. Bipolar disorder is managed with a first line treatment that may include a mood stabilizer like lithium, valproate and an anti-psychotic like olanzapine. The second line treatment may include an anti-epileptic like carbamazepine, lithium, divalproe and electroconvulsive therapy. The third line treatment may include lithium, haloperidol and carbamazepine. The electroconvulsive therapy is a therapy where electric waves are passed through your brain to cause seizures. ECT is used three times in a week with an average of nine sessions per patient. Drug compliance and reporting any drug reactions. How effective the treatment is at decompressing symptoms or is it deteriorating. Monitor the side effects of ECT like memory loss, nausea and vomiting. Monitor serum levels of lithium. Recommend her drug compliance to allow maximum drug reaction. Prevent overdosing or under dosing by taking the prescribed dosage at the right advised intervals. Abbey is an involuntary patient and is resistant to mental Health Services. In attempt to engage Abbey as her case manager, one would start with providing clinical care and self management support that Abbey understands. Psychoeducation empowers the patient with information hence provide her with knowledge on her condition and involve her in making decisions concerning her management. . It involves teaching the individual about their diagnosis, prognosis, treatment options, and how they can be active in their own health (Smith, Jones, & Simpson, 2011). The knowledge would enable her to understand the expected outcomes hence making an informed decision. Bipolar disorder is chronic hence requires a long-term management. The disorder is a mood disorder which is a combination of manic and depressive episodes. This explanation would be aimed to help her comprehend her on and forth high and low moods. Secondly, you should help her understand that there are other people living with bipolar disorder. The condition is manageable with a compliance therapy. Third, help her understand that the sooner she will be able to control her bipolar disorder than she will be able to lead a normal life. This should be a motivation to her as it will bring her closer to gaining custody over her children again. The goals one would expect Abbey to have for herself are drug compliance, alcohol and substance abuse abstinence. She has been reported to have a good response to drugs but has poor adherence. Adherence starts with a self-acceptance and self-admission to the current condition this would help her come to a self-agreement that she is sick and she needs treatment. Abbey has been reported to be able to control her substance abuse and with the same discipline can be able to control her alcohol abuse. One would expect her to develop a peer-recovery model. She should be prepared to take part in her treatment. As her case manager, one should be able to create goals aimed at her wellbeing. The first goal one should be to build and maintain a therapeutic relationship with her. The second goal would be to train and instruct her on how to make a list of the signs of her manic and depressive episodes. This includes the precipitating and accompanying factors. The list helps her identify when she needs assistance and should seek a physician help. That prevents emergency situations. The third goal should be helping her identify barriers to care and adherence. The goal is aimed at helping her accept care and demonstrate adherence in her future care. The fourth goal should aim at her treatment therapy. One should help her understand the benefits of her medication hence increasing her urge to adhere to medication. As her case manager, help her understand the need to take treatment in the right dosage and at instructed regularities. The fifth goal should be aimed at advising her to participate in a bipolar support programme. The programmes are aimed at helping people sharing a common problem come together and share strengths and challenges they have faced in relation to the problem at hand. Help her comprehend that the programme will only give her a sense of belonging and help her own up which will play a key role in management of the bipolar disorder. The sixth goal would be to teach her the negative effects of alcohol and substance abuse on her treatment. Drug abuse may cause signs of mania when on use and lead to depression signs during withdrawal. Alcohol has been known to cause dehydration which is a concern especially with lithium use. Alcohol also reduces a person’s ability to control their impulses. Psycho stimulants like cannabis are known to affect the mood and worsen the bipolar symptoms. As her case manager help her understand her needs like diet, social and physical. Encourage her to have a diet rich in vegetables, fruits, fish, unrefined whole grain, reduced fats, sugars and sat. Antipsychotics increase the risk of weight gain, high blood sugars, diabetes and high cholesterol levels. These risks raise her need to have a balanced diet and physical exercise like walking. Recommend Abbey to improve her social life to help diminish her lonely feeling. The interventions one would put in place as her case manager include compiling a health and psychosocial assessment putting to consideration her cultural background and her needs. Help her identify ways of decreasing or eliminating barriers to her care and adherence hence improving the outcome. Some of these will include family focused therapy which allows her family members and partner to take part in her care. She was reported to have a good relationship with her sister hence encourage Abbey to bring her during the follow up visits. Inclusion of someone close to her might help boost her psychosocial and general wellbeing. Invite her mother during the visits as she is registered as her care giver. Her mother lives with mental illness hence would offer a great pillar of support and example of a positive outcome. An interpersonal and social rhythm therapy is essential too. The interpersonal psychological therapy mainly focuses on improving her relationships with other people and her satisfaction with her social roles. This would also help improve her understanding of her role as a mother living with bipolar disorder to her children. The social rhythm therapy will regulate her social rhythms like sleep patterns. It will enable her modify a routine that will favor both her social and health life. The cognitive behavioral therapy would also be a great intervention. This teaches her to control her behaviors by creating a self-monitoring technique and developing coping skills. Her behavior has a great impact on the outcome of her management. Train her on management of her emotions and reaction to stressors. Help her understand that her reaction to stressors has a major influence on her moods hence symptoms. Make an examination of drugs side effects like using the Abnormal Involuntary Movements scale. Monitor for signs of drug toxicity like altered mentation, nystagmus, nausea and ataxia with lithium use. If she will be on lithium therapy, a continuous monitor of her serum lithium levels with a normal range of 0.6-1.2 mEq/L. A level higher than that may indicate ceasation of lithium use. Instruct her to seek a physician advice on observing any of the signs. Always ensure make ongoing assessment during the case management with a clear documentation to weigh the response to the plan of care. References GOODWIN, G., & SACHS, G. (2010). Bipolar Disorder. Abingdon, HEALTH Press. http://public.eblib.com/choice/publicfullrecord.aspx?p=744453. MOORE, E. (2009). Case management for community practice. South Melbourne, Vic, Oxford University Press. http://public.eblib.com/choice/PublicFullRecord.aspx?p=1986013. PEACOCK, J. (2000). Bipolar disorder. Minnetonka, MN, Life Matters. QUINN, B. (2007). Bipolar disorder. Hoboken, N.J., John Wiley & Sons. SMITH, D., JONES, I., & SIMPSON, S. (2010). Psychoeducation for bipolar disorder. Advances in Psychiatric Treatment, 16, 147-154. STRAKOWSKI, S. M. (2014). Bipolar disorder. YOUNG, A. H., FERRIER, I. N., & MICHALAK, E. E. (2010). Practical management of bipolar disorder. 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