Depicts The Signs of Bipolar Disorder

After reading about Helen’s case, I believe she portrays signs of Bipolar Disorder I vs. Anxiety. The exact diagnosis I would provide would be Bipolar 1 Disorder, current or most recent episode manic, with mood-congruent psychotic features 296.44. The grandiosity and themes of suspiciousness or paranoia which is representative in the fear she has for her husband is all inclusive in the mood-congruent psychotic features that come along with Bipolar I Disorder. There is no evidence as to why this is and I would like to speak to Helen more to understand why she has become fearful of her husband. Most likely she has made up scenarios in her mind that are instigating this fear. I do not believe anxiety is all we are dealing with here which is why I chose to diagnose her with Bipolar 1 Disorder instead of Anxiety . Her promiscuity, wandering the streets and not being able to sleep, along with her elation cause me to believe it is Bipolar I as well. Bipolar Disorder really wrecks havoc on family situations. The goal in treating Helen is to lessen the negative impact on her life and her family’s life.

Since Helen has not been on any medications and has no family history of the illness we cannot contribute this episode to either of those. Mild alcohol abuse would not typically cause a bipolar episode to occur. I would want to know if this is the first time Helen has shown symptoms such as these or if there is a past history of any symptoms including potentially ADHD as a child. I would want to complete a full assessment to further clarify before officially diagnosing this. According to the DSM-5 in order for someone to be diagnosed with bipolar disorder, the individual must meet the criteria for a manic episode. It may or may not have started or followed with a hypo-manic episode or a major depressive episode. The criteria for a Manic Episode is listed below. Notes will be attached to each criteria referring to Helen.

A period of time where abnormal and persistently elevated, or irritable mood is present as well as increased activities or energies. These must last at least a week and be present every day for most of the day. If any hospitalization is necessary also it’s included.  Helen reported increased energy in her day to day activities as well as racing thoughts. This could be attributed to anxiety however along with the other signs Helen is showing I would attribute this to her manic episode. 
 Three or more of the following symptoms must be present during a time in which a mood disturbance or during a period where activity level and energy have increased. Four must be present if the mood is only irritable.

Inflated self-esteem or grandiosity.  This would be evaluated in my assessment with Helen. There is not a lot of details in the paperwork in regards to Helen’s emotional state including self esteem. It does however state that she has moodiness with feelings of elation which could be attributed to feelings of grandiosity. Not as much sleep needed.  Helen’s husband noted that she has been taking walks in the neighborhood when she cannot sleep which shows us she has been having trouble sleeping.  Excessive talking or more talkative than usual.  There is no evidence in the information provided to show this with Helen and would need to be further assessed upon meeting. Racing thoughts could contribute to ones need to talk more though.

Racing thoughts and/or flighty thinking and ideas.  Helen has expressed that she experiences racing thoughts. Distracted easily, this can be noted or observed.  Increased activity in goals (this can be sexually, socially, work, school, etc.) or psychomotor agitation. There was no talk in regards to Helen’s day to day activity or if she has a career or goes to school. Once again this would be more information I would like to find out in a one on one assessment. I would also like to find out more about if here relationship with her 5 year old daughter is being affected. One could assume that sexually her goals have changed and are being increased due to her promiscuity.

Involvement in activity that are risky or would provide hurtful consequences to the patient or those around them.  Sexual promiscuity is known to appear in those with Bipolar disorder. Helen stating she is pregnant with another man’s child would represent this. I would want to ensure this is accurate before moving on with this situation as well. I would like to know the dates she has been promiscuous, with who, and how many men. I would also want to have a DNA test done to prove this is true if there is not sufficient evidence to prove. The actions and moods of the patient are creating noted problems at work or at home or in society in general. This can also include the need for hospitalization in fear that the patient would hurt themselves or others.

I would say we are on the line with Helen. There is definitely marked impairment in regards to her family situation however Helen has not presented any evidence that would suggest she is a threat to others or herself. It was noted that her OB/GYN has recommended that Helen stop drinking while pregnant so as to prevent fetal alcohol syndrome but it was not noted if she had stopped or if she is continuing to drink. Further assessment would show this. 
 The most recent episode cannot be attributed to a substance or to a medical condition of any kind.

We know that Helen is not on any medications and is not causing any substance other than alcohol. This would provide sufficient evidence that this episode is attributed to the disorder. 
 Criteria A-D shows a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder. According to the criteria represented above this would constitute as Helen’s one lifetime manic episode even if there has never been another episode. Looking at her symptoms in conjunction with the DSM-5’s criteria I believe this would solidify my previously stated diagnosis.

In today’s society there are multiple researched pharmacological treatments for Bipolar 1 Disorder. Mood stabilizers are the first course of treatment for Bipolar. A mood stabilizer treats both mania and depression. One of the main concern that comes along with treating Bipolar Disorder is if the medication causes TEAS, also known as treatment emergent effective switches. This simply means that we don’t want to put someone on mediation while exhibited depressive symptoms only to have the medication create a switch in the individuals mood leading to the opposite, or mania in this example. Mood stabilizers seem to protect against TEAS and also shows good evidence of preventing a relapse of both depression and mania. Lithium and Valproate are the first line medication choices among the mood stabilizers. Lithium is the oldest and most researched mood stabilizer, as it came onto the market as an approved drug in 1970. Valproate followed in 1994.

There are three known mood stabilizers including lithium, valproate, and carbamazapine. Lithium is the oldest and most researched as it came out in 1970. It is the only mood stabilizer that has shown to reduce the risk of suicide making it one of the most preferred. Some of the side effects make Lithium less desirable to patients including weight gain, tremors, acne, and regularly required blood work to be done to name a few along with risks of developing hypothyroidism and kidney disease. Valproate is prescribed seven times more than Lithium even though is has been researched less as it did not come onto the market as an approved drug until 1994. Reasons for this is that it comes with less side effects and there is no stigma attached as with Lithium.

Although there seems to be less side effects weight gain, menstrual irregularity, and problems with hair growth still seem to be a deterrent for some. The third drug is Lamotrigane, which is an anticonvulsant. It is now the most prescribed drug for bipolar due to it’s positive results to prevent relapse. It is also popular due to the fact that it rarely causes tremors, weight changes, or sedation. It does come with a change of a very serious fatal dermatological reaction and therefore the development of rashes must be closely monitored. As a last resort the combination of two mood stabilizers can be used in conjunction of one another. I would refer Helen to a Psychiatrist for all of her medication needs. I believe this along with therapy can provide hope for Helen’s situation and provide a much more positive outcome and promising future.

References

1.  In DSM-5 in Action, read Chapter 6, pages 202 – 239.
2.  Diagnostic and Statistical Manual of Mental Disorders DSM-5, 5th Edition. Pgs. 123-152.1.
3.  Thase, M. (2006). Bipolar depression and treatment considerations. Development and Psychophopathology, 18, 1213-1230. Week_4_Discussion_1.pdf

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