Bipolar Disorder Type I

Summary of the Clinical Case

The patient, Trisha, 28-year-old, is an unemployed white female who suffers from Bipolar disorder type I (F30.13) disorder. Bipolar or manic depressive disorders are mood disorders characterized by a single or multiple episodes of abnormally elevated moods, clinically known as mania or hypomania if the mood elevation is milder. Bipolar disorder type I is occasioned by one or more manic episodes, and the patient also experiences a single or multiple depressive episode. The manic symptoms present severely that the patient must get immediate medical attention. Depressive symptoms also occur, lasting for some days (Shah, Grover, & Rao, 2017).

Trisha is experiencing prolonged and deep depression, alternating with periods of excessively elevated moods mania. She has unusual changes in moods, activity levels, energy, concentration levels, and ability to conduct her day-to-day tasks. She is described as someone who does not take scrap from anyone and has had several part-times and a string of boyfriends because she gets angry easily (shifts in moods) and has been in counselling therapy, often possibly because of recurrence of manic episodes. Sometimes she gets so depressed that she does not eat, often gets excessively drunk (abuses alcohol) and disorderly, and sometimes hyperactive and lack sleep (sleeps little and parties lots). She is also hypersexual.

The patient’s family has a history of manic depression as her grandfather was diagnosed with manic depression, and her brother also had a long history of depression.

List of the Patient’s Problems and Priority

List of Patient’s Problems	Priority
Severe manic episodes	Acute and most recent
Depressive episodes	Acute and recent
Alcohol abuse	Pre-existing
Sleep disorder	Pre-existing

Pharmacological Treatment

Mood stabilizers: The patient requires mood-stabilizing medications to manage manic episodes. The patent can be prescribed Divalproex (Depakote), lithium (Lithobid), or lamotrigine (Lamictal), depending on the doctor’s assessment (Fountoulakis et al. 2017).  

Antipsychotics: If symptoms of mania and depression persist despite treatment with mood stabilizers, the doctor may prescribe antipsychotics, including Olanzapine-fluoxetine combination (Symbyax) or risperidone (Risperdal), along with mood stabilizers for treatment. Antipsychotics have proven effective for treating both long-term and short-term bipolar management psychotic symptoms such as mania symptoms occurring during acute mania or depression. Antipsychotics are prescribed along with mood stabilizers, act as a sedative for agitation or insomnia, and are effective for decreasing symptoms of mania until mood stabilizers take full effect (Fountoulakis et al. 2017).  

Antidepressants: The doctor can also prescribe an antidepressant, mostly SSRIs, to treat depression. However, antidepressants are prescribed alongside mood stabilizers or antipsychotics because they can trigger manic episodes sometimes (Fountoulakis et al. 2017).  

Naltrexone and acamprosate: naltrexone or acamprosate is prescribed for the patient to help control alcohol addiction and increase abstinence (Fountoulakis et al. 2017).  

Non-Pharmacological Treatment

Psychotherapy

Psychotherapy is an essential non-pharmacological treatment for bipolar disorders, which can be provided in different settings, individuals, families, or groups. Different types of psychotherapy can be helpful for our patient, including:

Cognitive-behavioral therapy (CBT): CBT is essential to help discover triggers of bipolar episodes in the patient, including negative behaviors or beliefs such as excessive drinking, and replace them with positive ones (Özdel et al., 2021). The patient can learn effective approaches to cope with upsetting situations and manage stress in the process.  

Interpersonal and social rhythm therapy (IPSRT): IPSRT’s focus is to stabilize everyday rhythms, including sleeping patterns, mealtimes, and waking time. This is important for bipolar patients like Trisha, who suffers from sleep pattern problems. According to Nestsiarovich et al. (2017) other important psychotherapies include family-focused therapy to help the patient stick to the treatment plan and psychoeducation to help the patient and the family learn about the bipolar condition and its management, including preventing relapse and sticking to the treatment plan.

Assessment of Treatment’s Appropriateness

A combination of pharmacological and non-pharmacological is the most appropriate and effective in terms of cost, patient’s safety and adherence. Study shows that CBT, IPSRT, and family-focused therapy used alongside medication can speed up treatment response for bipolar depression by almost 150% (Novick & Swartz, 2019). Psychotherapy helps the patient stay on medications, which reduces the cost of readmission, and they can also learn how to control interpersonal challenges and stabilize lifestyle habits.

References

Fountoulakis, K. N., Vieta, E., Young, A., Yatham, L., Grunze, H., Blier, P., & Kasper, S. (2017). The International College of Neuropsychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BD-2017), part 4: unmet needs in the treatment of bipolar disorder and recommendations for future research. International Journal of Neuropsychopharmacology, 20(2), 196-205.

Nestsiarovich, A., Hurwitz, N., Nelson, S., Crisanti, A., Kerner, B., & Kuntz, M. et al. (2017). Systemic challenges in bipolar disorder management: A patient-centered approach. Bipolar Disorders, 19(8), 676-688. https://doi.org/10.1111/bdi.12547

Novick, D., & Swartz, H. (2019). Evidence-Based Psychotherapies for Bipolar Disorder. FOCUS, 17(3), 238-248. https://doi.org/10.1176/appi.focus.20190004

Özdel, K., Kart, A., & Türkçapar, M. (2021). COGNITIVE BEHAVIORAL THERAPY IN TREATMENT OF BIPOLAR DISORDER. Archives Of Neuropsychiatry, 58(1). https://doi.org/10.29399/npa.27419

Shah, N., Grover, S., & Rao, G. P. (2017). Clinical practice guidelines for management of bipolar disorder. Indian Journal of Psychiatry, 59(Suppl 1), S51.