ANSWER
Answers to Enquiries on Management and Assessment
1. Extra Examinations to Distinguish Comorbidities
In order to rule out any possible comorbidities or determine the causes influencing the patient’s appearance, a number of additional tests may be useful:
To evaluate liver and kidney function, which might affect how medications are metabolised and general health, use the Complete Metabolic Panel (CMP). Cognitive function and emotions can also be impacted by electrolyte abnormalities.
To rule out hypothyroidism or hyperthyroidism, which can mimic manic or depressed episodes, use a thyroid panel.
Levels of vitamin B12 and folate: To look for deficiencies that could be causing mood swings or cognitive impairments.
Toxicology Screening: To identify any drug or medicine use that might be causing mood swings.
Sleep Study: This can assist in the diagnosis of sleep apnea or other conditions that may worsen mood problems if insomnia or hypersomnia are prevalent.
To rule out neurological illnesses that could manifest as psychiatric symptoms, such as stroke, tumours, or neurodegenerative disorders, an MRI or CT scan is recommended.
Panel of Autoimmune and Infectious Diseases: Psychiatric symptoms can be evident in conditions such as neurosyphilis or autoimmune encephalitis.
2. Additional Differential Diagnoses to Take into Account
Other differential diagnoses that could be made in light of the symptoms include:
Schizoaffective Disorder: This diagnosis should be taken into consideration if psychotic symptoms occur outside of mood episodes.
Substance-Induced Mood Disorder: Substance abuse or withdrawal can cause mood swings.
Major Depressive Disorder (MDD) with Psychotic Features: This could be a different diagnosis if psychosis coexists with depressive episodes.
A less severe but persistent mood swing that does not fully fit the criteria for either bipolar I or II is called cyclothymic disorder.
Dementia with Behavioural Disturbances: Mood instability or psychosis are two symptoms that dementia, such as Alzheimer’s or frontotemporal dementia, can cause in older persons.
Borderline Personality Disorder (BPD): This may be a differential diagnosis if mood swings are frequent and linked to interpersonal problems.
3. Additions to the Care Plan
The addition of the following tactics could improve this client’s management:
Management of Pharmacology
Mood Stabilisers: For long-term mood stabilisation, think about introducing or modifying drugs such lamotrigine or lithium.
Antipsychotics: Atypical antipsychotics, such as quetiapine or olanzapine, may be taken into consideration for acute mania or psychotic symptoms.
Medication Adherence: If adherence is a problem, look into long-acting injectable alternatives.
Interventions in Psychotherapy
The main goals of cognitive behavioural therapy (CBT) are relapse prevention, coping mechanisms, and mood control.
Family therapy: Involve family members to assist the client, comprehend the problem, and spot early warning signals.
Changes in Behaviour and Lifestyle
Routine Establishment: To lower stress and stabilise mood, make a planned daily routine for eating, sleeping, and exercising.
Stress management: To enhance emotional control, practice yoga, mindfulness, or relaxation techniques.
Nutrition and Exercise Counselling: To improve general health and mood stability, encourage a balanced diet and moderate exercise.
Medical and Social Support Care Coordination: To successfully treat comorbidities, work with primary care physicians.
Community Resources: To lessen isolation and encourage participation, put the client in touch with bipolar disorder support groups.
Create a crisis management safety plan that includes contact details for mental health specialists and instructions for carers in case of an emergency involving acute episodes.
Suicide Prevention Techniques: Conduct routine evaluations for suicidal thoughts and put policies in place like support hotlines and emergency contacts.
Techniques for Patient Education
Understanding Medication: Inform the patient and their carers about the advantages, disadvantages, and significance of taking their medications as prescribed.
Symptom Recognition: Instruct students on how to see the early warning indications of mood swings and when to get treatment.
Family Involvement: Educate family members on how to control mood swings and foster a nurturing atmosphere.
Lifestyle Focus: Stress the role that regular exercise, a healthy diet, and good sleep hygiene have in regulating mood.
In conclusion
The management and results of the patient can be greatly enhanced by a thorough strategy that includes more diagnostic testing, wider differential considerations, and customised interventions. In order to empower the patient and their support network, this strategy should also prioritise education and team-based care.
Citations
Klerman, G. L., and R. C. Young (2017). Clinical and treatment issues for bipolar disorder in later life. 30(5), 253–260, Journal of Geriatric Psychiatry and Neurology. 10.1177/0891988717693253 was found.
Reynolds, C. F., Butters, M. A., and Gildengers, A. G. (2019). The symptoms and treatment of bipolar disorder in later life. 653–664 in Bipolar Disorders, 21(7). Bdi.12813 https://doi.org/10.1111
Madhusoodanan, S., and Sajatovic, M. (2020). The treatment of bipolar disorder in the elderly. 11–15 in Psychiatric Times, 37(4).
QUESTION
Provide a response to the below questions according to the assessment completed from your collegue. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.
1. Are there any additional tests that we could have been ordered to help rule out any other comorbidities?
2. Are there any other differential diagnoses to consider?
3. Any plan of cares that you would add to assist in the management of this client?