Treating an Older Adult Client with a Bipolar Disorder

Treating Older Adult Client with a Bipolar Disorder Background Mental health, which comprises social, psychological, and emotional well-being, affects how an individual behaves, thinks, feels, and acts. It influences an individual’s interaction with other people besides handling stress and making choices (Flower, et al., 2018). People with poor mental health experience numerous challenges in their lives. Whereas some mental health issues have short-term implications, others have lifelong consequences.

Bipolar disorder is one of the mental health problems that can affect an individual throughout his/her life. Some of the different types of bipolar include bipolar I and II and cyclothymic disorder (Miller et al., 2015). The symptoms of bipolar include distractibility, increased activity, and a decrease in the need for sleep. Other symptoms are talkativeness, euphoria, poor decision-making, depression, and anxiety (Soares & Young, 2016). Some people may also express suicidal thoughts. To effectively treat bipolar disorder, the psychiatric mental health nurse practitioner PMHNP combines psychotherapeutic and pharmacological interventions to develop a treatment plan that suits the needs of the client (American Nurses Association, 2014). This exercise explores the treatment plan for an adult client presenting with bipolar symptoms observed during the practicum.

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History of Present Illness The client is a 44-year-old male client, who was brought to the facility by his son after developing symptoms of mania, resulting in a change of personality typified by irritability and labile mood. The client reported that he has been experiencing problems at his workplace. He also reported a decrease in the desire to sleep in addition to an inability to wake up in the morning. The client noted that he stays awake in his bed from as early as 4am to mid-morning.

His sleep problems have persisted for years. The client has turned to extensive cigarette smoking in an attempt to overcome his problems. The ongoing irritability, talkativeness, and lack of concentration have been a source of struggle with his wife. At the age of 27, the client was hospitalized on a psychiatric ward due to lack of sleep, excessive cigarette smoking and antisocial behavior.

Clinical Impression The symptoms presented by the patient satisfy the DSM-5 criteria for bipolar depressive disorder. The patient presented with an irritable mood that lasted for one week besides being present most of the day. The client also presented with increased talkativeness, decreased attention, inability to maintain sleep, decreased interest in social activities, and racing thoughts (Soares & Young, 2016). The MMSE score for the client was 24. The client is currently taking Wellbutrin SR 100mg for depression.

Pharmacological Intervention Several medications can be employed in the treatment of a bipolar disorder. In this case, the client was initially administered lithium XR 600mg to be taken twice daily. This pharmacologic agent was selected due to its effectiveness in addressing manic episodes of bipolar disorder as well as maintaining treatment for this condition (Stahl, 2017). It has minimal

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side effects when administered in low doses. Furthermore, it offers long-lasting mood stabilization. Wellbutrin was stopped since it produces insomnia as a side effect. Side effects may reduce compliance with treatment. Lithium works by modulating the neurotransmission of glutamate (Flower, et al., 2018).

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Psychotherapy Psychotherapy is usually integrated into the treatment plan for a person with bipolar to improve mental health, reduce the risk of relapse, and enhance compliance with treatment. The psychotherapeutic intervention selected for the current client was cognitive behavioral therapy.

CBT was selected as the best intervention since it can potentially improve manic and depressive symptoms, besides improving psychosocial functioning (Miklowitz, 2019). CBT focuses on an individual to improve behaviors, thoughts, and feelings. When used in bipolar treatment, CBT increases the ability to identify distorted thinking patterns, improves concentration, reduces distractibility and improves behavior (Miklowitz, 2019). In a randomized controlled trial by Johnson, Hoffart, Nordahl and Wampold (2017), the researchers found out that individuals' mental health improved significantly when anxiety disorders were treated with CBT compared to metacognitive therapy.

Medical Management Needs Considering the client presented with symptoms that typify bipolar disorder, his mental health needs would include alleviation of manic symptoms, a decrease in the severity of symptoms, improved concentration, ability to engage in a constructive speech and a low risk of relapse. To achieve the medical needs of the client, the nurse has to perform a comprehensive assessment of the client’s health. This procedure helps to detect potential comorbidities that may further affect the mental health of a person (Chiang et al., 2017).

The manic symptoms have negatively affected the client’s ability to maintain a positive relationship. Thus, the treatment plan should focus on improving social functioning and improving the client’s speech. Patient education is also important for the client. Education helps to enhance compliance with treatment eventually improving the outcome of patient care.

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Community Support Resources The primary source of social support for the client is the family. Despite the constant family wrangles, his wife has taken over the role of providing for the family to reduce the psychological burden on the client. Irrefutably, closer family members usually offer moral support despite the antisocial behaviors demonstrated by persons with bipolar. The client can also obtain social support from friends and members of the community. Bipolar related social support organizations also offer crucial social and educative support. For instance, DBSA (2020) provides various types of support, including education and treatment to persons diagnosed with bipolar. This organization also connects people with psychological disorders for peer support, inspiration and enhanced recovery. The counselling services provided by DBSA enable clients to overcome overwhelming psychiatric symptoms, eventually improving their interpersonal relationships.

Follow-up Plan The PMHNP developed a 4-week follow-up plan for the client. This follow-up plan was appropriate since it would give the client ample time to take the medications uninterrupted.

Notably, Lithium takes approximately three to four weeks to achieve the maximum therapeutic effect. A 4-weeks period would, thus, help the nurse to assess the effectiveness of this medication. This period would also allow the client to attend the CBT sessions with minimal interruptions. The nurse encouraged the client to always visit the facility when faced with severe psychiatric symptoms. The nurse also advised the client to seek the services of a psychological counsellor for enhanced psychiatric assessment.

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Conclusion Psychotherapy and pharmacologic agents play an integral role in the treatment of persons with bipolar disorder. This combination helps to reduce the severity of the symptoms besides improving interpersonal relationships. CBT is the best therapy for bipolar since it helps the client to identify and deal with potential triggers adequately. Regular follow-up of persons with bipolar disorder is necessary to monitor mental health progress. Interventions, including medications, can be changed to suit the mental health needs of the client.

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References American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Author Chiang, K. J., Tsai, J. C., Liu, D., Lin, C. H., Chiu, H. L., & Chou, K. R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PloS one, 12(5), e0176849. https://doi.org/10.1371/journal.pone.0176849 DBSA (2020). Depression And Bipolar Support Alliance. https://www.dbsalliance.org/ Flower, R. J., Henderson, G., Loke, Y. K., MacEwan, D., & Rang, H. P. (2018). Rang & Dale's Pharmacology E-Book. Elsevier Health Sciences.

Johnson, S., Hoffart, A., Nordahl, H., & Wampold, B. (2017). Metacognitive therapy versus disorder-specific CBT for comorbid anxiety disorders: a randomized controlled trial.

Journal of Anxiety Disorders, 50, 103-112. https://doi.org/10.1016/j.janxdis.2017.06.004 Miklowitz, D.M., (2019). Different Types of Therapy for Bipolar Disorder. https://www.nami.org/Blogs/NAMI-Blog/April-2019/Different-Types-of-Therapy-forBipolar-Disorder Miller, L. J., Ghadiali, N. Y., Larusso, E. M., Wahlen, K. J., Avni-Barron, O., Mittal, L., & Greene, J. A. (2015). Bipolar disorder in women. Health Care for Women International, 36(4), 475–498. http://doi:10.1080/07399332.2014.962138 Soares, J. C., & Young, A. H. (Eds.). (2016). Bipolar disorders: basic mechanisms and therapeutic implications. CRC Press.

Stahl, S. M. (2017). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (6th ed.).

Cambridge University Press.

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