NR 547 Week 5 Discussion; Psychiatric Evaluation & Treatment Plan for Bipolar II

Mental Status Examination Casual attire, well-groomed, no motor abnormalities. Cooperative, good eye contact. Alert and oriented x 3. Speech is clear, with normal rate and volume. Her mood is depressed, irritable, and angry. The effect is appropriate, and congruent to mood. Does not appear to respond to external stimuli. Memory is grossly intact, with fair concentration and attention. Thought processes are coherent with average intellectual functioning. Thought processes appear organized and content is appropriate to the subject. Denies suicidality or homicidal. Insight and judgment are fair. a. Select an appropriate screening tool for Kristin and provide a score for the tool. Screening Tool: Bipolar Spectrum Diagnostic Scale (BSDS) Score: 14 (Moderate probability) b. Provide a rationale for the screening tool you selected. Kristin has symptoms of mood swings, sleep disturbances, and periods of increased energy (crafting_ that extends “all day and night” for 3-4 days in a row, which suggests a bipolar disorder. The BSDS is the most appropriate scale to measure the spectrum of bipolar including milder forms whereas the Mood Disorder Questionnaire (MDQ) is more directed at measuring clients with more manic episodes. c. Determine the most likely diagnosis for Kristin based on the available information. The most likely diagnosis is Bipolar II. Bipolar II can be characterized by at least 1 depressive episode and 1 current/past episode of hypomania. The hypomania symptoms need to be present at least 4 days, and include the same symptoms as mania, but do not cause severe impairment or require hospitalization. Kristin expresses her current symptoms of feeling depressed, easily irritated, and weight gain of 10lbs, sleep disturbances, a decrease in ability to focus, and feelings of worthlessness that have lasted for a month, which meets the criteria for a depressive episode. She also reports that when she does not feel depressed, her energy level is higher than normal she can craft for days without sleeping, buying sprees, and racing thoughts. D. Provide the ICD-10-CM code for the selected diagnosis Bipolar Disorder F31.81 E. Provide a treatment plan with a rationale for each plan step. Pharmacological: • Lamotrigine (Lamictal) 25mg once daily (Stahl, 2020). Kristin is experiencing currently a depressive episode. Lamotrigine has been shown to alleviate the depressive symptoms of bipolar disorder, without causing mood destabilization or precipitating mania (Prabhavalkar et al., 2015). Reference Shah, N., Grover, S., & Rao, G. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian Journal of Psychiatry, 59(5), 51. https://doi.org/10.4103/0019-5545.196974 Novick, D. M., & Swartz, H. A. (2019). Psychosocial interventions for Bipolar II Disorder. American Journal of Psychotherapy, 72(2), 47–57. https://doi.org/10.1176/appi.psychotherapy.20190008 Prabhavalkar, K. S., Poovanpallil, N. B., & Bhatt, L. K. (2015). Management of bipolar depression with lamotrigine: an antiepileptic mood stabilizer. Frontiers in Pharmacology, 6. https://doi.org/10.3389/fphar.2015.00242 Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan & Sadock’s Synopsis of Psychiatry. Lippincott Williams & Wilkins. Stahl, S. M. (2020). Prescriber’s Guide: Stahl’s Essential Psychopharmacology. Cambridge University Press.