Posted: December 13th, 2022
Assignment : Cyclothymic Disorder
For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder. Learning Objectives Students will: Evaluate clients for treatment of mental health disorders Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders THE CASE STUDY Cyclothymic Disorder BACKGROUND SUBJECTIVE Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep. You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. Cyclothymic Disorder Essay Paper. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks. Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels “depressed”—but then states: “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!” OBJECTIVE Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits. MENTAL STATUS EXAM Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented. At this point, please discuss any additional diagnostic tests you would perform on Stefanie. 1.Cyclothymic Disorder Essay Paper. Decision Point One Diagnosis: Cyclothymic disorder 2.Decision Point Two: Begin Abilify 10mg orally daily RESULTS OF DECISION POINT TWO – Client returns to clinic in four weeks -Stefanie reports that her mood seems a bit more “stable.” She states that she notices that she has not been as “sad” since she started taking the medication. She does report that for the first 2 weeks, she noticed that whenever she went from a lying or sitting to a standing position, she felt “lightheaded.” -She does report that the side effect was quite concerning at times. However, she reports that this is no longer happening. 3.Decision Point Three: Maintain current dose of Abilify Guidance to Student In order to meet the criteria for a major depressive episode, the client needs to have five or more symptoms (refer to DSM–5 major depressive episode criteria). She only demonstrates criteria # 1: depressed mood most of the day, nearly every day, as indicated by either subjective reports (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful); criteria # 6: “fatigue or loss of energy nearly every day”; and criteria # 8: “diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).” Thus, Stefanie does not meet the criteria for a major depressive episode as she only has three out of the needed five criteria for the diagnosis of a major depressive episode. In order to meet criteria for a hypomanic episode, the client needs to have a period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. Stefanie’s symptoms last 3 days. Cyclothymic Disorder Essay Paper. Additionally, during the period of mood disturbance, the person must have three or more of the qualifying symptoms. Stefanie only has an increase in goal-directed activity and distractibility. Thus, Stefanie does not meet criteria for a hypomanic episode as she only has a decreased need for sleep and an increase in goal-directed activity. Since Stefanie has symptoms of both hypomania and depression (but does not meet the criteria for a major depressive or hypomanic episode), and since these behaviors do not occur in the context of a drug/substance or medical condition, Stefanie meets the diagnostic criteria for cyclothymic disorder. Some providers will treat cyclothymic disorder with pharmacologic agents used to treat bipolar disorder because individuals with cyclothymic disorder have a higher risk of progression to bipolar disorder. However, there is no consensus in the literature as to the optimal treatment, or if prophylactic psychopharmacologic treatment is beneficial in consideration of the side effects associated with antipsychotics and mood stabilizers. Stefanie’s symptoms are most consistent with orthostatic hypotension, which is not uncommon when initiating Abilify. At this point, it sounds as if the side effects have subsided. There is nothing to tell us that we should increase the dose. Similarly, there is nothing in the case to tell us that we should discontinue the Abilify. Instead, routine monitoring should occur. The Assignment: . At each Decision Point, stop to complete the following: Decision #1: Cyclothymic disorder Which Decision did you select? o Why did you select this Decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different? Decision #2: Treatment Plan for Psychotherapy o Why did you select this Decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Cyclothymic Disorder Essay Paper. o Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different? Decision #3: Treatment Plan for Psychopharmacology o Why did you select this Decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients and their family. IMPORTANT INFORMATION: PLEASE WRITER DO NOT FORGET THE ETHICAL PART WHICH IS THE LAST SENTENCE IN THE ASSIGNMENT. PLEASE I ATTACHED A SAMPLE OF THIS ASSIGNMENT WHICH I WROTE MYSELF LAST YEAR. PLEASE FOLLOW THE FORMAT OF HOW I WROTE THIS PAPER, YOU WILL NOT GO WRONG. PLEASE ADD CONCLUSION AT THE END. Cyclothymic Disorder Essay Paper
Decision #1: Diagnosis
Reason for Selecting This Decision
Stephanie presents with symptoms of both depression and hypomania. Besides, her symptoms are not influenced by an underlying medical illness, a substance or a drug. These symptoms meet the DSM-V criteria for diagnosing cyclothymic disorder (American Psychiatric Association, 2013). The diagnosis of major depressive disorder is unlikely since Stephanie needs to have five symptoms or more based on the DSM-V criteria for diagnosing major depressive episode (American Psychiatric Association, 2013). Instead, she only has three of the five required that is; having a depressed mood most of the day, loss of energy nearly every day and a diminished ability to concentrate.
A diagnosis of hypomanic disorder for Stephanie is unlikely. Based on the DSM-V criteria for a hypomanic disorder, a client should continuously have expansive moods and high energy levels that last for at least 4 consecutive days. Stephanie’s lasted for 3 days. A patient should also have 3 or more of qualifying symptoms during a mood disturbance period (American Psychiatric Association, 2013). However, Stephanie only presents with symptoms of a reduced need for sleep and a significant increase in goal-directed activity. Therefore, she does not meet the criteria for diagnosing a hypomanic disorder. Cyclothymic Disorder Essay Paper
With the diagnosis of cyclothymic disorder, it was expected that the client’s presentation will be consistent with several episodes of depression and hypomania which were not severe enough for diagnosing major depression (Perugia, Hantouchec & Vannucchia, 2017). It was also expected that the client couldn’t have thought disorder, her symptoms could not be as a result of the direct effects of drugs or a medical condition and that the symptoms caused impairment in the client’s professional, social and family functioning.
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Difference between Expected Outcomes and Actual Outcomes
No significant difference was noted between the expected outcome and the actual outcome. The client’s chief complaints during the presentation were consistent with the criteria for the cyclothymic disorder.
Cognitive-behavioral Therapy. Cyclothymic Disorder Essay Paper
Reason for Selecting This Decision
Cognitive behavioral therapy has proven to be a highly effective psychotherapeutic approach in the management of cyclothymic disorder to address the underlying depression. It involves efforts to change thoughts and behavioral patterns. It utilizes strategies such as role-playing to prepare for interactions that could otherwise prove to cause problems, to directly face fears and prevent avoidance and to develop techniques of relaxing and calming the body and mind (Sadock, Sadock & Ruiz, 2014).
Upon the initiation of CBT, it was expected that the client’s mood episodes would stabilize. It was also expected that the client will be equipped with the necessary behavioral and cognitive skills to become more informed on the potential triggers and how to effectively manage them (Perugia, Hantouchec & Vannucchia, 2017). Stephanie will be able to recognize some of the warning signs of mood changes and gradually learn how to replace negative thoughts and dysfunctional behavioral patterns with those that are positive. By integrating it with social rhythm, the client could improve how she handled activities, interactions and situations of daily life.
The client returned to the clinic after four weeks with reports that she felt no significant difference. Instead, her symptoms continued to follow the same pattern as they initially were during her first visit. Although CBT is recommended as the best psychotherapeutic approach for the cyclothymic disorder to reduce stress by training one to be able to recognize, monitor and manage symptoms, management with medications is the mainstay of treatment (Perugi, Vannucchi & Mazzarini, 2017). Therefore, CBT needs to be combined with antipsychotic medications for the patient to be able to build and maintain positive relations and have stable moods. Cyclothymic Disorder Essay Paper
Begin Abilify 10mg orally daily
Reason for Selecting This Decision
Abilify, also known as apriprazole is an antipsychotic mood stabilizer that improves manic and psychotic symptoms within weeks. It results in positive effects on cognition, behavior, and effect. It works by increasing dopamine output, especially during low concentrations to enhance behavioral and cognitive symptoms (Perugi, Vannucchi & Mazzarini, 2017). When the concentrations are high, it reduces the output of dopamine to result in more positive symptoms. Cyclothymic Disorder Essay Paper
The efficacy of Abilify is expected to be demonstrated within 4-6 weeks. However, it can take to a maximum of 20 weeks for the effects on cognitive symptoms to be noted. When prescribing this medication, it will be essential to educate Stephanie on some of the side effects that she ought to expect. Side effects that should be expected include a headache, insomnia, drooling, nausea and weight gain. As recommended by Perugi, Vannucchi & Mazzarini, (2017), during the subsequent follow-up clinics, a comprehensive assessment on the client’s tolerability to the drugs side effects, compliance, and its efficacy will be considered. There are also a number of baseline investigations which will be done before the patient starts to take Abilify. These tests include fasting plasma glucose, blood pressure, weight, fasting lipid profile. After three months of starting the medications, the same baseline tests will also be done (Perugi, Vannucchi & Mazzarini, 2017). Cyclothymic Disorder Essay Paper
By prescribing abilify to the patient, it was expected that her mood would be stabilized and she would be able to think uprightly. Abilify would also prevent the occurrence of a full-blown manic (Perugi, Vannucchi & Mazzarini, 2017).
After four weeks, the client returned to the clinic and reported to have a more stable mood. She reportedly informed that, since she started taking the medications, she noticed that she hadn’t been sad. However, during the first two weeks of medication, she noticed some lightheadedness whenever she went from a sitting or lying position to a standing position. At certain times, she was quite concerned with this side effect. The good news was that it no longer happened. Cyclothymic Disorder Essay Paper
The symptoms she reported are consistent with orthostatic hypotension. This is common during the initiation of abilify (Perugia, Hantouchec & Vannucchia, 2017). However, this side effect tends to gradually decline as a patient’s tolerance to the drug improves. Therefore, in this case, no amount of information is worth convincing that the current dosage should be reduced, increased or discontinued. As a result, she will maintain the current dose of Abilify since it has demonstrated to be efficacious with the desired therapeutic goals.
How Ethical Considerations Might Impact Treatment Plan and Communication with Clients and Their Families
Managing patients with cyclothymic disorders can be an uphill task for mental health practitioners. The most significant ethical issues that should be considered are that of patient autonomy, non-maleficence, and beneficence (Sadock, Sadock & Ruiz, 2014). More often, healthcare providers may feel that a patient’s ability to make decisions regarding treatment may be impaired by the underlying cognitive deficits caused by the disorder such that, she/he might end up choosing a treatment option that is less effective or has more side effects. This can create a conflict between the ethical principles of patient autonomy, beneficence, and non-maleficence. As emphasized by Sadock, Sadock & Ruiz (2014), a mental health practitioner should ensure that the three principles are observed and any decisions made are in the patient’s best interest. Cyclothymic Disorder Essay Paper
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Perugia, G., Hantouchec, E., & Vannucchia, G. (2017). Diagnosis and treatment of cyclothymia: the “primacy” of temperament. Current Neuropharmacology, 15(3), 372-379.
Perugi, G., Vannucchi, G., & Mazzarini, L. (2017). The treatment of cyclothymia. The Treatment of Bipolar Disorder: Integrative Clinical Strategies and Future Directions.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. Cyclothymic Disorder Essay Paper
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