Describe diagnosis and treatment of Cyclothymic Disorder

Describe diagnosis and treatment of Cyclothymic Disorder
Cyclothymic Disorder Decision Tree Case Study Essay Assignment Example

Assignment : Cyclothymic Disorder

For this Cyclothymic Disorder decision tree case study essay assignment example, 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. 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. Cyclothymic Disorder decision tree case study essay assignment example.
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. Cyclothymic Disorder decision tree case study essay assignment example. 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. Cyclothymic Disorder decision tree case study essay assignment example.
At this point, please discuss any additional diagnostic tests you would perform on Stefanie.

1.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.” Cyclothymic Disorder decision tree case study essay assignment example.
-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. Additionally, during the period of mood disturbance, the person must have three or more of the qualifying symptoms. Cyclothymic Disorder decision tree case study essay assignment example. 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. Cyclothymic Disorder decision tree case study essay assignment example.
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 decision tree case study essay assignment example.
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? Cyclothymic Disorder decision tree case study essay assignment example.

Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

Psychiatric Mental Health Nurse Practitioner Role I1: Adult – NURS 6670 – Cyclothymic Disorder decision tree case study essay assignment example

Decision #1: Differential Diagnosis

Cyclothymic disorder

Reason for this Decision

Cyclothymic disorder is a mild form of bipolar disorder in which a patient has mood swings throughout two years. The patient has a fluctuating mood swing between depression and hypomania with irritability and a short period of regular activity in between. The patient may sometimes deny that a problem exists. The Cyclothymic disorder starts in adolescence with 15 to 50 percent possibility of developing bipolar type 1 (Tracy, 2012). Patient with this disorder is known to abuse alcohol and other substance abuse. The patient also has a history of multiple religious cults and dilettantism (Saddock, Sadock & Pedro, 2014). Cyclothymic Disorder decision tree case study essay assignment example.

What was Hoping to Achieve by Making this Decision

The patient (Stephanie) is a 32-year-old Hispanic female from Puerto Rican. She is well dressed for the weather. Stephanie is alert oriented x 4. Her speech is clear, spontaneous, goal-directed and coherent. Her gross neurological assessment is within reasonable limits with a steady gait. She denies any homicidal or suicidal ideation. No auditory or visual hallucinations reported (Laureate Education, 2017d).

Patient Stephanie has been having the following issues for the past two years. She complains of sleeping about 3 hours for few days without being tired and other days have a good night sleep. She experiences period depression now and then, hypomanic phases with enhanced energy, fatigue, sad when unable to concentrate or think good. Cyclothymic Disorder decision tree case study essay assignment example. She had distractibility and enhanced goal-directed activity. Patient symptoms are indicative of cyclothymic disorder (Laureate Education, 2017d).

Difference between Expected outcome and Achieve outcome with Decision #1

There is no difference between the expected outcome and the achieve an outcome. The Patient symptoms of mood swings between hypomania and depression, fatigue, high energy, distractibility, decrease the need for sleep and enhanced goal-directed activity are indicative of Cyclothymic disorder.

Decision #2: Treatment Plan for Psychotherapy

Begin Abilify 10mg orally daily

Reason for this Decision

Abilify is known to be effective with improving psychotic and manic symptoms within a week but take several weeks for full effect on behavior, cognition and affective stabilization. It increases dopamine output when the concentrations are low, consequently enhancing cognitive, behavioral and affective symptoms. It also reduces dopamine output when the concentrations are high, therefore improving mediating antipsychotic actions and positive symptoms (Stahl, 2014). Cyclothymic Disorder decision tree case study essay assignment example.

The efficacy of the medication shows between 4–6 weeks for some patient but takes up to 16–20 weeks to show the effect on cognitive symptoms. Educating the patient about the side effect of the medication is crucial. Cyclothymic Disorder decision tree case study essay assignment example. The following baseline of blood pressure, weight, fasting plasma glucose, and fasting lipid profile must be taken and check within three months after starting the medication (Stahl, 2014).The patient is educated about the medication and the side effects (dizziness, hypotension, sedation, nausea, vomiting, headache.

The patient will be informed to go for psychotherapy because it increased patient awareness of their diagnosis and helped cope with their mood swings. Cyclothymic Disorder decision tree case study essay assignment example. It also helps to prevent full-blown manic attacks from happening (Saddock, Sadock & Ruiz, 2014).

What was Hoping to Achieve by Making this Decision?

The aim of giving the patient Abilify is to help stabilize her mood and ability to think well and prevent a full-blown manic attack from happening. When the patient returns for follow up, she will express feeling a little better.

The Difference between what is Expected and the Achieve outcome with Decision #2

The expected outcome and achieved outcome are the same. The medication was reduced the symptoms of cyclothymic disorder and the side effect was expected. The patient returned to the clinic for follow-up after four weeks and reported that the medication had helped her not feel sad, but she noted some dizziness which had subsided.

Decision #3: Treatment Plan for Psychopharmacology

Decision Point Three

Maintain current dose of Abilify

Reason for Decision

It is crucial to continue with the same dosage of medication because the patient is doing fine, and the side effect of drugs had disappeared. Increasing the medication or have the patient halting the medication will not able at an advantage to the patient. It is vital to continue to monitor patient progress. Cyclothymic Disorder decision tree case study essay assignment example.

What was Hoping to Achieve by Making this Decision?

The expectation is to achieve significant decreased in patient’s symptoms and to halt relapse of cyclothymic symptoms.

Expected Result with this Decision.

The expected result is that the patient will continue to do well with the medication with little or no side effect and prevent relapse. The patient is expected to be doing well with psychotherapy to help with behavioral symptoms.

Difference between Expected Result and the Achieved Result with Decision

The expected result and achieved result are the same. Ms. Stephanie returned to the clinic showing decreases symptoms of swing mood and no report of sadness or any issues.

Ethical Considerations

It is crucial to consider the following ethical issue while providing care for this patient which beneficence, autonomy, and nonmaleficence. It is significant to assess the patient thoroughly and provided the best treatment without any harm. It is imperative to consider and respect a patient autonomy when providing care. Cyclothymic Disorder decision tree case study essay assignment example.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Laureate Education (Producer). (2017d). A young woman with depression [Multimedia file] Baltimore, MD: Author.

Perugi, G., Hantouche, E., & Vannucchi, G. (2017). Diagnosis and Treatment of Cyclothymia: The “Primacy” of Temperament. Current Neuropharmacology, 15(3), 372–379. https://doi-org.ezp.waldenulibrary.org/10.2174/1570159X14666160616120157

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 decision tree case study essay assignment example.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Tracy, N. (2012). Bipolar Spectrum Disorders – What is Cyclothymia?. Retrieved from https://natashatracy.com/mental-illness/bipolar-spectrum-disorders-cyclothymia/

Van Meter, A., Youngstrom, E., Freeman, A., Feeny, N., Youngstrom, J. K., & Findling, R. L. (2016). Impact of Irritability and Impulsive Aggressive Behavior on Impairment and Social Functioning in Youth with Cyclothymic Disorder. Journal Of Child And Adolescent Psychopharmacology, 26(1), 26–37. https://doi-rg.ezp.waldenulibrary.org /10.1089/cap.2015.0111. Cyclothymic Disorder decision tree case study essay assignment example.

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