use reference db 1 sarah — angel H u m a n i t i e s

Respond to at least two colleagues who presented a different diagnosis in the following ways:

• Explain the differences and similarities in your choice of criteria used to determine diagnosis, including Z codes (other conditions that may be a focus of clinical attention).
• Bipolar I Disorder Severe was what i thought the diagnosis was
• Explain whether or not you agree with your colleague’s treatment recommendations.
• Use Reference

DB 1

Sarah—

Angel is a 53-year-old Hispanic male. Angel has been married to his wife for 19 years. For the past four months, they have been separated and living apart. Angel and his wife have three children. One daughter and two sons. Angel’s kids live with their mother. Angel is currently employed as a car salesman manager.

Formal Diagnosis

F38.1 Bipolar ll Disorder, current episode depressed

Z63.5 Disruption of Family by Separation

Diagnostic Criteria

Angel presents with symptoms and behaviors that are consistent with a DSM-5 Diagnosis of Bipolar ll Disorder. Criteria were met for previous hypomanic episodes and a current depressive episode. In the past, there was a hypomanic episode where Angel was described as excited and on “top of the world” (A). During this elevated mood, Angel was hardly sleeping, more talkative than usual, increased focus on advancing career, and engaging in excessive shopping sprees (B2,3,6,7). These changes in behavior were uncharacteristic of Angel and observable by his partner (C, D). This episode was not severe enough to cause impairment in his life as he was still working and providing for his family (E). This episode was not attributable to substance use or medical conditions (F).

For the past four months, Angel reported feeling consistently depressed (A1). Angel’s wife said he has changed in work performance, difficulty sleeping, slow-talking, and fatigue (A2,4,5,6). These symptoms have affected Angel’s attendance at work and relationship with family (B). This episode is not attributable to substance use or medical conditions (C).

Treatment

It can be hard for a client to understand a bipolar diagnosis. It would be beneficial to find a treatment option that provides education for the client. I would recommend using Psychotherapy. “Psychotherapy can provide strategies for 1) recognizing and attenuating cycling mood states, 2) addressing illness-associated traumas, and 3) managing psychosocial consequences of the illness” (Swartz, Levenson, and Frank, 2012). During treatment, I would utilize a Mood Disorder Questionnaire (MDQ) to assess the outcome of Angel’s treatment. I would take caution when it comes to medications for a client with a bipolar disorder. I would refer a client to a medical provider for mood-stabilizing medications to help with Angel’s highs and lows.

Swartz, H. A., Levenson, J. C., & Frank, E. (2012). Psychotherapy for Bipolar II Disorder: The Role of Interpersonal and Social Rhythm Therapy. Professional psychology, research and practice, 43(2), 145–153. https://doi.org/10.1037/a0027671

DB 2

Vanessa,

Provide the full DSM-5 diagnosis for the client. For any diagnosis that you choose, be sure to concisely explain how the client fits that diagnostic criteria. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, medical needs, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.

F31.31 Bipolar I Disorder, most recent episode depressed, mild

Z63.0 Relationship Distress with Spouse or Intimate Partner

Z63.5 Disruption of Family by Separation or Divorce

Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.

Bipolar I Disorder.

”For a diagnosis of Bipolar I Disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episode.” (APA, 2013)

Manic Episode

Criteria A – A distinct period of abnormality and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day; nearly everyday (or any duration if hospitalization is necessary). (APA, 2013).

The history of illness reports that at the age of 24, Angel sought treatment. His girlfriend described him as strange, was always excited, Angel would spend money he did not have and became very irritable. Angel’s focus was in advancing his career. (The case of Angel).

Criteria B – During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior. (APA, 2013).

2. Decreased need for sleep.

The history of illness reports Angel would be up most of the night and a few hours of sleep did not seem to affect Angel.

3. More talkative than usual or pressure to keep talking

The history of illness reports Angel was always a fast talker, but during a period, his girlfriend could not get a word in edgewise.

6. Increase in goal-directed activity

Angel’s focus was in his career and he thought he could be in charge of the entire dealership.

7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments

Angel would by gifts for his girlfriend and did not have money for such expenses.

Recommend a specific evidence-based measurement instrument to validate the diagnosis and assess outcomes of treatment.

The Mood Disorder Questionnaire (MDQ) is a self-report questionnaire screening for bipolar disorder. There is a total of 13 yes-no questions. The MDQ is validated to use with adults and it only takes 5 minutes to do. The MDQ can provide important information into diagnosis and information for treatment. The MDQ has a high rate of accuracy. “It is able to identify seven out of ten people who have bipolar disorder and screen nine out of ten people who do not.” (2010).

Another tool that can be helpful is the Young Mania Rating scale. It is one of the most used rating scales to assess manic symptoms. The scale has 11 items and it is based on patient’s report of the clinical conditi0on over the previous 48 hours.(2006)

Describe your treatment recommendations, including the type of treatment modality and whether or not you would refer the client to a medical provider for psychotropic medications.

I think it will be important to do ensure there are no medical conditions that may be factoring in and need to be taken into consideration. Check for any other psychosocial stressors, current medications, if any or past medications, the severity of the alcohol use as well as frequency (to assess whether if it has only increased due to his wife leaving him).

Individual and group Psychoeducational therapy can be beneficial. According to Smith, Jones, & Simpson (2010),“Although the principal goal of psychoeducation for bipolar disorder is to provide accurate and reliable information, additional objectives include teaching patients self-management skills and help them make more informed decisions about their own management within the context of a collaborative working relationship with their clinical team.”Because Angel has had suicidal ideations in the past, I think I would refer him to a medical provider for medication.

References:

User, S. (2000). THE MOOD DISORDER QUESTIONNAIRE. Retrieved October 08, 2020, from https://mbsdirect.vitalsource.com/#/books/97808904…

MEASURE: Modeling Effective Antipsychotic Therapeutic Success by Utilizing Real Evidence. (2006). Retrieved 2020, from https://dcf.psychiatry.ufl.edu/

Smith, D., Jones, I., & Simpson, S. (2010). Psychoeducation for bipolar disorder. Advances in Psychiatric Treatment, 16(2), 147-154. doi:10.1192/apt.bp.108.006403