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643 – Week 12: Geriatric Case Study
E.L., the 84-year-old patient in the case study, has a history of bipolar disorder and moderate dementia. She is cantankerous and opinionated at the baseline, but more recently, her caregiver reports that she has been exhibiting agitated and oppositional behavior. Although her caregiver denies E.L being aggressive, she is likely to be kicked out of the programs when she is with other patients in the day program. This paper, therefore, provides this patient’s assessment, a tentative treatment plan, and a rationale for the decision made.
Assessment
When carrying out the assessment, various things to consider include the findings, diagnosis, and the differentials (DSM-5), alongside other ICD-10 codes treatment options that may be reported from the patient. To be diagnosed with bipolar condition, a patient should show symptoms such as a distracted and decreased need for sleep, increased talkativeness, racing thoughts, and inflated grandiosity (Drake, 2020). E.L., the patient in the case study, has been resisting sleep, staying up late, and walking in the middle of the night. At other times, she has been paranoid such that she always talks about the caregiver when she is on the phone. All these symptoms approve that E.L. suffers from this condition; thus should be treated for the bipolar condition. On the ICD-10 Codes, it is evident that she exhibits F03.91which shows unspecified Dementia with Behavioral Disturbance, and F31.60 – a Bipolar Disorder, current episode mixed, unspecified. The other thing to consider in the assessment section is the treatment options for the patient. E.L is currently under three types of medication, i.e., Depakote 500 mg 1 Tab PO TID (1500 mg daily – last level was therapeutic), Quetiapine 100 mg 1 Tab PO QHS, and Bupropion 75 mg 1 Tab PO QD. Some of these medications can still be administered in the same dosage to help her cure the condition while other dosages can be increased. The other approach to help individuals recover from the bipolar mental condition is Interpersonal and social rhythm therapy (Steardo et al., 2020). When administering these treatments, various obstacles may arise. One of them is that the patient may refuse to take medication or consider therapy unworthy. At other times, she may be rude to individuals that try to persuade her to get the treatment. It is, therefore, essential to understand the patient to help her recover from the condition.
Plan
For the E.L to recover from the bipolar and dementia conditions, a tentative treatment plan should be put in place. In this section, various factors that need to be considered are medication and dosing and titration considerations, therapies recommendations and holistic options, referrals to psychiatrists, and a rationale for why those decisions are appropriate. In our case, E.L. needs to take various medications; some of these dosages will remain the same, while others will have to be increased. E.L needs to continue taking the same dosage of Depakote 500 mg 1 Tab PO TID (1500 mg daily – last level was therapeutic), and Bupropion 75 mg 1 Tab PO QD. However, the Quetiapine dosage needs to be increased to 100 mg 1 and ½ Tab (150 mg) PO QHS. And these two medical prescriptions will be followed up for 10 days. The other treatment that she will need to consider is the Interpersonal and Social Rhythm Therapy (IPSRT); this is a kind of therapy designed to help people improve their moods by understanding and working with their social and biological rhythms (Goldstein et al., 2018). The rationale behind me advising E.L to visit IPSRT therapists and taking the above medication is that combining the two treatment options yields the best results.
References
Drake Jr, M. E. (2020). Bipolar I Disorder DSM-5 296 (ICD-10-CM Multiple Codes).
Steardo, L., Luciano, M., Sampogna, G., Zinno, F., Saviano, P., Staltari, F. … & Fiorillo, A. (2020). Efficacy of the interpersonal and social rhythm therapy (IPSRT) in patients with bipolar disorder: results from a real-world, controlled trial. Annals of General Psychiatry, 19(1), 1-7.
Goldstein, T. R., Merranko, J., Krantz, M., Garcia, M., Franzen, P., Levenson, J. … & Frank, E. (2018). Early intervention for adolescents at-risk for bipolar disorder: A pilot randomized trial of Interpersonal and Social Rhythm Therapy (IPSRT). Journal of affective disorders, 235, 348-356.