Case Study Peer Response-Bipolar Diagnosis
Responding to Erica
Hello Erica,
This is a great post. I concur with the bipolar diagnosis for the patient in the case. Bipolar disorder is a mental health illness characterized by alternating depressive and manic or hypomanic phases. According to the Diagnostic and Statistical Manual for Mental Health Disorders, DSM, bipolar spectrum disorders consist of bipolar I disorder, bipolar II disorder, cyclothymic disorder, and specified and unspecified bipolar and related disorders. A positive diagnosis of bipolar I disorder is made in the presence of mania, demonstrated by an irritable mood for at least seven consecutive days and accompanied by grandiosity, decreased need for sleep, a flight of ideas, high distractibility, and compulsivity (McIntyre et al., 2020). The patient in the case had an irritable mood, grandiosity, compulsivity, and flight of ideas. These manifestations are consistent with those of bipolar I disorder.
Bipolar diagnosis is made clinically after a comprehensive assessment of the patient. While no lab work or diagnostic is confirmatory of the disorder, diagnostics may be necessitated to rule out secondary causes of the disorder. Diverse screening tools exist to aid the assessment and diagnosis of bipolar disorders. As evident in your post, screening tools such as the Hypomania checklist and the Mood Disorders questionnaire are widely used tools with high accuracy and specificity in diagnosing the disorder. Bipolar comorbidity with other illnesses, such as depression and substance abuse disorders, is common. It is, therefore, important that they are ruled out or defined during diagnosis.
Comprehensive management of bipolar disorders utilizes psychotherapeutic and pharmacotherapy to alleviate the symptoms and improve individuals’ functionalities. Mood stabilizers are the mainstay therapeutic modality in the management of bipolar disorders (Goes, 2023). Other agents, such as antidepressant medications and anticonvulsants, are also effective in alleviating the symptoms of the disorder.
References
Goes, F. S. (2023). Diagnosis and management of bipolar disorders. BMJ. https://doi.org/10.1136/bmj-2022-073591
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841–1856. https://doi.org/10.1016/s0140-6736(20)31544-0
Responding to April
Hello April,
Great work with your post. The case presented indeed represents someone with bipolar disorder. The presentation of grandiosity, irritable mood, flight of ideas, and decreased need for sleep are consistent with those of bipolar I disorder per DSM-V. Additionally, subjective findings from the case were also affirmative of the diagnosis.
Bipolar comorbidity with other mental health disorders and other medical conditions, such as substance abuse disorders and schizoaffective disorders, are common (Spoorthy et al., 2019). In the case presented, the patient had reports of binge alcohol drinking and occasional blackouts. The presence of delusional thoughts, as evident in the case and captured in your post, gave insights into comorbidity with schizophrenia spectrum disorders. Notwithstanding, the facts of the case do not meet the criteria for substance-induced psychotic disorders. As Fiorentini et al. (2021) report, substance or medication-induced psychotic illness is the manifestation of delusional thought patterns or hallucinations due to the direct effects of the substance. In as much as there are manifestations of delusion in the case, there is no correlation between the delusional thought pattern and the substances the patient has been taking.
Diagnosis of bipolar disorder is made clinically. No lab work is confirmatory of the disorder. Lab work and other diagnostics may be necessary only to rule out secondary causes of the disorder. As evident in your post, treatment is necessitated upon confirming the bipolar diagnosis. Admission to inpatient care may be warranted when there is a high potential for self-harm. Mood stabilizers such as lithium and sodium valproate are the mainstay medications used in managing bipolar disorder. Antiepileptic and antipsychotics have also been used in managing bipolar disorder. Cognitive behavioral therapy is a psychotherapeutic modality that can be used alongside medications to optimize the clinical outcomes for patients with bipolar disorders.
References
Fiorentini, A., Cantù, F., Crisanti, C., Cereda, G., Oldani, L., & Brambilla, P. (2021). Substance-induced psychoses: An updated literature review. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.694863
Spoorthy, M. S., Chakrabarti, S., & Grover, S. (2019). Comorbidity of bipolar and anxiety disorders: An overview of trends in research. World Journal of Psychiatry, 9(1), 7–29. https://doi.org/10.5498/
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I have provided two discussion posts that were written by peers. Please write a peer response to the two discussion posts that I have provided. At least 250 words.
Case Study Peer Response-Bipolar Diagnosis
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