Primary diagnosis: Bipolar I (2022) Questions and Answers -Graded A

A full psychiatric assessment including a detailed mood history, over activity and disinhibiting changes, triggers to previous episodes, patterns of relapse and family history should be taken (NICE, 2020). Social and personal function as well as potential mental and physical comorbidities should be explored (NICE, 2020). If the patient is suspected of mania, severe depression, a threat to themselves or others, they should have an urgent referral to a mental health specialist and be hospitalized (Konstantin’s, et al., 2017). Questionnaires should not be used in primary care to diagnose bipolar in adults (NICE, 2020). Medications First line treatment is fluoxetine combined with olanzapine or quetiapine on its own (NICE, 2020). If there is no response to those medications, lamotrigine can be considered (NICE, 2020). The amount of medication should be limited to reduce the risk to life if the person overdoses (NICE, 2020). Lithium should be offered as a first-line, long term treatment for bipolar. If ineffective, valproate can be added (NICE, 2020). Interventions Development of a risk management plan with the patient and their caregivers should be done if possible (NICE, 2020). Crisis support information should also be given to the patient (NICE, 2020). A high-intensity psychological intervention (cognitive behavior therapy or interpersonal therapy) should be discussed and initiated with the patient (NICE, 2020). Electroconvulsive therapy can be used for the treatment of severe mania that has not responded to other interventions (NICE, 2020). Family intervention should be offered to people who are living, or in close contact, with family which has been designed for bipolar disorder (NICE, 2020). Education Sleep disturbance can disrupt the course of bipolar and can be an early warning sign of relapse (Konstantin’s, et al., 2017). If this is noticed, the provider should be contacted immediately to address these issues. Labs The physical health of the patient should also be monitored. There should be baseline labs drawn and then re-checked annually (NICE, 2020). Physical health check should include: weight/BMI, diet, level of physical activity, pulse and blood pressure. Labs that should be monitored are: liver function tests, hemoglobin A1C, lipid profile, renal function, thyroid function and calcium levels (NICE, 2020). Follow up Follow up should be done in 1 month to repeat laboratory testing and every 3-6 months after (Konstantin’s, et al.,2017). Within 4 weeks of symptom resolution, it should be discussed whether to continue psychological or pharmacological treatment or start long-term treatment while explaining the risks and benefits as well as side effects of medication used for long-term treatment (NICE, 2020). Referrals ANALYSIS: 1. Pathophysiology and Pharmacology: For the primary diagnoses in the case, write a brief summary of the underlying pathophysiology and tie pharmacological treatment chosen in the reversal or control of that pathology. Bipolar disorder is a potentially lifelong and disabling condition characterized by episodes of mania (abnormally elevated mood or irritability and related symptoms with severe functional impairment or psychotic symptoms for 7 days or more) or hypomania (abnormally elevated mood or irritability and related symptoms with decreased or increased function for 4 days or more) and episodes of depressed mood 2. Additional analysis of the case: This includes national guidelines that were or should have been used to make diagnosis or treatment and review how they applied or how care was unique but based in guidelines. 3. Follow-up/Referrals: This means how the patient was doing when seen a second time if this applies. This would be their response to your plan of care. OR when Follow up will occur and what actions will be taken on the follow up visit. Referrals if indicated. 4. Quality: Include anything that should have been considered in hindsight or changes you would make in seeing similar patients in the future with the same complaint, history, exam, or diagnosis. Add anything you learned from discussion in the class that shed new light on this patient. 5. Coding and Billing. Any or all CPT and ICD-10 codes that should have been used (List them and name them only. References: Konstantin’s, Fountoulakis, Grunge, Viet, Young, Latham, Bluer, Kasper, Moeller. (2017). Treatment Guidelines for Bipolar Disorder in Adults Part 3: The Clinical Guidelines, International Journal of Neuropsychopharmacology; 20(2):180-195 National Institute for Health and Care Excellence. (2020). Bipolar Disorder: assessment and management clinical guideline.