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.
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