Pt data: Oliver, a 32-year-old male presents to the emergency…Pt data:Oliver, a 32-year-old male presents to the emergency psychiatric unit with his husband. Married with 2 children, ages 1 and 4. Highest level of education is MBA. Successful career in commercial real estate. C/o is stress and mood swings.Hx of growing up in a small rural town. He had a single mother that raised him in the very cold and distant town after divorce at 5 years of age. Father was never involved. No fond memories with mother, and she has not spoken to him since he got married to his husband. Pt support is his “loving, supportive, and source of stability” husband.Asked for a divorce from husband about a month ago d/t an affair that only lasted a couple weeks. Felt like he was “on top of the world” d/t his business “booming” at the same time. 2 weeks later, he lost $100,000 to his business partner that turned out to be a fraud. SI d/t incident but the thought of his kids stopped him.Past dx of anxiety of depression. PCP prescribed him escitalopram “a few months ago” which worked for the first week.Hx of self-medicating with drugs and alcohol with first depressive episode after graduating college d/t the stress of finding a job.Family hx of depression and anxiety (biological mother), and hospitalization d/t other psychiatric d/o (biological father). Dx: Bipolar d/o, type 2 with depression and anxietyWith further information provided by Oliver, the biopsychosocial formulation grid would help formulate the best diagnosis and comprehensive treatment plan to meet his needs for a better quality of life. Along with Oliver’s history of depression and anxiety, a mood disorder I considered as a diagnosis d/t his past actions. Bipolar d/o, specifically type 2, would best fit Oliver’s diagnosis. Bipolar d/o, type 2 is depression with at least 1 hypomanic episode. Also, people who struggle with bipolar d/o are known to have trouble handling stress. Since Oliver’s father’s psychiatric hospitalization reason is not known, we would assume he may have been hospitalized d/t a manic episode. Dependent personality d/o was considered d/t Oliver’s personal hx of having a lack of guardianship with his parents and also the lack of close relationships he has, but should be r/o d/t his ability to achieve and maintain a successful career with a high level of schooling. Adjustment d/o was also considered d/t his financial loss of $100,000, and current anxiety, but will not be diagnosed d/t the event being less than 3 months ago (Spoorthy, Chakrabarti, & Grover, 2019). Treatment plan:Treatment differs based on Oliver’s mood state of mania, hypomania, depression, and euthymia. The recent start of the antidepressant escitalopram might be the cause of Oliver’s mania that happened a month ago. Antidepressant meds can cause people with bipolar d/o to trigger manic episodes. I would want to take Oliver off escitalopram, and offer him an anticonvulsant, either oxcarbazepine or lamotrigine. I would suggest oxcarbazepine over lamotrigine d/t the serious but rare dermatological reaction and incase the patient already has any skin rashes. I would initially prescribe the lowest dose for treatment, which is oxcarbazepine 300 mg PO BID, and follow-up in 2 weeks for his medication response. Use of this medication is suggested for manic depression and should also help with anxiety symptoms. Along with medication administration, it is shown that best outcomes show when psychopharmacology and psychotherapy are done together. Cognitive behavioral therapy (CBT) would be best suggested for Oliver. CBT involves working on changing patterns of thinking, especially with how to handle/cope with stress. Marriage therapy can be suggested after Oliver is stable working on himself with CBT; only if him and his husband are having problems with their relationship, however, his husband seems to be very supportive with his mental illness (Baldessarini, Vázquez, & Tondo, 2020). ReferenceBaldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), 1. https://doi.org/10.1186/s40345-019-0160-1Spoorthy, 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/wjp.v9.i1.7 Health ScienceScienceNursing NURS 676A
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