Addressing the Needs of a Patient With Bipolar and Generalized Anxiety Disorders

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Chief Complaint

M. is a 22-year-old African American male patient, who has developed bipolar disorder and GAD. The patient complained about frequent mood swings and increased inattention and excessive worrying, as well as increased muscle tension.

Past Psychiatric History

The patient used to have mild depression caused by bullying at school. However, after several months of therapy, the problem disappeared. Since then, the patient has not expressed major concerns about his psychological health.

Substance Use History

The patient smokes about 0.5 packs of cigarettes per day, which he admits to being a bad habit. M. started smoking at the age of 18, yet his use of it has varied depending on his mood swings and stress factors.

Past Medical History

M. has experienced hypertension caused by stress.

Family History

The patient does not communicate with his family members often, although there are no conflicts between them.

Past Surgical History

M. has not undergone any surgeries.

Social and Environmental History

M. is currently studying for a Bachelor’s degree in Aviation. The patient has been in relationships for two years, yet he prefers to live separately from his partner in a 1-room apartment. M. does not have any legal issues. The patient seems to be dependent on social media since he checks his status regularly and is easily distracted from other activities due to the unceasing monitoring of social media activities. Furthermore, the patient should restore his connection to his family members since the specified issue contributes to the problem significantly.

Developmental History

During the first crisis according to Eriksson’s theory, the patient has experienced abandonment from his parents resulting in mistrust. The specified issue has shaped the patient’s further life, causing him to develop anxiety out of fear of being abandoned.

Trauma History

The patient denies having had any physical traumas in the past.

Allergies

The patient is allergic to peanuts, which makes him check his food for possible allergens regularly.

Review of System

General: No fever observed

HEENT: Nasal issues, chest pain, or respiratory issue shave been noticed

CV: No edema, chest pain, or murmur

GI: Neither diarrhea nor constipation has been detected

GU: Neither frequency nor urgency has been noticed

Skin: No rash or abscess has been observed

Hematology: No bleeding or bruises noticed

Endocrine: no issues concerning intolerance toward heat or cold noticed

Neurologic: no weakness or headache noticed

Immunologic: the patient is allergic to peanuts; no asthma or asthma-related issues

Musculoskeletal: No pain in joints or back

Psychiatric: anxiety and depression as the key signs of GAD and bipolar disorder observed.

Risk Assessment

M. does not display any traces of suicidal ideations or hallucinations.

Mental Status Exam

The patient has proper time-space orientation, yet his speech is slightly quickened.

Screening Tool

Using the Mood Disorder Questionnaire; M. has answered: “Yes” to 11 items in question #1, answering “Yes” to question #2, and responding “Serious” to question #3.

Differential Diagnosis

Bipolar I disorder, moderate, current episode: depressed 296.42;

Generalized Anxiety Disorder 300.02 (F41.1) ).

DSM-5 Diagnosis

Bipolar I disorder, mild, current episode: depressed 296.51 (F3131);

Generalized Anxiety Disorder 300.02 (F41.1).

Medications

Selective Serotonin Reuptake Inhibitors (SSRIs);

Tricyclic Antidepressants (TCAs) (Amitriptyline and Amoxapine);

Side effects destabilization of mood

Vitals

Height: 72 inches, Weight: 168lbs, Blood Pressure: 117/82, Heart rate: 75, Respiration: 15.

Medical Problem

The patient also experiences high-pressure levels. The specified concern is likely to shape the further treatment process to avoid possible side effects.

Interventions: Plan

Both medication-based treatment and cognitive behavior therapy (CBT) is recommended to reduce stress. A drop in anxiety levels is expected as the primary outcome following the specified intervention. Therapies to be used include cognitive-behavioral, interpersonal, and relaxation ones. The described combination will help to reduce the threat of a manic episode, at the same time relieving M. of the stress that he is constantly experiencing.

Outcome

It is believed that the proposed intervention will have a positive impact on M.’s well-being. By considering the connection between anxiety disorder and bipolar disorder together with the effect that each has on the other, one will be able to avoid the further deterioration of the patient’s state. Moreover, the tools for assisting M. in controlling his behavior can be provided. As a result, there are reasons to believe that the treatment will produce a positive outcome.

Questions About the Case

The connection between bipolar disorder and anxiety disorder will have to be studied. Moreover, one will have to determine whether the use of SSRIs as the means of managing both disorders simultaneously is warranted. Finally, the strategies for avoiding side effects caused by the selected treatment tools will have to be offered.

Reasons for Choosing the Case

The need to observe a scenario involving a combination of bipolar and generalized anxiety disorders (GADs) is the key reason for considering the case. Since each of the disorders requires a unique treatment approach, one needs to explore each problem individually. However, to create a solution, the disorders have to be addressed simultaneously, thus, the case provides a unique conflict.

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