Pathophysiology
The major pathological adjustment of bipolar 1 disorder involves the limbic system’s breakage, which causes neurotransmitter changes. The fluctuations in the neurotransmitters are prompted by the diverse stressors near the construction of the damaged limbic system, which results in the phasic reconfigurations of the essential happenings of the brain, from subcortical-cortical join to changes of the network actions. During the manic and depressing stages of bipolar, inequality happens along the systems, such as sensorimotor, saliences, and default mode systems, which are established clinically by combining the modifications of the psychomotricity, affectivity, and thoughts (Magioncalda & Martino, 2022). A clinical, biological subgroup of bipolar is characterized by altering the grey matter and related cognitive deteriorations.
DSM Criteria, Rational, and Diagnosis
The patient diagnosed with bipolar 1 disorder must show various manic episodes, which are headed by and be tracked by hypomanic or major episodes of unhappiness. The manic episodes of the patient include having a distinct period of abnormally irritable moods on most days. During this period of moods disturbance, the patient should be noted to represent changes from the usual behaviours such as inflated self-esteem, decreases in sleeping needs, having the pressure to keep talking, fighting for ideas, increase in activities that are goal-oriented and being involved in activities that are high potentials of consequences that are painful (Ghaemi et al. 2022).
In the clinical scenario, Mark meets various criteria for a manic episode as he was brought into the office by his mother, who had observed him drastically change his behaviours. He was reported to have difficulty sleeping, only for 3 hours within a day, and then he is hyperactive throughout the day. He cannot focus on completing the task and becomes very distracted during a conversation. Her mum reports that her credit card statements showcase outrageous purchases, and also she continues to see numerous delivery packages at the house after her credit card went missing, where mark cries and denies stealing the credit card after he is confronted. Marks calls himself a king, and his Princeton scholarship pays for whatever he wants. His moods have been noted to be all over, and before the examination, he becomes anxious, irritable, angry, and depressed. Mark can be diagnosed with bipolar 1 disorder since he has meant all manic episodes, followed by episodes of depression (Ghaemi et al. 2022). Therefore, Mark is observed to be suffering from bipolar 1 disorder.
Treatment Plan
Treatment of bipolar 1disorder is directed at managing the patient’s symptoms in various ways. The patient will be directed to take medications to help him stabilize his moods and control manic or hypomanic episodes, such as lithoid, which should be taken once daily at 40 mg and Depakote at an initial dose of 750 mg once daily. In treating symptoms of depression, the patient will be directed to antipsychotics such as quetiapine which is taken at a dose of 50 mg every 12 hours (Nolen et al. 2019). To help the patient recover from anxiety and improve his sleeping time, he will be directed to anti-anxiety medications such as benzodiazepines at 4 mg 3 times daily.
Psychotherapy treatment will be introduced as part of the treatment, involving the patient in interpersonal and social therapy to help him stabilize with the daily rhythms such as sleeping and mood management. The patient will be offered cognitive behavioural therapy to help replace unhealthy behaviours with healthy behaviours (Miklowitz et al., 2021). Psychoeducation will be presented to the patient, and assistance in learning about bipolar 1 disorder and enable him to recognize the disorder. Also, the family will be given therapy to be able to provide support to him as he continues adhering to the treatment plan and being able to control his moods.
References
Magioncalda, P., & Martino, M. (2022). A unified model of the pathophysiology of bipolar disorder. Molecular Psychiatry, 27(1), 202-211.
Ghaemi, S. N., Angst, J., Vohringer, P. A., Youngstrom, E. A., Phelps, J., Mitchell, P. B., … & Gershon, S. (2022). Clinical research diagnostic criteria for bipolar illness (CRDC-BP): rationale and validity. International Journal of Bipolar Disorders, 10(1), 1-16.
Nolen, W. A., Licht, R. W., Young, A. H., Malhi, G. S., Tohen, M., Vieta, E., … & ISBD/IGSLI Task Force on the treatment with lithium. (2019). What is the optimal serum level for lithium in maintaining bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium. Bipolar disorders, 21(5), 394-409.
Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J., McLaren, R., Geddes, J. R., & Cipriani, A. (2021). Adjunctive psychotherapy for bipolar disorder: a systematic review and component network meta-analysis. JAMA psychiatry, 78(2), 141-150.
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