What is the plan of care for a 26-year-old male patient with bipolar disorder (Bipolar Disorder) with psychotic features, generalized anxiety disorder, cannabis use disorder, alcohol abuse, and hallucinogen use, presenting with agitation, aggression, visual hallucinations, and delusions, currently taking Haldol (Haloperidol) 2 mg twice daily and Zyprexa (Olanzapine) 5 mg twice daily?

From the Guidelines

The patient will continue hospitalization on the acute psychiatric unit due to persistent psychotic symptoms and potential for harm, with a medication regimen including Zyprexa 5mg BID and Haldol 2mg BID, as recommended by the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1. The patient's treatment plan will prioritize reducing morbidity and mortality associated with physical health, as well as addressing the psychosocial and health consequences of bipolar disorder with psychotic features.

Medication Management

• The patient will be closely monitored for efficacy and side effects of the medication regimen, particularly extrapyramidal symptoms, as suggested by the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1.
• Daily psychiatric evaluation will assess response to medications with potential dose adjustments as needed.

Psychosocial Interventions

• Individual therapy sessions will focus on reality testing, coping skills for hallucinations, and medication adherence, as recommended by the practice parameter for the assessment and treatment of children and adolescents with bipolar disorder 1.
• Group therapy participation will be encouraged when the patient is stable enough to participate.
• A comprehensive discharge plan will be developed including outpatient psychiatric follow-up within one week of discharge, substance abuse treatment referrals, and connection to community support services.

Substance Abuse Treatment

• Substance abuse assessment and treatment planning will be initiated to address cannabis, alcohol, and hallucinogen use disorders, as recommended by the antipsychotic polypharmacy for the management of schizophrenia: evidence and recommendations study 1.
• The treatment team will monitor for improvement in psychotic symptoms, decreased agitation, improved insight, and stabilization of mood as indicators for potential step-down to a lower level of care.

Family Education and Involvement

• Family education and involvement will be incorporated if available, as recommended by the practice parameter for the assessment and treatment of children and adolescents with bipolar disorder 1.
• The treatment team will prioritize the patient's safety and well-being, while also addressing the underlying bipolar disorder and complicating factors of substance abuse history. Key considerations in the patient's treatment plan include:
• Reducing morbidity and mortality associated with physical health
• Addressing psychosocial and health consequences of bipolar disorder with psychotic features
• Monitoring for efficacy and side effects of medication regimen
• Providing individual and group therapy sessions
• Developing a comprehensive discharge plan
• Initiating substance abuse treatment and planning
• Incorporating family education and involvement
• Prioritizing patient safety and well-being.

From the FDA Drug Label

FULL PRESCRIBING INFORMATION: CONTENTS* WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS 1 INDICATIONS AND USAGE 1.1 Schizophrenia 1.2 Bipolar I Disorder (Manic or Mixed Episodes) 1.3 Special Considerations in Treating Pediatric Schizophrenia and Bipolar I Disorder 1.4 ZYPREXA IntraMuscular: Agitation Associated with Schizophrenia and Bipolar I Mania

1. 5 ZYPREXA and Fluoxetine in Combination: Depressive Episodes Associated with Bipolar I Disorder 1.6 ZYPREXA and Fluoxetine in Combination: Treatment Resistant Depression 2 DOSAGE AND ADMINISTRATION 2.1 Schizophrenia 2.2 Bipolar I Disorder (Manic or Mixed Episodes) 2.3 Administration of ZYPREXA ZYDIS (olanzapine orally disintegrating tablets)
2. 4 ZYPREXA IntraMuscular: Agitation Associated with Schizophrenia and Bipolar I Mania 2.5 ZYPREXA and Fluoxetine in Combination: Depressive Episodes Associated with Bipolar I Disorder 2.6 ZYPREXA and Fluoxetine in Combination: Treatment Resistant Depression
3. 7 ZYPREXA and Fluoxetine in Combination: Dosing in Special Populations 5 WARNINGS AND PRECAUTIONS 5.1 Elderly Patients with Dementia-Related Psychosis 5.2 Suicide 5.3 Neuroleptic Malignant Syndrome (NMS) 5.4 Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) 5.5 Metabolic Changes 5.6 Tardive Dyskinesia 5.7 Orthostatic Hypotension
4. 8 Falls 5.9 Leukopenia, Neutropenia, and Agranulocytosis 5.10 Dysphagia 5.11 Seizures 5.12 Potential for Cognitive and Motor Impairment 5.13 Body Temperature Regulation 5.14 Anticholinergic (antimuscarinic) Effects 5.15 Hyperprolactinemia 5.16 Use in Combination with Fluoxetine, Lithium, or Valproate 5.17 Laboratory Tests

The patient is diagnosed with Bipolar Disorder with psychotic features and has a history of substance abuse. The patient is experiencing visual hallucinations, delusions, and agitation.

• The patient is prescribed Zyprexa (olanzapine) 5 mg BID and Haldol (haloperidol) 2 mg BID.
• The patient will remain on the acute psychiatric unit for close monitoring and further evaluation and treatment related to dangerous behaviors.
• The patient's medication compliance and side effects will be closely monitored.
• The patient's vital signs will be regularly checked.
• The patient's mental status will be regularly assessed to monitor for any changes in mood, affect, thought process, and thought content.
• The patient's safety will be ensured by providing a safe environment and closely monitoring for any suicidal or homicidal ideations. 2

From the Research

Patient Care Plan

• The patient, a 26-year-old male, presents with bipolar disorder with psychotic features and substance abuse history, currently admitted to an acute psychiatric holding unit due to agitation, aggression, and visual hallucinations 3, 4.
• The patient's behavior is characterized by hallucinations, delusions, and aggression, with a history of substance abuse, including cannabis, alcohol, and hallucinogens 5, 6.
• The patient has been prescribed Haldol 2 mg BID and Zyprexa 5 mg BID, with no reported side effects, and has shown some improvement in accepting help and conversing about his experiences 7.

Treatment Goals

• Reduce the patient's agitation, aggression, and visual hallucinations
• Improve the patient's mood and reduce depressive symptoms
• Enhance the patient's insight and judgment regarding his condition and treatment
• Reduce the patient's substance abuse and promote a healthy lifestyle

Intervention Strategies

• Close monitoring and observation to ensure the patient's safety and the safety of others
• Medication management, including regular assessments and adjustments as needed
• Individual and group therapy to address the patient's psychotic symptoms, substance abuse, and coping skills
• Family education and support to promote a collaborative treatment approach
• Coordination with community resources to ensure a smooth transition to outpatient care

Progress Monitoring

• Regular assessments of the patient's mental status, behavior, and symptoms
• Monitoring of the patient's medication adherence and side effects
• Evaluation of the patient's progress towards treatment goals and adjustment of the treatment plan as needed
• Collaboration with the patient's treatment team to ensure a comprehensive and coordinated approach to care 3, 4, 5, 6, 7.