From the Guidelines
The plan of care for Kristen, a patient with bipolar disorder and recent suicide attempt, should focus on immediate safety measures and medication optimization, including increasing Seroquel from 250mg to 300mg daily and increasing Lamictal to 50mg twice daily, as well as implementing a crisis response plan and providing psychoeducation on bipolar disorder and medication adherence, as supported by the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1. The patient requires continued inpatient psychiatric hospitalization with suicide watch protocol implementation and daily assessment of suicidal ideation.
- Key components of the care plan include:
- Medication optimization: increasing Seroquel and Lamictal to better control bipolar symptoms
- Crisis response plan: collaborative approach between patient and clinician to identify clear signs of crisis and develop self-management skills
- Psychoeducation: providing education on bipolar disorder and medication adherence to improve patient understanding and engagement
- Exploration of psychosocial stressors: identifying and addressing triggers of suicidal ideation and behavior
- Hormone replacement therapy evaluation: considering the potential impact of hormonal fluctuations on mood stability
- Probiotic supplement: supporting gastrointestinal health The care plan should be tailored to address Kristen's specific needs and circumstances, including her history of multiple psychiatric hospitalizations and chronic passive suicidal ideation.
- The plan should also involve:
- Regular monitoring of suicidal ideation and behavior
- Collaboration with mental health professionals to develop a comprehensive treatment plan
- Involvement of family members and support systems to provide emotional support and encouragement
- Consideration of alternative therapies, such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), to support coping skills and emotional regulation By prioritizing immediate safety measures and medication optimization, and incorporating a comprehensive and collaborative approach to care, the plan aims to reduce Kristen's risk of suicide and improve her overall mental health and well-being, as supported by the evidence from studies such as those published in the Annals of Internal Medicine 1.
From the Research
Assessment and Plan
The patient, Kristen, presents with a history of bipolar disorder, recent symptoms of psychosis and sleep deprivation, and a recent suicide attempt by self-strangulation. The plan of care should address the following key areas:
- Suicide Attempt and Suicidal Ideation
- Bipolar Disorder
- Hormone Replacement Therapy Interruption
- Gastrointestinal Health
Suicide Attempt and Suicidal Ideation
The patient's recent suicide attempt and ongoing suicidal ideation require immediate attention. The plan should include:
- Continuing inpatient psychiatric hospitalization for at least 72 hours 2
- Implementing suicide watch protocol 2
- Assessing patient's safety and suicidal ideation daily 2
- Providing close monitoring and removing potential means of self-harm 2
- Exploring and addressing underlying factors contributing to suicidal thoughts 2 Therapeutic approaches such as cognitive behavioral therapy and dialectical behavior therapy may be effective in reducing suicidal ideation and self-harm behaviors 3, 4.
Bipolar Disorder
The patient's known diagnosis of bipolar disorder and history of multiple psychiatric hospitalizations require a comprehensive treatment plan. The plan should include:
- Reviewing and optimizing current medication regimen 2
- Considering adjusting medications if necessary 2
- Providing psychoeducation on bipolar disorder and medication adherence 2
- Exploring psychosocial stressors and providing appropriate interventions 2 Medications such as lithium and clozapine have been shown to be effective in reducing suicide risk in patients with bipolar disorder 2.
Hormone Replacement Therapy Interruption
The patient's interruption of hormone replacement therapy during current treatment and hospitalization requires evaluation. The plan should include:
- Evaluating the need for resuming hormone replacement therapy 2
- Consulting with endocrinology or gynecology if necessary 2
- Monitoring for any mood changes related to hormonal fluctuations 2
Gastrointestinal Health
The patient's gastrointestinal health requires attention. The plan should include:
- Starting probiotic supplement 2 Probiotics may have a positive effect on mental health and mood stabilization 2.
Treatment Approaches
The patient may benefit from various treatment approaches, including:
- Cognitive behavioral therapy (CBT) 3, 4
- Dialectical behavior therapy (DBT) 3
- Mentalization-based treatment 3
- Medications such as lithium, clozapine, and ketamine 2
- Brain stimulation techniques such as rTMS 2 These approaches may help reduce suicidal ideation, self-harm behaviors, and symptoms of bipolar disorder.