Questions: Problem: (LF) Psychiatric Assessment TX Goal: Alexis desires appropriate medical/Clinical services to decrease symptoms of bipolar with mood dysregulation, depressed mood, mania, and pressured speech. She desires to decrease symptoms of anxiety with feeling on edge and excessive worrying. She states "I want to take medication to help fix my depression and anxiety." Problem: (LF) Whole health awareness Goal: Alexis desires to support recovery through learning/applying health changes (e.g., improving sleep, eating habits, exercise, etc.) She states "I want to get some actual sleep." Problem: (RB) Suicidal Thought- BX Goal: Alexis desires to eliminate suicidal ideations and related distress. She states "I want to live without having those thoughts anymore and the negativity." Problem: (BH) Depression/Anxiety Goal: Alexis desires to decrease symptoms of depression with sleep disturbances, anhedonia, worthlessness, and hopelessness. She states "I want to not have so many negative thoughts." Goal: Alexis desires to decrease symptoms of anxiety with excessive worrying, nervousness, and feeling on edge. She states "I want to slow my mind down and use breathing techniques."

Goal: Alexis desires appropriate medical/clinical services to decrease symptoms of bipolar 1 disorder with mood dysregulation, depressed mood, mania, and pressured speech. She also wants to decrease symptoms of anxiety, including feeling on edge and excessive worrying. Alexis states, "I want to take medication to help fix my depression and anxiety."

Approach:

1. Medication Management:

   • Mood Stabilizers: Medications such as lithium, valproate, or lamotrigine can help manage mood swings and prevent manic and depressive episodes.
   • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may be prescribed to address depressive symptoms, but they should be used cautiously to avoid triggering mania.
   • Antipsychotics: Atypical antipsychotics like quetiapine or olanzapine can help manage mania and mood dysregulation.

2. Psychotherapy:

   • Cognitive Behavioral Therapy (CBT): CBT can help Alexis identify and change negative thought patterns and behaviors associated with bipolar disorder and anxiety.
   • Dialectical Behavior Therapy (DBT): DBT can be beneficial in managing mood swings and emotional dysregulation.

3. Lifestyle Modifications:

   • Regular Sleep Schedule: Establishing a consistent sleep routine can help stabilize mood.
   • Healthy Diet and Exercise: A balanced diet and regular physical activity can improve overall well-being and mood stability.

Goal: Alexis desires to support recovery through learning and applying health changes, such as improving sleep, eating habits, and exercise. She states, "I want to get some actual sleep."

Approach:

1. Sleep Hygiene:

   • Consistent Sleep Schedule: Going to bed and waking up at the same time every day.
   • Sleep Environment: Creating a comfortable and quiet sleep environment.
   • Limiting Stimulants: Reducing caffeine and electronic device usage before bedtime.

2. Nutrition:

   • Balanced Diet: Incorporating a variety of fruits, vegetables, whole grains, and lean proteins.
   • Hydration: Ensuring adequate water intake throughout the day.

3. Exercise:

   • Regular Physical Activity: Engaging in at least 30 minutes of moderate exercise most days of the week.
   • Mind-Body Practices: Activities like yoga or tai chi can promote relaxation and improve sleep quality.

Goal: Alexis desires to eliminate suicidal ideations and related distress. She states, "I want to live without having those thoughts anymore and the negativity."

Approach:

1. Crisis Intervention:

   • Safety Plan: Developing a safety plan that includes identifying warning signs, coping strategies, and emergency contacts.
   • Crisis Hotline: Providing information about crisis hotlines and emergency services.

2. Therapeutic Interventions:

   • Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP): A structured approach to reduce suicidal thoughts and behaviors.
   • Dialectical Behavior Therapy (DBT): DBT can help manage intense emotions and reduce self-harm behaviors.

3. Support Systems:

   • Family and Friends: Encouraging Alexis to reach out to supportive family members and friends.
   • Support Groups: Connecting Alexis with support groups for individuals experiencing similar challenges.

By addressing these problems with a comprehensive and multi-faceted approach, Alexis can work towards achieving her goals of reducing symptoms of bipolar disorder, anxiety, and depression, improving her overall health, and eliminating suicidal thoughts.