Urgent Care photo

 

Evidence Based Practice

In our last post we took a look at the basic guidelines that doctors use to treat bipolar along with basic clinical points that doctors are encouraged to follow. In previous posts, you learned how to create your own Plan of Action, and your own Wellness Plan that guides you and your loved ones in optional treatment for you. The Wellness plan is designed to be your own individualized plan that includes all approaches for different specific scenarios that might be relevant for you. By understanding how your doctor is guided in performing his role in your care, you can continue to revise your won Actions Plans and Wellness Plans in a way that includes the treatment that you would be receiving from your medical doctors and psychiatrists as well as your psychotherapist.

We will continue to look at the conclusions of the Evidence Based guidelines from the Primary Care Companion for CNS Disorders. [i] Today, we will look at treating bipolar during urgent and emergent episodes. Below is a summary from the research that is found in the report.

URGENT AND EMERGENT CARE

  • Acute mania, depression, and mixed states may all include psychosis, poor insight, and high risks of suicide. An immediate assessment must be made and a psychiatric consultation should be sought as soon as possible. The individual’s family should be recruited to help support the patient if possible.
  • Safety should be the focus of the urgent evaluation. The doctor should strongly consider impatient hospitalization except in mild cases where there is no risk of harm to self or others, and there is evidence of strong social support.
  • An individual who is experiencing a manic or mixed state may also display agitated behavior. This person may need a rapid-acting medication. The doctor should have a plan for transport of a person who is prone to these episodes that can take the person to a nearby emergency center. The doctor should also be familiar with state laws concerning involuntary hospitalization.

PSYCHOSOCIAL TREATMENT

Psychoeducation that focuses on recognition of early warning signs of should be offered to all patients with bipolar disorder. It is considered a effective adjunct intervention.  Additionally, therapies such as (but not necessarily limited to) cognitive-behavioral therapy, family focused therapy, interpersonal and social rhythm therapy have been demonstrated to benefit individuals with bipolar disorder and can improve symptoms and function and should be considered when available and financially feasible.

In conclusion, consider being very candid with your doctor. Consider incorporating evidence base practices and discussing what medications you will be prescribed should you find yourself in a manic or severely depressed episode. Discuss where you will be transported and who should be notified if you are going to require hospitalization. Talk about how you might receive additional preventative and or symptom management support with psychotherapy. This is your life, and it can truly be a happy and manageable life with the help of your “Wellness Team” that You put together in a way that works specifically for you. So yes, include your medical doctor, your psychiatrist, your family, and your psychotherapist in your team, and write down what you need them to do in your plan.


[i] Prim Care Companion CNS Disord. 2011; 13(4): PCC.10r01097.

doi:  10.4088/PCC.10r01097

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219517/ (retrieved 5/25/2015)

Photo by *Zoup*

Photo by *Zoup*

Photo by *Zoup*