from mania/hypomania symptoms and addiction.The client was assisted in processing and clarifying ideas and feelings regarding the existence of a higher power.The client was encouraged to describe beliefs about the idea of a higher power.The client rejected the concept of a higher power; the client was urged to remain open to this idea.18 Use Step 3 (18)The client was taught about a 12-step program's third step, focusing on how to turn over problems to a higher power.The client was taught about trusting that a higher power is going to help resolve the situation.The client participated in turning problems over to a higher power and is trusting that the higher power is going to help resolve the situation; this progress was reinforced.The client rejected the idea of turning problems over to a higher power and does not feel that this will be helpful to resolve the situation; the client was urged to remain open to this idea.
19 Review Step 3 Implementation (19)The client was assigned to turn over one problem each day to a higher power.The client's implementation of the third-step exercise of turning problems over to a higher power was reviewed.The client reported success in turning problems over to a higher power and was verbally reinforced and encouraged.The client reported difficulty or failure in attempting to turn problems over to a higher power, and these difficulties/failures were reviewed, resolved, and redirected.As the client has successfully turned problems over to a higher power, the client has been noted to have an increased pattern of relief from problems and addictive behavior.
20 Arrange for a More Restrictive Setting (20)Arrangements were made for the client to be evaluated for and/or hospitalized in a psychiatric setting based on the fact that their mania is so intense that the client could cause harm to self or others or be unable to care for basic needs.The client was supported for acknowledging the need for hospitalization and voluntary admission to the psychiatric facility.The client was not willing to submit voluntarily to hospitalization; therefore, commitment procedures were initiated.
21 Refer for Medication Evaluation (21)The client was referred for a medication evaluation to consider psychotropic medication to control the manic state.The client has followed through with the medication evaluation and pharmacotherapy has begun.The client has been resistive to cooperating with a medication evaluation and was encouraged to follow through on this recommendation.
22 Refer to Outpatient Systematic Care Team (22)The client was referred to an outpatient systematic care team to help manage medications and provide support services.The client has followed through with the referral to an outpatient systematic care team and support services have begun.The client has not engaged with the outpatient systematic care team and was redirected to follow through on this recommendation.
23 Monitor Medication Reaction (23)The client's reaction to the medication in terms of side effects and effectiveness was monitored.The client reported that the medication has been effective at reducing energy levels, flight of ideas, and the decreased need for sleep; the client was urged to continue this medication regimen.The client has been reluctant to take the prescribed medication for their manic state but was urged to follow through on the prescription.As the client has taken medication, which has been successful in reducing the intensity of the mania, they have begun to feel that it is no longer necessary and indicated a desire to stop taking it; the client was urged to continue the medication as prescribed.
24 Maintain Reviews of Psychotropic Medication (24)The client's adherence with the psychotropic medication prescription was reviewed.The client indicated a desire to terminate medication because the client “doesn't feel normal”; the client was encouraged to continue to use the medication, in consultation with the prescribing clinician.The client was monitored regarding compliance with the psychotropic medication in regard to their belief that they no longer need the medication because the client has stabilized.The client was reinforced for maintaining medication use in accordance with the prescribing clinician's expectations.The client was confronted for nonadherence with the psychotropic medication regimen.
25 Monitor Ability to Participate in Group Psychotherapy (25)The client's pattern of symptom improvement was monitored, with a focus on how stable the client is in regard to participation in group psychotherapy.The client was judged to be significantly improved and capable of participating in group psychotherapy.The client was judged to still be too manic to allow helpful participation in group psychotherapy.
26 Educate About Mood Episodes (26)A variety of modalities were used to teach the family about signs and symptoms of the client's mood episodes.The phasic relapsing nature of the client's mood episodes was emphasized.The client's mood episode concerns were normalized.The client's mood episodes were destigmatized.
27 Teach Stress Diathesis Model (27)The client was taught a stress diathesis model of bipolar disorder.The biological predisposition to mood episodes was emphasized.The client was taught about how stress can make them more vulnerable to mood episodes.The manageability of mood episodes was emphasized.The client was reinforced for their clear understanding of the stress diathesis model of bipolar disorder.The client struggled to display a clear understanding of the stress diathesis model of bipolar disorder and was provided with additional remedial information in this area.
28 Provide Rationale for Treatment (28)The client was provided with the rationale for treatment involving ongoing medication and psychosocial treatment.The focus of treatment was emphasized, including recognizing, managing, and reducing biological and psychological vulnerabilities that could precipitate relapse.A discussion was held about the rationale for treatment.The client was reinforced for understanding of the appropriate rationale for treatment.The client was redirected when displaying a poor understanding of the rationale for treatment.
29 Enhance Motivation for Medication Adherence (29)Motivational interviewing techniques were used to help the client identify and increase motivation for medication adherence.The client was asked about satisfaction with the current level of medication adherence and mood stability.The client was assisted in identifying the benefits of changing their approach to the medication.The client was assisted in assessing optimism for making changes in the medication adherence pattern.The client was assisted in developing specific tactics for medication adherence.
30 Educate About Medication Adherence (30)The client was educated about the importance of medication adherence.The client was taught about the risk for relapse that occurs when medication is discontinued.The client was asked to make a commitment to prescription adherence.The client was reinforced for understanding and commitment to prescription adherence.The client was redirected when displaying poor understanding or commitment to prescription adherence.
31 Assess Prescription Nonadherence Factors (31)Factors that have precipitated the client's prescription nonadherence were assessed.The client was checked for specific thoughts, feelings, and stressors that might contribute to prescription nonadherence.The client was assigned “Why I Dislike Taking My Medication” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).A plan was developed for recognizing and addressing the factors that have precipitated the client's prescription nonadherence.
32 Coordinate Group Psychoeducational Program (32)The client was admitted to a group psychoeducational program that teaches clients the psychological, biological, and social influences in the development of bipolar disorder.The client's involvement in the group psychoeducational program focused on the biological and psychological treatment of the disorder.The client has followed through on involvement in a group psychoeducational program and key topics were reviewed.The client has not followed through on involvement in a group psychoeducational program and was redirected to do so.
33 Teach Illness Management Skills (33)The client was taught about illness management skills.The client was taught about identifying early warning signs, common triggers, and coping strategies.The client was taught about problem-solving regarding life goals and development of a personal care plan.
34 Use Cognitive Therapy Techniques (34)Cognitive therapy techniques were used to identify, challenge, and change cognitive appraisals that make the client vulnerable to manic
