Assessing and Treating Patients With Bipolar Disorder Essay

Assessing and Treating Patients With Bipolar Disorder Essay

Assessing and Treating Patients With Bipolar Disorder Essay

One of the unique depressive disorders is a bipolar disorder which makes an individual experience shifts in energy and mood. Even though the condition may have various negative impacts on the patients, accurate diagnosis of the condition is usually a challenge. In addition, the conditions need the use of various appropriate medications (Ostacher& Hsin, 2016). The implication is that misdiagnosis is not uncommon hence making it a matter of importance to understand its pathophysiology. Therefore the purpose of this assignment is to examine a patient and discuss various aspects as well as decision points.

The Case Summary

The patient in this case study is a twenty-six-year-old Korean woman who walks to the clinic for her first visit since she was hospitalized for twenty-one days due to the onset of acute mania. The patient was also diagnosed with bipolar I disorder. When she walked in, the patient looked busy, trying to play with things placed on the desk and moving from side to side while sitting in the chair. She also says that they believe she is bipolar, but she doesn’t have the same belief. The patient also reports a “fantastic mood.” She reports usually having a sleep of five hours every night but admits to hating sleep as there is no fun in it. The data from medical records also indicate that the patient had been worked by a professional, and the reports indicate that she is in good health with the vital laboratory information all within the normal ranges. Genetic testing was conducted, which showed that she is CYP2D6 * 10 allele positive.

Decision #1

The first decision point is to commence medication for the individual with bipolar disorder. The patient had been directed to take Lithium upon discharge. However, she stated that she had stopped the medication. The patient shows symptoms of the early stages of a manic episode, even though she does not have any homicidal or suicidal thoughts. The genetic tests performed also revealed that she is CYP2D6*10 allele positive. The options available for treatment commencement include Seroquel, Risperdal, or Lithium. Due to the diagnostic results, it would be appropriate to start with 1 mg of Risperdal administered two times daily (Perlis et al., 2016). However, the patient would require some monitoring for sedation which may result from diminished rates of clearance. Paliperidone is the metabolite in the medication, and the impacts of the medication can last long. Risperdal belongs to the benzisoxazole derivatives and therefore functions as an antipsychotic. It works by stabilizing an individual’s brain. The medication balances a person’s serotonin and dopamine to help improve behavior, mood, and thinking.

Even though Lithium may be an option, it was not chosen since it may take up to a couple of weeks for it to be effective. In addition, the medication also needs consistent laboratory work for therapeutic monitoring levels and needs dietary modifications and restrictions (Perlis et al., 2016). The patient’s history of medication non-adherence may also put her at risk of Lithium toxicity in the event that she does not follow up with regular labs. However, this treatment can be considered later when the patient is more stable and has better adherence behaviors.

Seroquel was ignored since it has potential severe effects such as tooth decay, extreme dry mouth, constipation, and a substantial weight gain. Due to her condition, the patient might abruptly cut off the use of the medication regimen even without the advice of healthcare professionals. Withdrawal can be a significant problem that can span for weeks depending on the amount already consumed and for how long the patient has been using the medication.

Decision #2

In her next visit a month later, the patient showed symptoms of sedation and sluggishness, symptoms which were not expected in the previous visit. It is worth noting that these symptoms commenced about a week after the patient started using Risperdal. Therefore, various options could be explored to help the patient. For example, the dosage of Risperdal can be changed to 2 mg at bedtime, reduced to 1 mg at bedtime, or to completely discontinue Risperdal (Perlis et al., 2016) and begin administering Lithium.

Reducing the Risperdal dose to 1 mg at bedtime can be necessary due to the observed enhanced lethargy and sedation. Due to the results of the genetic testing, the patient has longer effects and lower rates of clearance related to the medication. There will be no need to change the medication to Lithium, as reducing the Risperdal dosage and administering it at bedtime is sufficient to eliminate lethargy and sedation (Perlis et al., 2016). Even though sedation and lethargy have been reported, the patient also reported improved symptoms; hence there is no need to discontinue the medication. The patient is then expected to have a smooth night’s sleep and an appropriately functional date. Therefore, giving Risperdal dosage of 2 mg at bedtime should be avoided as it is likely to cause more lethargy and sedation, which is not good for the patient. It would be necessary, to begin with, the low dosage and increase if need be. With the adjustment in the dosage, it is expected that there will be no report of lethargy or sedation.

Decision #3

The next visit coincided with the patient presenting as being more alert and with better symptoms. Indeed, an assessment done by applying the Young Mania Rating Scale indicated that the patient’s symptoms went lower by 25%. Therefore, no dose adjustments should be made. However, the patient should continue with the medication and visit the clinic in one month time for re-evaluation. Since she is responding well to the Risperdal 1 mg at bedtime well, it would not be advisable to increase it back to twice daily or change the medication. It is expected that the patient will continue doing better, with improved symptoms expected (Traeger et al., 2016). It has been decided at this point that the patient continues with the dosage and the regimen as the expected results have been achieved. In addition, changing the current regimen may destabilize the patient’s rate of healing. However, the patient still needs to be under close monitoring until the next visit.

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The Ethical Consideration

One of the ethical considerations regarding the treatment of various conditions is that the patient needs to agree with the prescribed medication regimen before it can be administered (Bloch & Green, 2021). However, such a direction can be overlooked in case the patient is not in the right mental state to consent due to severe psychiatric complications. Therefore, when handling a patient with bipolar disorder, the healthcare practitioner should strive to help the patient achieve the best results or uphold their autonomy.

Various cultures view or treat mental illness from various perspectives. In the Asian culture, mental illness is still viewed with a lot of stigmas as individuals shun those who have been diagnosed with the condition. The implication is that if a family member has a mental health challenge, the family members would prefer to keep it as a family problem and remain with it rather than going out and seeking professional help. Therefore, the patient needs consistent education on psychotherapy every time she visits the facility together with the family.

It is also an ethical and clinical responsibility of a clinician to closely monitor patients who test positive for CYP2D6 as they need close monitoring. One of the reasons why they need close monitoring is that they become poor Risperdal metabolizers, and they may end up being far much toxic at a lower dosage when compared to other patients. Recent research has also shown that individuals of Asian descent are more prone to CYP2D6. Therefore, they need to be monitored and treated so that the possible adverse impacts of the condition can be eliminated. The professionals have an obligation to ensure that they administer the correct medication to patients by following every instruction (Bloch & Green, 2021). For instance, the medication route and dosage should all be correct to avoid any possible adverse drug impacts on the patient. As a deemed fit, the physicians should also change the medications and dosages to ensure that the patient has the best outcomes or the symptoms are relieved.

Conclusion

Assessment of patients with psychiatric disorders is one of the specialties of psychiatric nurses. Therefore, these nurses should be able to accurately examine this group of the patient at any point of their sickness and appropriately formulate a therapeutic plan capable of leading the patient to health. However, such a task can be demanding and challenging, calling for the nurses to have better training and experience. In addition, the patients and their families usually need proper education regarding various specific mental health conditions affecting them. Therefore, psychiatric nurses also need to have adequate teaching skills to enable them to pass the appropriate information to the patients and their families. Conditions like bipolar disorder have several medications for treatment. However, a professional has to wisely choose the correct medication depending on the patient’s history and symptoms. The Asian woman in the case study can thus be managed by a careful choice of medication and ensuring that the patient is closely monitored.

References

Bloch, S., & Green, S. A. (Eds.). (2021). Psychiatric ethics. Oxford University Press.

Ostacher, M. J., & Hsin, H. (2016). The use of antiepileptic drugs in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 93–98). Elsevier.

Perlis, R. H., & Ostacher, M. J. (2016a). Bipolar disorder. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 48–60). Elsevier.

Perlis, R. H., & Ostacher, M. J. (2016b). Lithium and its role in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 86–92). Elsevier.

Traeger, L., Brennan, M. M., & Herman, J. B. (2016). Treatment adherence. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 20–26). Elsevier.

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Assignment: Assessing and Treating Patients With Bipolar Disorder
Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.

To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring bipolar therapy.
The Assignment: 5 pages
Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)

Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at

https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

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