Assessing and Treating Clients with Bipolar Disorder

Assessing and Treating Clients with Bipolar Disorder

Assessing and Treating Clients with Bipolar Disorder

 

Bipolar-1-disorder is a condition characterized by the manic episodes, which disrupt an individual’s normalcy. The presenting symptoms include elevated mood and high energy. Studies show that diagnosis of the condition difficult since there are other mental disorders that present with mania or hypomania episodes. As a result, proper considerations have to be made in ensuring that the correct diagnosis is made and the condition is managed in time. The pharmacotherapeutic intervention selection for the condition depends on the levels of safety and effectiveness of the available drug (Stahl, 2013). A few reviews have demonstrated likely impacts of coordinated treatment programs for patients with bipolar disorder. The current paper analyzes a case of a Korean woman came to the PMNHP nurse after a 21-day hospitalization for acute mania alongside bipolar I disorder considering that her score from the Young Mania Rating Scale (YMRS) was 22 (Laureate Education, 2016f). Thus, in this paper, bipolar therapy is examined with considerations to making the right treatment choices amid ethical considerations.

Decision Point One

Selected Decision

Begin Risperdal 1 mg orally BID

Reason for the Selection

Risperdal is a second generation antipsychotic that has been used in management of the mental disorders such as bipolar. These antipsychotic has been proven effective in alleviating manic symptoms among patients with bipolar 1 (Stahl & Ball, 2009b). Its main action is through rebalancing the dopamine and serotonin levels thereby improving mood, thinking, and behavior. According to Castellan et al. (2013), studies show that there are “no consistent results reported about the relationship between cytochrome P450 (CYP) 2D6*10 allele and plasma 9‐OH‐RIS or active moiety levels of Risperdal, hence adequate clearance in right doses can be achieved” (p. 204). Additionally, lithium and Seroquel SR have also been used widely in the management of bipolar condition. However, lithium cannot be used in managing the patient in this case because of the non-compliance and poor adherence history from the Korean patient. Furthermore, combining the two medications could result in drug interactions leading to adverse effects to the patient (Daglas et al., 2016). As a result, it is not recommended to prescribe it again. Regarding the latter, its tolerability has been questioned in some subjects hence given the genetic make-up of the patient, it cannot be elected for the pharmacotherapeutic care plan. From the foregoing reasons, Risperdal prescription is the best option to use in this scenario.

Expected Results

Risperdal represses the manic symptoms within three weeks; therefore, patients using the drug experience positive outcomes within the stated period. During this period, the Asian patient should experience improved appearance, have reduction in the level of irritability, and demonstrate improved speech, tamed disruptive behavior, and good sleeping pattern (Stahl, 2013). Therefore, it is expected that the Korean patient will have a significant improvement by the fourth week of medication.

Difference between Expected Results and Actual Results

The patient visited the hospital after four weeks, and she was lethargic and sedated. It was stated that these symptoms appeared after one week of medication. This was contrary to the anticipated results of reduced bipolar symptoms. It was expected that the patient would have improved mood and appropriate thinking. The difference in the results is the side effects of the drug. The high amount of Risperdal in the blood leads to sedation. Given that the patient is from Korean ancestry and positive for CYP2D6*10 allele means that she may not have a swift clearance of Risperdal from the blood leading to accumulation (Demant, Vinberg, Kessing, & Miskowiak, 2015).

Decision Point Two

Selected Decision 

Decrease Risperdal to 1 mg at HS

 

Reason for the Selection

Risperdal 1 mg orally BID did not fail to work during the second visit; it only caused some side effects. It is wise to alter the dosage to manage the side effects rather than cease the use of the drug. Altering Risperdal to 2 mg at HS may still attest to be a lot, and the side effects may not be sufficiently managed. A choice to switch back to lithium is still not right as the patient still has an attitude towards it (Demant, Vinberg, Kessing, & Miskowiak, 2015). Furthermore, it might confuse the patient on drugs used. Helping her cope with different dosage of the same drug will increase her confidence in drugs and appreciate that it is all about the alteration of the dosage.

Expected Results

As mentioned previously, Risperdal is effective in balancing dopamine and serotonin in the brains and thus managing mood, behavior and thought problems. The adverse effects have been ascribed to the accumulation of Risperdal in the patient’s blood. Lowering the dosage to Risperdal 1 mg at HS will warrant no accumulation of the drug in the patient’s blood as the body will be able to excrete it quite quickly. By altering the dosage, the patient should begin being less sedated and less lethargic. The patient should also begin experiencing improvement in the mood, have proper behaviors as well as think well (Demant, Vinberg, Kessing, & Miskowiak, 2015). This is the effect of Risperdal when taken in the correct amount.

Differences between Actual Results and Expected Results

The patient visited after four weeks, and she was less lethargic and sedated. Furthermore, the Young Mania Rating Scale had reduced from 22 to 16. The patient reported that there were no other side effects. These outcomes are very similar to the anticipated results. The side effects diminished quite faster than it was assumed and this the only difference and luckily in a positive direction. The results are similar because just as stated earlier, Risperdal is a proper medication for bipolar disorder. The adverse effects could not be used as a reason for discarding the drug in this case.

Decision Point Three

Selected Decision

The client will continue on the same dose of Risperdal and reassess in 4 weeks

Reasons for the Selection

The selected client was a Korean descent and was positive for CYP2D6*10 allele. Scientifically, the clearance level for the drug ought to be slower compared to the patient of different descent and without the allele (Castellan et al., 2013). Thus, by using the recommended dosage after the review, the PMNHP nurse will eliminate over dosage of Risperdal in the patient’s system. This intervention will protect the patient from suffering the side effects witnessed when the dosage was at 1 mg BID. Similarly, Latuda is approved for Bipolar I depression by the FDA; though, this case focused on bipolar I disorder (Stahl, 2013).

Expected Results

The dose should be maintained so long as the patient responds well to the treatment. The intervention aims at reducing the symptoms even further. The client responded positively to the current medication by week eight of using the drug. Therefore, it is apparent that the drug is working and helpful to the patient. As a consequence, the client’s quality of life will improve significantly as the symptoms diminished by about 50% (Stahl, 2013). Long-term, the Korean patient is expected to recover fully.

Differences between Expected Results and Actual Results

The decision to continue using the dose was consistent with the standard procedures. The clients’ history indicated that she has the CYP2D6*10 allele. The allele may hinder efforts to adjust the dosage because she responded negatively to higher doses (Chen et al., 2015). Since the nurses have to promote patients’ safety, retaining the dosage is consistent with the expected results.

Impact of Ethics on Intervention

In healthcare, ethical considerations play a huge role in the treatment plan. When handling patients having bipolar disorder, ethical considerations come centrally to the way the PMHNP approaches the treatment (Burdick, Ketter, Goldberg, & Calabrese, 2015; Chen et al., 2015). The patient is mentally unstable, and therefore the PMHNP nurse has to know the appropriate way to present any info to them and the exact time to do that. Ethical contemplations affected the way the patient was counseled to go on using Risperdal in an altered dosage after the first one had caused sedation and lethargy side effects.

When choosing among the drugs to use, ethical considerations were at the core since some drugs are known for specific side effects to several descents of people. For example, Seroquel XL is known for constipation and dry mouth. The patient had complained of comparable side effects when she used lithium in her previous medication. Ethical considerations demand that the PMHNP considers the long-term effects of the drugs such as damage to the teeth (Goodwin et al., 2016). Hence, the medication had to be foregone for a better alternative with relatively fewer adverse effects.

Conclusion

Developing the intervention therapy for bipolar I disorder patients requires a lot accuracy in the diagnostic protocols and results. People suffering from the condition may also present with other mental disorders therefore, it is necessary to perform the diagnosis with a lot of cautiousness. After the diagnosis, a pharmacotherapeutic intervention developed depending on side-effects and a patient understands of the same.

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Assessing and Treating Clients with Bipolar Disorder

Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for clients. Proper

diagnosis of this disorder is often a challenge for two reasons: 1) clients 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 client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with bipolar disorder.
Learning Objectives
Students will:
• Assess client factors and history to develop personalized plans of bipolar therapy for clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespan
Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
• Chapter 6, “Mood Disorders”
• Chapter 8, “Mood Stabilizers”
Stahl, S. M., & Ball, S. (2009b). Stahl’s illustrated mood stabilizers. New York, NY: Cambridge University Press.

To access the following chapters, click on the Illustrated Guides tab and then the Mood Stabilizers tab.
• Chapter 4, “Lithium and Various Anticonvulsants as Mood Stabilizers for Bipolar Disorder”
• Chapter 5, “Atypical Antipsychotics as Mood Stabilizers for Bipolar Disorder”
Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-0060-3
Note: Retrieved from Walden Library databases.
Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6
Note: Retrieved from Walden Library databases.
Required Media

Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

Mostafavi, A., Solhi, M., Mohammadi, M., Hamedi, M., Keshavarzi, M., & Akhondzadeh, S. (2014). Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Acta Medica Iranica, 52(10), 734-739.
Retrieved from http://acta.tums.ac.ir/index.php/acta

To prepare for this Assignment:
• Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy.
The Assignment
Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
• Decision #1
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.