Assessing And Treating Patients With Bipolar Disorder
Bipolar disorder is a mental illness that begins in adolescence or adulthood and is linked to anxiety problems and illicit substance use. Bipolar disorder, according to Muneer (2015), is one of the major causes of impairment worldwide, with an elevated risk of suicide among psychiatric patients resulting from feelings of death and despair. There are currently no criteria for a bipolar diagnosis. Therefore clinicians have to depend on the client’s medical history, clinical manifestations, and psychiatric assessment procedures. The purpose of this paper is to discuss the proper medication and treatment choice for a 26-year-old Asian American woman who comes for a follow-up visit after 21 days of hospital admission with the beginning of a manic episode (Laureate Education, 2020). The client was diagnosed with bipolar disorder and given a Lithium medication when he was released. However, he admits to discontinuing taking Lithium two weeks later. Moreover, while entering the clinic, the client was constantly playing with items on the desk and switching the sitting sides of the chair from one to the next, claiming that she does not think she has bipolar but enjoys chatting, dancing, and cooking. The client is also alert and focused, clothed strangely in an evening dress, speaks quickly and hurriedly, has a pleasant disposition, sleeps five hours per night while expressing a dislike for sleeping since it is unpleasant, and denies suicidal ideation and hallucinations. Furthermore, genetic screening showed that she has the CYP2D6 *10 variant Assessing And Treating Patients With Bipolar Disorder.
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Decision # 1: Restart Lithium 300 mg Orally BID
This choice was made considering the client revealed no adverse effects from Lithium after being discharged from the facility. Still, she discontinued using medication since she believes she does not have bipolar disorder (Laureate Education, 2020). Lithium has been the recommended maintenance medication therapy for people with bipolar disorder for more than seven decades (Volkmann et al., 2020). Lithium has been used to treat bipolar disorder in the past and has been shown to reduce flare-ups during acute episodes of mania, depression mania, and other mood disorders. It is also recommended for the treatment of individuals at increased risk of suicide, as it prevents future manic bouts while also regulating emotions.
I did not choose Risperdal since there have been reports of rising mania and hypomania bouts in individuals who use this medication to treat bipolar disorder (Kavoor et al., 2014). Given the present clinical indications of fluctuating mood, I did not select Seroquel as the therapy of preference owing to documented extrapyramidal complications such as vertigo, constipation, weight gain, drowsiness, dry mouth, exhaustion, and headaches (Suttajit et al., 2014) Assessing And Treating Patients With Bipolar Disorder.
By choosing this decision, I was hoping that the client’s symptoms will be stabilized and that her safety and compliance will be sustained.
In this situation, getting client consent prior to administering psychiatric medications is an ethical concern. Only if the client is educated about the drug’s pharmacodynamics may they provide informed consent. Since the client belongs to a minority ethnic community, she ought to obtain culturally appropriate therapy, which should commence with culturally appropriate client teaching.
Decision # 2: Increase Lithium to 450 mg orally BID
After evaluating the client for non-compliance and thoughts of suicide, I made this decision. This due to the reason that in bipolar disorder patients, Lithium is the recommended first-line treatment for preventing mania and depression events. It may be utilized for bipolar disorder’s flare up’s as well as to provide long-term stabilization. Lithium contains antisuicidal properties that are useful in the treatment of the bipolar depressive disorder, wherein the suicide risk is higher owing to depressed mood (Alda, 2015). Non – compliance is common among people with mental health issues, leading to relapses in people with bipolar disorder, increased safety problems, and suicidality. Client education on failure to comply with medicine and its consequences on unresolved bipolar, such as re-hospitalization and flare-ups, is critical at this point, and including members of the family in the treatment plan may help clients adhere to their medication regimen (Moosavi et al., 2014) Assessing And Treating Patients With Bipolar Disorder.
Because of the recognized danger of extrapyramidal complications, aggravation of depressive indications such as tardive dyskinesia, and suicide, which happens with long-term utilization of Risperdal in people with bipolar disorder, I did not select it for therapy (Moosavi et al., 2014). I did not pick Seroquel XR since it is used off-label to manage bipolar disorder, and there’s little proof to back it up (Brett, 2015). Seroquel XR is linked to overdosing in suicidal individuals, increased mood swings and anxiety, dependence, and hyperglycemia in bipolar disorder patients (Brett’s, 2015).
By choosing this decision, I was hoping the patient returns in four weeks, this time with improved symptoms and evidence of drug compliance. The client’s present challenge is non-compliance since she thinks she does not have bipolar disorder, and transitioning to a new drug would not assure compliance with the different medication.
In terms of ethical concerns, the medication’s impact on Asians ought to be a key factor in decision-making. The Practitioner must consider taking all essential measures to protect the client. The Practitioner can improve patient safety by knowing the psychodynamics of Lithium in Asian individuals. Certain antipsychotic medicines have a distinct effect on Asians. Practitioners must administer medicines that have been shown to function in a variety of individuals.
Decision # 3: Assess the rationale for non-compliance and educate the patient on the side effects and complications of non-compliance and safety
The reason for choosing this decision is to examine the client for depression, suicidal ideation, and cleanliness. If she poses a risk to herself, I will admit her to an inpatient facility. I will proceed with compliance teaching without hospital admission if the client is not a threat to herself (Laureate Education, 2020). Since mania therapy may make a client feel “down or flat,” resulting in symptoms of depression like despair, my emphasis will be on evaluating and treating depression alongside mania. Abilify is an FDA-approved medication for bipolar presentation and manic episodes with a beginning dosage of 15 mg per day. It may be used to treat bipolar and depressive symptoms. Furthermore, owing to their denial of having bipolar disorder, individuals are generally non-compliant Assessing And Treating Patients With Bipolar Disorder.
The client may not adhere to the drug regimen even if the prescription is modified at this point.
According to Chakrabarti (2016), no medication adherence is typical among bipolar patients. A variety of reasons affect clients’ decisions, including community and family discrimination, individual views and attitudes, insufficient information, patient participation in the treatment regimen, and financial means. The usage of patient-centered techniques by clinicians may help bipolar patients with non-compliance and decrease depressive and manic episodes and re-hospitalizations. Furthermore, patient-centered approaches enhance clinicians’ knowledge of clients’ behavioral patterns, interests, and general health while also fostering trustworthy relationships in the face of non-compliance problems.
It is an ethical obligation to keep track of a patient who is taking psychiatric medication. In this situation, informing family members about the drug and its possible adverse effects may aid in better patient management.
Conclusion
Conclusively, it is critical to figure out how bipolar disorder affects not just the person but also their ethnic identity. The case study taught us about the patient’s bipolar disorder manifestations and the particular medication choices that were made to aid in the patient’s treatment. Furthermore, ethical concerns for Asian Americans, treatment plan, communication, and genetic assessment of the CYP2D6*10 variant were addressed. Stigma is a problem that Asian American patients suffering from psychiatric illnesses encounter in their community, hindering most of them from seeking medical help and treating their illnesses (Zhang et al., 2019). Low self-esteem, financial hardship, and stigma among Asian individuals with psychiatric disorders have a negative impact on treatment adherence and psychiatric care, with several individuals opting to forgo therapy in order to keep their condition hidden from society. It is suggested that clinicians establish opportunities that promote health and minimize psychiatric ailments while also focusing on client risk variables and maintaining high levels of follow-up treatment for individuals suffering from a psychiatric condition Assessing And Treating Patients With Bipolar Disorder.
References
Alda, M. Lithium in the treatment of bipolar disorder: pharmacology and pharmacogenetics. Mol Psychiatry 20, 661–670 (2015). https://doi.org/10.1038/mp.2015.4
Brett J. (2015). Concerns about quetiapine. Australian prescriber, 38(3), 95–97. https://doi.org/10.18773/austprescr.2015.032
Chakrabarti S. (2016). Treatment-adherence in bipolar disorder: A patient-centred approach.
World journal of psychiatry, 6(4), 399–409. https://doi.org/10.5498/wjp.v6.i4.399
Kavoor, A. R., Mitra, S., Mondal, S. K., & Das, B. (2014). Risperidone-induced mania: An emergent complication of treatment. Journal of pharmacology & pharmacotherapeutics, 5(4), 258–260. https://doi.org/10.4103/0976-500X.142448
Laureate Education. (2020). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author
Moosavi, S. M., Ahmadi, M., & Monajemi, M. B. (2014). Risperidone versus risperidone plus sodium valproate for treatment of bipolar disorders: a randomized, double-blind clinical- trial. Global journal of health science, 6(6), 163–167. https://doi.org/10.5539/gjhs.v6n6p163
Muneer A. (2015). Pharmacotherapy of bipolar disorder with quetiapine: a recent literature review and an update. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 13(1), 25–35. https://doi.org/10.9758/cpn.2015.13.1.25
Suttajit, S., Srisurapanont, M., Maneeton, N., & Maneeton, B. (2014). Quetiapine for acute bipolar depression: a systematic review and meta-analysis. Drug design, development and therapy, 8, 827–838. https://doi.org/10.2147/DDDT.S63779
Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium Treatment Over the Lifespan in Bipolar Disorders. Frontiers in psychiatry, 11, 377. https://doi.org/10.3389/fpsyt.2020.00377
Zhang, Z., Sun, K., Jatchavala, C., Koh, J., Chia, Y., Bose, J., Li, Z., Tan, W., Wang, S., Chu, W., Wang, J., Tran, B., & Ho, R. (2019). Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies. International journal of environmental research and public health, 17(1), 280. https://doi.org/10.3390/ijerph17010280 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 Assessing And Treating Patients With Bipolar Disorder.
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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? Assessing And Treating Patients With Bipolar Disorder
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 Assessing And Treating Patients With Bipolar Disorder