Bipolar Disorder Discussion Paper
Assessing and Treating Patients with Bipolar Disorders
Bipolar disorder is a mental condition that causes a person to undergo rapid bouts of euphoria and depression. This mental disorder induces irregular behavior in the temperament of the person and his or her failure to function adequately in many social contexts. Sometimes, those suffering from bipolar disorder may exhibit signs of mania, mood swings, and extreme depression (Chen et al, 2015). The disorder is very complex, hence making it very difficult to identify due to numerous other illnesses, including schizophrenia, having identical signs and symptoms. Bipolar Disorder Discussion Paper
In other cases, a person who is suffering from bipolar disorder experiences excessive manic episodes that can lead to delusions and hallucinations. In addition, the condition triggers a chemical imbalance in the brain, eventually causing mood fluctuations and uneasy thoughts. In this article, I will discuss the case of a 26-year-old woman with bipolar disorder and aim to draw professional decisions on three hospital visits to maximize treatment.
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Case Study
The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for the onset of acute mania. She was diagnosed with bipolar I disorder. A physician who reported her to be in overall good health has medically worked up the patient. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work. Genetic testing reveals that she is positive for the CYP2D6*10 allele. The patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.
Decision 1
The first step is to start her on Risperdal one mg orally Bis In Die (BID) – Risperdal’s brand name is risperidone, an atypical antipsychotic whose applications include antipsychotic therapy. The latest trials have shown the efficacy of most atypical antipsychotic medication in the treatment of mania. Many of these agents have been tested both as monotherapy and as an add-on treatment for acute mania. Since the patient was found to have bipolar confusion, Risperdal is the better solution to the current medication choices. The patient did not agree with lithium in the previous therapy. Therefore, due to the risk of patient non-compliance, it might not be the wisest option to resume lithium 300 mg. Seroquel XR may well be a good option, but its adverse effects including weight gain may also contribute to the issue of non-compliance. Bipolar Disorder Discussion Paper
The goal of this line of treatment
The expectation is to stabilize her mood as well as behavioral symptoms in her within the first four weeks of initiation of therapy and eventually restore its premorbid level of functioning.). The self-destructive tendency is expected to decrease.
Real and Expected Outcomes
After four weeks, the client returned for a follow-up visit, and she looks sedated and lethargic, her mother needed to escort her and help her into the clinic. Risperidone may cause sedation and lethargy; this effect may be pronounced at high doses. The distinction in the outcomes is because of the reactions of the medication. The client is of Korean extraction and positive for “CYP2D6*10 allele” may also contribute to a high serum level of the drug, contributing to the level of sedation and lethargy.
Decision 2
Reduction in the dose of Risperdal to one mg of HS, the explanation for this is that the patient is stable and appears to be responsive. Regrettably, there is an unwelcome side effect that has often decreased the patient’s quality of life and rendered it impossible for her to return to normal activities. The aim here is to reduce the occurrence of adverse reactions; hence titrating the dose down to Risperdal 1 mg orally of HS will be the next step. Increasing Risperdal to 2 mg at HS could still be the same 2 mg daily dose, and the person may still have the same serum concentration and potentially the same degree of adverse reaction. The client’s prior experience with lithium would not make it a safe choice; one big takeaway is right here is the patient’s compliance. With a reduction in dosage, the expectation is to minimize adverse effects while retaining therapeutic value. Bipolar Disorder Discussion Paper
Real and Expected Outcomes
Symptoms improved when the patient came for the second follow-up, she was also less sedative and less lethargic. The Young Mania Rating Scale also fell from 22 to 11. It is per the treatment objective.
Decision 3
Continued use of Risperdal 1 mg HS for the client seems to be the safest choice as the condition progresses and the best recommendation is to continue treatment and carry out reassessment in 4 weeks. The knowledge that the individual is of Korean descent and is positive for CYP2D6 * 10 is one just not to be so quick to raise the dose to 2 mg daily. The slower removal of Risperdal from her skin may again result in extreme sedation, which is not advisable. Latuda is recommended by the FDA for bipolar depression, which is not the case in this case where the goal of management is to stabilize the client’s behavioral symptoms and mood and gradually restore her premorbid functioning.
Ethical Consideration
Psychiatric mental health nurse practitioners must recognize ethical concerns during the care process to ensure confidentiality of the information relating to the patient. The individual should be informed of all choices, in particular when implementing the claim and changing the dose during the second follow-up. Any inappropriate side effects, such as sedation and weight gain, should be disclosed to the patient (Chen et al, 2015). The individual should be assured that the effects of this drug outweigh the risks involved. The consent of the patient or the authorization of the family member may be secured if the information relating to the patient is to be exchanged with a third party. Bipolar Disorder Discussion Paper
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Conclusion
The goal of therapy for manic episodes is to gain quick regulation of symptoms. More attention should be extended to long-term mood stabilizers in patients with bipolar disorder. The decision tree discussed in this paper identified some of the care choices for a bipolar disorder patient. Owing to the patient’s history of lithium, Risperdal was found to be the appropriate therapeutic agent. During the first follow-up, the patient demonstrated progress and proved to be successful as well as achieving a substantial improvement in negative symptoms. Bipolar disorder affects the lives of the individuals and family members, and treatment can prove problematic due to non-adherence. Healthcare Providers and practitioners must come up with a tailored recovery package that recognizes the particularities of each individual.
References
Chen R, W. H. (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.
Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., & Brewin, C. R. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC medicine, 18(1), 1-24. Bipolar Disorder Discussion Paper