Psycho pharmacotherapy Approaches to Treatment
Introduction
Bipolar disorder is characterized by manic and depressive episodes. The manic episodes manifest as increased energy, excessive happiness, insomnia, euphoria, aggression, engaging in risky behaviors, racing mind, and poor concentration (Jauhar & Young, 2019). Depressive episodes manifest as sad mood, decreased energy and activity levels, anxiety, sleep problems, fatigue, suicidal thoughts, lack of concentration, and forgetfulness (Jauhar & Young, 2019). The client in the case study presented to the clinic after a 21-day admission due to acute mania. The client reported a lack of sleep and an eccentric mood. The client stated that she was not adhering to the treatment (lithium). The MSE indicated rapid speech, broad affect, impaired insight, and euthymic mood. This paper will discuss the appropriate treatment choices for the client and the ethical considerations relevant when treating this client. Psycho pharmacotherapy Approaches to Treatment
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Decision Point One
The presented treatment choices are Seroquel XR 100 mg; Risperdal 1 mg; and lithium 300 mg. The medication selected for this client is Lithium 300 mg orally BID. Lithium was chosen because it is a first-line and FDA approved mediation in the treatment of manic-depressive and mania. Lithium changes the metabolism of catecholamines and serotonin and this improves symptoms manifested in people with bipolar disorder. Risperdal was not chosen due to the severe metabolic effects such as weight gain (Jauhar & Young, 2019). Seroquel was not chosen since the client is taking lithium and seems to be tolerating the medication. Psycho pharmacotherapy Approaches to Treatment
The treatment goal is to have the client attain symptom remission or stable improvement. It will also be ensured that the client continues with the medication to avoid the recurrence of symptoms.
Nonetheless, the client did not report any symptom improvement and the client reported a lack of adherence to treatment. The lack of improvement could be because of the failure to adhere to the treatment.
Decision Point Two
The availed treatment choices are increasing lithium to 450 mg orally; assessing the reason for non-adherence and educating the client about the medication; and the third choice is to change Depakote ER 500 mg orally at HS. The appropriate decision is to assess the reason for the client’s nonadherence and educate her about the pharmacology and side effects associated with the medication. Jawad et al (2018) explain that non-adherence is a common aspect when treating patients with lithium medication. Increasing the lithium dose to 450 mg was not chosen since the client is not adhering to lithium treatment and hence it is not possible to assess the efficacy of the treatment and the dose. Depakote was not selected because lithium is the first-line treatment in acute mania and thus the efficacy of lithium should be examined before changing the medication (Stahl, 2008).
The treatment foal was to ensure the client adheres to the treatment and achieves symptom remission (Stahl, 2008). However, after four weeks, the client experienced side effects such as diarrhea and nausea; these side effects contributed to the non-adherence. Both diarrhea and nausea are common side effects of lithium (Chakrabarti, 2018).
Decision Point Three
The available treatment choices are changing lithium to sustained-release preparation; changing to Depakote ER 500; or changing to Trileptal 300 mg orally BID. The choice that was chosen is to change the lithium to sustained sustained-release preparation. An extended-release formulation will ensure the client benefits from the medication and at the same time prevent side effects reported by the client. Lithium is effective in stabilizing mood and controlling acute mania symptoms (Stahl, 2008). Depakote was not chosen because the client has not adhered to lithium and hence the efficacy of lithium cannot be examined. Trileptal was not chosen since it is a second-line treatment in patients with bipolar and the first-line medication should be adequately tried before using a second-line medication (Stahl, 2008). It is hoped that the client will achieve symptom remission and tolerate the medication. Psycho pharmacotherapy Approaches to Treatment
Ethical Considerations
Patients should consent to treatment before any treatment is administered (Richaa et al., 2017). However, the autonomy of the client can be overlooked if the mental illness is serious, if the patient poses harm to self or others, or if the life of the patient is in danger. When treating clients with bipolar disorder, PMHNPs face various ethical dilemmas that include respecting the autonomy of the client and attaining the best health outcomes. The best choice for this client would be patient autonomy since the life of the client is not in danger, the client does not pose danger to self and others, and also her mental illness is not severe to interfere with her ability to make treatment decisions. The PMHNP should seek and obtain informed consent from the client, by providing all the essential information about the available medications, including their side effects and their efficacy (Richaa et al, 2017).
Conclusion
The first decision was for the client to take Lithium 300 mg since lithium is FDA approved as a mood stabilizer and as the first-line treatment choice in treating acute mania. The client did not fully adhere to the medication and thus the second treatment choice is to assess the reason for nonadherence and educate her about the pharmacology of lithium and the associated side effects. The third treatment choice is to change to sustained-release preparation to encourage adherence to treatment because an extended-release formulation will eliminate side effects. The PMHNP should seek informed consent from the client and at the same time respect the autonomy of the client throughout the treatment process.
References
Chakrabarti S. (2018). Treatment alliance and adherence in bipolar disorder. World J Psychiatry.8(5), 114–124.
Jauhar S & Young A. (2019). Controversies in bipolar disorder; the role of second-generation antipsychotics for maintenance therapy. Int J Bipolar Disorder, 7(10).
Jawad I, Watson S, Peter H, Peter T & William H. (2018). Medication nonadherence in bipolar disorder: a narrative review. Ther Adv Psychopharmacology, 8(12), 349–363.
Richaa S, Chammaya A, Dargel C & Masson H. (2017). Ethical considerations in bipolar disorders. Encéphale, xxx–xxx.
Stahl M. (2008). Essential Psychopharmacology Online. Retrieved September 23, 2020, from
https://stahlonline-cambridge org.ezp.waldenulibrary.org/essential_4th_chapter.jsf?page=chapter6_introduction.htm&name=Chapter%206&title=Description%20of%20mood%20disorders
Psycho pharmacotherapy Approaches to Treatment