Assignment: An Asian American Woman with Bipolar Disorder

Assignment: An Asian American Woman with Bipolar Disorder

Assignment An Asian American Woman with Bipolar Disorder

 

Bipolar disorder refers to a mental illness that makes one experience a dramatic shift in mood, energy, and ability to think clearly. The disease causes a high and low mood referred to as mania and depression. The average age onset of bipolar is 25 years and it affects about 2.8% of adults in the United States (Grunze, 2015). The disease worsens without treatment but with proper management, one can execute daily tasks with ease. To explain more on bipolar management, this paper will review a 26-year-old Korean woman diagnosed with bipolar I disorder. The patient was hospitalized for acute mania. The patient appears to be busy and states she likes to talk, dance, sing and cook. Her mood is fantastic and she asserts that she hates sleep. Medications are not working on her and she is positive for the CYP2D6*10 allele (Laureate media, 2020). She reports that she stopped taking her lithium. She has a rapid, pressured and tangential speech with a broad affect. She denies delusions, hallucinations or suicidal ideation. She has a score of 22 on the Young Mania Rating Scale (YMRS). The paper will use a decision tree to prescribe psychopharmacological agents for the patient. The paper will also outline ethical considerations guiding the treatment protocol.

Decision -1

Begin Seroquel XR 100 mg orally at HS

Reason for Selection.

Seroquel XR 100 is selected because of its efficacy in the management of the bipolar disorder. As an atypical antipsychotic, it works by interacting with serotonin 5-HT2 receptors and dopamine D2 receptors. The main mechanism behind Seroquel’s antipsychotic efficacy is the blockade of the dopamine D2 receptor in the mesolimbic pathway (Muneer, 2015). The drug can modify the systems of dopaminergic, serotonergic and noradrenergic neurotransmission. The drug has a liner kinetic and an elimination half-life of approximately 7 hours. Seroquel XR has a peak plasma of 5 hours and sustains higher plasma levels for long allowing for once-daily dosing. Minimal metabolism occurs through CYP2D6 thus the patient’s positive allele will not affect the drug. The drug has minimal side effect profile, it’s well-tolerated and requires no therapeutic plasma monitoring.

Risperdal 1mg orally BID is avoided because the patient is positive for the CYP2D6*10 allele. The allele makes her a “poor metabolizer” with a decreased capacity to metabolize risperidone. She is therefore at a higher risk of adverse effects caused by increased exposure to plasma risperidone (Puangpetch et al., 2016). Equally lithium 300 mg orally BD is avoided because research indicates that it has limited clinical efficacy in severe manic and mixed episodes. It also has a narrow therapeutic index which calls for frequent plasma determination to avoid toxicity and adverse effects (Muneer, 2015).

Expected Results

The clinician expects that the patient will report improvement in symptoms. Seroquel efficiently improves mood, thinking, and behaviors and thus it will stabilize the patient increased energy, enhance her sleep, reduce nervousness and enhance her social life (Muneer, 2015). Her tolerance for the medication should also be better. The YMRS score should also decrease.

Difference between Expected and Actual Results

After four weeks, the patient stated that she slept more at bedtime, had a good mood and her YMRS score reduced from 22 to 18 (Laureate media, 2020). All these were in line with the clinician’s expectations. However, she indicated that she had gain 2-3 pounds, was constipated and had a dry mouth. The presentation is in line with frequent adverse events seen when using Seroquel which are dry mouth, sedation, constipation, increased appetite, dizziness and somnolence (Muneer, 2015). The client requested for a change of medication.

Decision 2

Discontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie meal

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The need to maintain a strong therapeutic relationship prompted the change of the drug. The patient experienced adverse events from

Seroquel. Geodon is backed up by research on reducing weight and generating better lipid profiles. A third of Geodon is cleared via CYP-3A4, 1A2 alleles while the rest is cleared via aldehyde oxidase and thus will not cause the adverse effects like Seroquel (Bahar, Setiawan, Hak & Wilffert, 2017). The major pathway of metabolizing Geodon is 3A4 while 2D6 acts as a minor pathway for metabolism. The meal is added to assure adequate absorption of the drug. Increasing Seroquel to 300mg is avoided because it will exacerbate the adverse events resulting in compliance issues. Additionally maintaining the current drug and counseling on constipation will not help because the major concern of the patient is weight loss.

Expected Results

The patient is expected to report improved disease symptoms. Her bipolar symptoms should be better and weight gain should not be a problem anymore. An improvement in symptoms will be indicated by a better YMRS score.

Difference between expected and actual results

After four weeks, the patient had improved remarkably. Her YMRS score was 11, an indication that her disease symptoms reduced by 50% (Laureate Media, 2020). She tolerated the medication well and reported that weight gain was no longer an issue.

Decision Three

Increase Geodon to 60 mg orally BID with a 500 calorie meal

Reason for Selection

The patient responded positively to Geodon. Her disease symptoms improved and her weight gain problem resolved. Geodon can be adjusted depending on tolerability and efficacy within the range of 40-80mg twice daily (Wecker, Currier & Catalano, 2018).  The increased dosage will offer significant symptomatic improvement. Nevertheless, there is a risk of adverse events. Maintaining the patient on the current dosage and assessing after four weeks is also an option.  However bipolar patients require rapid relief of symptoms to prevent and minimize mood cycling (Murray et al., 2017). Augmenting the current medication with lithium is avoided because it is only an option when the plan is to stop the antipsychotic therapy and initiate a lithium monotherapy. The patient also indicated that she stopped taking Lithium initially before visiting the clinic meaning that she will have compliance issues unless educated about its side effects.

Expected Results

The increased dosage is expected to result in rapid relief of symptoms and significant symptomatic improvement. The patient should YMRS score should reduce by 75% and she should report a balanced mood, better concertation, clear thoughts, normal sleep, and positive behaviors.

Differences between Expected and Actual Results

As per the clinician’s expectation, the patient went to remission. She tolerated the medication well and she scored 7 on her YMRS. She executed her daily activities normally and her social life improved.

Ethical Considerations

When managing bipolar patients, it is the duty of the clinician to ensure rapid relief of symptoms because it is a cyclic disorder. One should strive to have a positive therapeutic relationship with the patient. Additionally, informed consent should be followed to ensure that the patient understands the risk and benefits of medication used as well as alternative psychopharmacological therapies that can be used (Ratheesh et al., 2017). Evidence-based research should guide the therapies used. For the current patient, she was started on a drug that has a research backup on its efficacy on the management of bipolar. However, due to adverse events, she requested a change of drug.  As a way of creating a therapeutic alliance and resolving the patient’s concerns, the clinician offered a different drug. The patient was taken through the risks and benefits of the new drug and consented on the use of the drug. Additionally, since the patient had a therapeutic response without any adverse events, the new drug dosage was increased to get a rapid relief of symptoms. The patient improved and went to remission.

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.

I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. I do not need you to tell me the treatment options available to you – I am very familiar with the cases. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data).

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.

**reminder that I require five references based on the grading rubric**

Due date: Monday by 02:00 EST

Good luck!!

Please do not wait until the last minute to complete assignments, discussions or quizzes as we all know technology can be quirky from time to time. This is a GRADUATE LEVEL program and you should be managing your time effectively by this point in your academic and professional career.

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For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource