Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630C
Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630C
Introduction to the Case Study
Bipolar disorder is one of the most prevalent mental health conditions worldwide. Bipolar disorder is defined by bouts of neuropsychological deficits, mood disorders, physiological alterations, immunological inadequacies, and impairments in daily functioning. Bipolar disorder has long been regarded as a primary cause of impairment on a global scale. Additionally, the disease contributes to premature mortality as a result of medical complications and suicide (Rowland & Marwaha, 2018). Genetics has been widely assumed to be a major factor in the development of bipolar disorder. Genetics has a role in the increased risk of developing bipolar illness in those born into families with a history of the disorder. Additionally, environmental factors have been implicated in the development of bipolar disorder.
For example, infectious agents such as Epstein-Barr virus and varicella zoster virus have been demonstrated to enhance the risk of bipolar disorder during the perinatal period. Additional risk factors for the development of bipolar illness include childhood maltreatment, psychological stressors, substance addiction, and medical comorbidities (Ferrari et al., 2016). As such, this paper will analyze the treatment decisions that should be made for a client who has bipolar illness. The client is a 26-year-old Korean woman with a bipolar I disease diagnosis. The client stated that she was in a terrific mood and despised sleep. The client was found to carry the CYP2D6*10 allele. She stopped taking lithium two weeks after being prescribed it. The client’s mental status evaluation revealed that he was alert, dressed strangely, spoke rapidly, and was in a euthymic mood. Additionally, the customer received a rating of 22 on the Young Mania Rating Scale. These results contribute to the patient’s diagnosis of bipolar I illness.
Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630C
Decision 1
The first decision that I will adopt for treating this patient is the use of Risperdal 1 mg orally BID. The fact that Risperdal is an effective antipsychotic agent used in the treatment of bipolar disorders informed the decision to prescribe the patient this drug, orally BID.
Assignment Assessing and Treating Patients With Bipolar Disorder NURS 6630C
Risperdal has been shown to exert its effect in bipolar disorders by balancing the levels of dopamine and serotonin. The balancing of these hormones result in good conduct as well as moods (Wu et al., 2016). The patient in the case study exhibited symptoms of bipolar confusion such as disorderly dressed, fantastic mood, hating sleep, and disbelief in having bipolar disorder. As a result, the use of Risperdal is an effective treatment that will restore the mood and behavior of the client (Chan et al., 2016).
The other two treatment options for the client were not selected due to a number of reasons. Firstly, lithium was not selected because the client has poor history of adherence to lithium. Accordingly, the client was prescribed lithium two weeks ago, which she stopped taking. It therefore implies that the risk of non-adherence is high if the patient is prescribed lithium (Severus et al., 2018). The decision not to prescribe the patient Seroquel was because of the adverse and side effects associated with this drug. Studies have shown that the use of Seroquel as the first line of drug in bipolar disorder increases the risk of weight gain in patients (Joas et al., 2017). Consequently, Risperdal is an effective alternative from the given medications. Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630C
Expected Outcomes
One of the expected outcomes with the above decision is the reduction in the symptoms of bipolar disorder that the client is experiencing. The client should be able to engage in her activities of the daily living with minimal difficulties. The patient should also be able to make informed decisions about her behavior and minimize engagement in self-destructive practices.
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Expectations vs. Outcomes
The client came to the clinic after four weeks accompanied by her mother. The client looked very lethargic and sedated. The client’s mother reported that the client has been experiencing the symptoms for the last three weeks. The symptoms were expected because of the presence of CYP2D6*10 allele, which lowers the clearance of Risperdal from the system. As a result, the medication remains long in circulation, leading to the symptoms that the client presented with to the clinic. An effective decision would therefore involve lowering the dosage of Risperdal to increase serum clearance and levels of circulating Risperdal (Wu et al., 2016). Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630C
Decision 2
The selected decision in this step is decreasing the dosage of Risperdal to 1 mg at HS. As noted in the above analysis, the patient came back after four weeks with evidence of increased side effects of Risperdal. The use of Risperdal was however effective in managing the symptoms of bipolar I disorder as evidenced by symptom improvement in the first week followed by the increased effect of the side effects of the medication. The best decision would therefore be lowering the dosage of Risperdal to reduce the side effects of the drug on the patient. Reducing the dosage would also increase the rate of drug clearance in the system, leading to lowered or eliminated incidence of side effects with the treatment (Chan et al., 2016). The other options of treatment were not adopted because of some reasons. Firstly, the patient has poor adherence to lithium. The poor adherence makes it not the best option for treating the client. Changing Risperdal to 2 mg at HS would increase the risk of side effects of the medications, hence, not an appropriate decision at this time.
Expected Outcomes
One of the expected outcomes with the treatment is the reduction in the side effects of Risperdal in the patient. It is expected that the client will report less incidences of lethargy and sedation. The other expected outcome is the improved social and occupational functioning. The patient should also report a reduction in self-destructive behaviors with the current treatment.
Outcomes vs. Expectations
The client came to the clinic after four weeks. The client was less sedated, less lethargic with evidence of symptom improvement. The score of the client was 16 from 22, which translated into more than 25% decrease in symptoms. Therefore, the expectations were moderately achieved with the reduction of the dosage of Risperdal for managing the bipolar disorder. Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630C
Decision 3
The decision to be adopted at this point is continuing with the same dose of Risperdal and reassess the client in four weeks. The client has demonstrated significant improvement in symptoms. The reduction in the dosage of Risperdal led to improvements that included reduced rate of sedation and lethargy and improvement in symptoms. The reduction of the dosage of Risperdal also led to significant decline in the score of the Young Mania Rating Scale from 22 to 16. Therefore, there is no indication for the need to change the current dosage of medication.
The other options were not selected for the client because of a number of reasons. The decision to increase Risperdal back to 1 mg orally BID was not selected because of the increased risk of side effects of Risperdal such as sedation and lethargy. The adoption of this option would imply that the symptoms of the client would not improve. The decision to change the medication to Latuda 40 mg orally daily was not selected because there is moderate achievement of the set treatment outcomes (Wu et al., 2016). Changing the treatment plan to a new drug would also increase the risk of adverse events in the management process. Consequently, sustaining the current dosage and treatment plan is the most effective decision for management.
Expected Outcomes
The expected outcomes with the adoption of the above decision is that the patient will reported a further improvement in her symptoms. The patient will also reported a further reduction in sedation and lethargy. Therefore, the treatment outcomes would have been achieved.
Conclusion
In conclusion, the treatment of bipolar I disorder should take into consideration the ethical issues affecting the practice of psychiatric mental health nurse practitioner. PMHNP should ensure that the treatments selected for patients with bipolar I disorder are safe. The selected options should have optimum benefits and minimal side effects or harm to the patients. The patients should also be informed about the treatment options for them to make an informed decision on the methods that should be used to manage their health problems. Patients should also be assured of the integrity of their information through the promotion of privacy and confidentiality of their data. Therefore, the consideration of these ethical aspects promote the provision of high quality mental health care to patients suffering from bipolar disorders.
References
Chan, H.-W., Huang, C.-Y., Feng, W.-J., & Yen, Y.-C. (2016). Clinical outcomes of long-acting injectable risperidone in patients with bipolar I disorder: A 1-year retrospective cohort study. Journal of Affective Disorders, 205, 360–364. https://doi.org/10.1016/j.jad.2016.08.023
Ferrari, A. J., Stockings, E., Khoo, J.-P., Erskine, H. E., Degenhardt, L., Vos, T., & Whiteford, H. A. (2016). The prevalence and burden of bipolar disorder: Findings from the Global Burden of Disease Study 2013. Bipolar Disorders, 18(5), 440–450. https://doi.org/10.1111/bdi.12423
Joas, E., Karanti, A., Song, J., Goodwin, G. M., Lichtenstein, P., & Landén, M. (2017). Pharmacological treatment and risk of psychiatric hospital admission in bipolar disorder. The British Journal of Psychiatry, 210(3), 197–202. https://doi.org/10.1192/bjp.bp.116.187989
Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251–269. https://doi.org/10.1177/2045125318769235
Severus, E., Bauer, M., & Geddes, J. (2018). Efficacy and effectiveness of lithium in the long-term treatment of bipolar disorders: An Update 2018. Pharmacopsychiatry, 51(5), 173–176. https://doi.org/10.1055/a-0627-7489
Wu, C.-S., Hsieh, M. H., Tang, C.-H., & Chang, C.-J. (2016). Comparative effectiveness of long-acting injectable risperidone vs. Long-acting injectable first-generation antipsychotics in bipolar disorder. Journal of Affective Disorders, 197, 189–195. https://doi.org/10.1016/j.jad.2016.03.043