Feb 23, 2024 NURS 6630 Assessing and Treating Patients With Bipolar Disorder
NURS 6630 Assessing and Treating Patients With Bipolar Disorder
A Sample Answer For the Assignment: NURS 6630 Assessing and Treating Patients with Bipolar Disorder
The DSM V describes Bipolar disorder as a group of mental disorders that result in extreme fluctuation in an individual’s mood, energy, and functioning. Bipolar disorder presents with intervals of deep, prolonged, and profound depression that alternate with intervals of mania characterized by an excessively elevated or irritable mood (APA, 2013). A manic episode represents a significant change from usual behavior. It manifests with at least three of the following symptoms: Inflated self-esteem or grandiosity, increased talkativeness, decreased need for sleep, racing thoughts, easy distraction, increase in goal-directed activity, and engaging in activities that have negative consequences (APA, 2013). This paper seeks to review a client with Bipolar disorder and outline the client’s treatment plan using a decision tree.
Case Study Overview
The case scenario depicts a 26-year-old woman of Korean descent on her first appointment after a 21-day hospitalization for acute mania. The client has been diagnosed with bipolar I disorder. Her current weight is 110 pounds, and her height is 5’ 5. She describes her mood as fantastic and mentions that she sleeps roughly 5 hours/night, but she hates sleep because it is not fun (Laureate Education, 2016). The client’s patient records show that she is in overall good health and her lab results are within normal limits.
However, genetic testing shows that she is positive for the CYP2D6*10 allele. The client admits that she stopped taking Lithium after being discharged two weeks ago. On MSE, the client is alert and oriented to person, place, time, and event. Her dressing is odd, and her speech is rapid, pressured, and tangential. Her self-reported mood is euthymic, and her affect is broad. She denies visual or auditory hallucinations, and she has no overt delusional or paranoid thought processes readily apparent (Laureate Education, 2016). Her insight is impaired, but she denies suicidal or homicidal ideation. She scores 22 on the Young Mania Rating Scale (YMRS).
Decision Point One
Begin Lithium 300 mg orally BID.
Struggling to Meet Your Deadline?
Get your assignment on NURS 6630 Assessing and Treating Patients With Bipolar Disorder done on time by medical experts. Don’t wait – ORDER NOW!
Meet my deadline
Why I Selected This Decision
Lithium is a mood stabilizer recommended for treating Mania in Bipolar disorder and maintenance therapy of bipolar disorder in persons with a history of mania. I selected Lithium because it targets unstable mood, which is the major symptom of mania (Won & Kim, 2017). Besides, mania is recommended as first-line therapy for long-term prevention of Bipolar disorder, particularly for euphoric mania.
I did not select Seroquel because it has documented side effects of dry mouth, fatigue, constipation, and dizziness, contributing to decreased medication compliance. Seroquel is also associated with increased appetite and weight and elevated triglycerides and total cholesterol levels (Shah et al., 2017). The side effects make it an inappropriate drug since the client is overweight. I did not select Risperdal since the patient was positive for the CYP2D6*10 allele. According to Puangpetch et al. (2016), the CYP2D6*10 allele slows the drug’s clearance resulting in high levels of Risperdal in the blood, causing sedation.
What I Was Hoping To Achieve By Making This Decision
I hoped that prescribing Lithium would stabilize the patient’s mood and reduce the severity of manic symptoms by at least 50% in the first four weeks of treatment. According to Won and Kim (2017), Lithium exerts mood-stabilizing effects by acting on cellular targets and exerting neuroprotective effects.
How Ethical Considerations May Impact the Treatment Plan and Communication with Patients
Ethical principles of nonmaleficence and beneficence may impact the treatment plan as the PMHNP has a duty to prevent harm and promote better patient outcomes. The PMHNP is obliged to assess a drug for its impact and potential side effects before prescribing it to ensure it will promote better outcomes and have no adverse consequences to the patient (Bipeta, 2019). In this case, the PMHNP assessed each drug’s potential side effects and selected the one associated with better outcomes and fewer adverse effects.
Decision Point Two
Assess rationale for non-compliance to elicit reason for non-compliance and educate the client on drug effects and pharmacology.
Why I Selected This Decision
I selected this decision because the client reported taking the medication “off and on” when she feels that she needs it. The decision aimed at understanding the primary cause for the patient not complying with the medication (Won & Kim, 2017). Besides, educating the patient on the possible side effects and pharmacology of Lithium would enlighten her on the drug’s impact in improving her health outcomes.
I did not increase Lithium to 450 mg because the non-compliance behavior would persist if the reasons for the behavior were not identified and addressed. Besides, it is crucial that the PMHNP assess a patient’s response to Lithium and associated side effects before increasing the dose (Won & Kim, 2017). I did not switch treatment to Depakote because the patient’s response to Lithium had not been established. According to Shah et al. (2017), the evidence for Depakote efficacy in acute depression is not as robust as that for Lithium.
What I Was Hoping To Achieve By Making This Decision
I was hoping that assessing and eliciting reason for non-compliance would help in identifying a practical solution to increasing compliance and eventually improve the manic symptoms. I was hoping that educating the patient on Lithium’s drug effects and pharmacology would enable her to understand the importance of adhering to treatment and increase her medication compliance.
How Ethical Considerations May Impact the Treatment Plan and Communication with Patients
The ethical principle of autonomy, which means that patients have a right to make decisions about their lives without interference from others, may impact the treatment plan. The PMHNP must respect the patient’s decision regarding her care which may impact the treatment interventions (Bipeta, 2019). In this case, the PMHNP had to elicit the rationale for the patient not complying with treatment, which determined the next intervention.
Bipolar I Disorder is a mental health condition characterized by episodes of mania and depression, with significant impact on the individual’s daily functioning. Effective treatment of this disorder is crucial to achieving stabilization of symptoms, preventing relapse, and improving overall quality of life.
Pharmacological interventions have been shown to be an effective treatment option for individuals with Bipolar I Disorder. This paper seeks to explore the prevalence and neurobiology of Bipolar I Disorder, as well as its diagnostic criteria and special populations and considerations. Additionally, we will explore the pharmacological treatment options, including the side effects, FDA approvals and warnings, and what to monitor in terms of labs and comorbid medical issues.
Prevalence and Neurobiology
Bipolar I Disorder is a serious mental health condition that is characterized by periods of manic episodes, depressive episodes, and sometimes mixed episodes. The prevalence of Bipolar I Disorder in the general population is estimated to be around 1% to 2%, making it a relatively rare condition. However, despite its rarity, it can have a significant impact on the lives of those who suffer from it and their loved ones.
Bipolar I Disorder affects men and women equally and typically develops in late adolescence or early adulthood (Carvalho et al., 2020). The neurobiology of Bipolar I Disorder is not yet fully understood, but research suggests that it may be caused by a combination of genetic, environmental, and biological factors.
Studies have shown that there are abnormalities in the structure and function of certain brain regions, including the prefrontal cortex, amygdala, and hippocampus, in individuals with Bipolar I Disorder. Additionally, imbalances in neurotransmitters such as dopamine, norepinephrine, and serotonin have been implicated in the development of this disorder.
Differences between Bipolar I Disorder and Bipolar II Disorder
Bipolar II Disorder is a related condition to Bipolar I Disorder, but the diagnostic criteria and symptom presentation differ. The main difference between these two disorders is the severity of the manic episodes (Jain & Mitra, 2022). In Bipolar II Disorder, the manic episodes are less severe and are classified as hypomanic episodes, while in Bipolar I Disorder, the manic episodes are more severe and can cause significant impairment in social, occupational, or other areas of functioning.
Another difference between these two disorders is the number of episodes required for diagnosis. Bipolar II Disorder requires at least one major depressive episode and at least one hypomanic episode, while Bipolar I Disorder requires at least one manic or mixed episode, which may be preceded or followed by a hypomanic or major depressive episode.
Special Populations and Considerations
Bipolar I Disorder is rare in children and adolescents, but it can occur. Holtzman et al. (2018) assert that diagnosing Biposal 1 in children and adolescents is challenging as the symptoms may overlap with other mental health conditions such as ADHD, conduct disorder, or substance use disorders. Treatment for children and adolescents with Bipolar I Disorder may include psychotherapy, medication, or a combination of both.
Individuals with Bipolar I Disorder may experience legal issues, such as arrest or incarceration, as a result of their symptoms. It is important for mental health professionals to be aware of the legal implications of this disorder and to advocate for their clients when necessary. For example, a person experiencing a manic episode may engage in impulsive and reckless behavior, which could lead to legal trouble. Mental health professionals may need to work with legal professionals to ensure that their clients are treated fairly and receive appropriate care.
NURS 6630 Assessing and Treating Patients With Bipolar Disorder
Social determinants of health that might affect adolescents’ diagnosis and treatment of Bipolar 1 disorder include access to healthcare services, family support systems, poverty levels, educational attainment, cultural beliefs about mental health and stigma around seeking help. Additionally, social factors such as peer pressure can also have an impact on adolescents’ ability to seek proper diagnosis and treatment for their condition (Latifian et al., 2023).
Mental health professionals working with individuals with adolescents with Bipolar I disorder must ensure that they provide informed consent for treatment, respect their autonomy, and maintain confidentiality. Additionally, they should be aware of the potential for boundary violations in the context of manic or hypomanic episodes. For example, a therapist may need to set clear boundaries around communication during a manic episode to avoid blurring the professional relationship.
Women with Bipolar I Disorder may experience unique challenges during pregnancy and postpartum. Some medications used to treat this disorder may be harmful to a developing fetus, and women may be at increased risk of relapse during this time. Mental health professionals working with pregnant or postpartum women with Bipolar I Disorder must carefully balance the risks and benefits of medication use and provide support and resources to these women and their families.
Legal aspects such as balancing medication needs against risks posed toward the fetus must be considered alongside ethical concerns like drug transmitting through breast milk which could potentially impact infant development. Cultural elements such as fear of judgement or being stigmatized leading women to not seek medical attention when needed. Social determinants like access to healthcare services or lack thereof would also contribute towards a mother’s ability in managing her condition during these times according (Bergink et al., 2018).
Bipolar I Disorder can also occur in older adults, but it may be underdiagnosed and undertreated in this population. Symptoms of this disorder may be mistaken for normal age-related changes in cognition. Mental health professionals working with older adults with Bipolar I Disorder must be aware of the unique challenges and considerations in this population, including the increased risk of medication side effects and potential interactions with other medications.
Cultural challenges would encompass belief systems on mental health issues, and the effect of religiosity which could impede some individuals from seeking healthcare services. Social determinants of health such as insurance for older adults and limited access to care could affect delivery of care (Ryan et al., 2020).
When dealing with emergency care, legal considerations for bipolar 1 disorder include the need for involuntary commitment if the patient poses a danger to themselves or others. Ethical considerations may include balancing the patient’s autonomy with their treatment needs, and considering potential risks such as over-medication.
Social determinants of health that might affect diagnosis and treatment could include poverty levels, limited access to healthcare resources, social isolation, and stigma around mental illness in certain cultures. Cultural beliefs about mental health can also play a role in diagnosis and treatment decisions for individuals with bipolar 1 disorder (Ostacher, 2019).
FDA and Clinical Practice Guidelines Approved Pharmacological Treatment Options
The FDA and clinical practice guidelines have approved several pharmacological treatment options for Bipolar I Disorder. The choice of medication and treatment regimen will depend on the severity of symptoms and the phase of the illness. For acute manic or mixed episodes, mood stabilizers such as lithium, valproate, or carbamazepine are typically the first-line treatment.
These medications help to reduce the severity and duration of manic symptoms and prevent relapse. Second-generation antipsychotics such as risperidone, olanzapine, or quetiapine may also be used as adjunctive therapy or as monotherapy in cases where mood stabilizers are ineffective or not well-tolerated (American Psychiatric Association, 2021).
According to the American Psychiatric Association (2021), maintenance treatment for Bipolar 2 would have mood stabilizers as the first-line treatment to prevent future episodes of mania or depression. Lithium, valproate, and carbamazepine have all been shown to be effective in reducing the risk of relapse in individuals with Bipolar I Disorder.
Second-generation antipsychotics such as aripiprazole and quetiapine are also effective in reducing the risk of relapse and may be used as an adjunct to mood stabilizers. In addition to mood stabilizers and antipsychotics, antidepressants may also be used in the treatment of Bipolar I Disorder, but they must be used with caution due to the risk of inducing manic or mixed episodes. Antidepressants should only be used as adjunctive therapy to mood stabilizers or antipsychotics in cases of severe depressive symptoms.
Side Effects, FDA Approvals and Warnings
Medication treatment for Bipolar I Disorder can be effective, but it is important to be aware of potential side effects, FDA approvals and warnings, as well as what to monitor in terms of labs and comorbid medical issues. Side effects vary depending on the medication used. Lithium, for example, may cause side effects such as tremors, increased thirst and urination, weight gain, and kidney problems (McIntyre et al., 2020).
Valproate may cause nausea, tremors, hair loss, and liver problems. Second-generation antipsychotics may cause side effects such as weight gain, sedation, movement disorders, and metabolic changes. Patients should be informed of potential side effects and instructed to report any new or worsening symptoms to their healthcare provider.
FDA approvals and warnings also vary by medication. For example, lithium has an FDA-approved indication for the treatment of acute manic and mixed episodes of Bipolar I Disorder and for maintenance treatment of Bipolar I Disorder. However, it has a boxed warning for the risk of toxicity, particularly in the elderly and those with renal or cardiac impairment (McIntyre et al., 2020).
Antipsychotics have an FDA-Approved indication for the treatment of acute manic and mixed episodes of Bipolar I Disorder and for maintenance treatment of Bipolar I Disorder. However, they also carry warnings for potential metabolic side effects such as weight gain, hyperlipidemia, and hyperglycemia.
Lithium levels should be checked regularly to ensure that levels are within therapeutic range and to monitor for potential toxicity (Chen et al., 2021). Additionally, kidney function and electrolyte levels should be monitored. Valproate levels should also be monitored, along with liver function tests. Antipsychotics may require monitoring for metabolic side effects such as weight gain, glucose levels, and lipid levels.
Examples of Proper Prescription writing for Medications Used in Bipolar I Disorder for a Start Dose for Adults
Example 1Example 2Example 3Date: April 2, 2023 Medication: Lithium Carbonate Strength: 300 mg Formulation: Tablet Route: Oral Frequency: 3 times per day Duration: Ongoing Indication: Bipolar 1 disorder Quantity: 60 tablets Refill: Thrice Provider Signature: Dr. Landon, ChristineDate: April 2, 2023 Medication: Quetiapine Fumarate Strength: 50mg Formulation: Tablet Route: Oral Frequency: Once at bedtime Duration: Ongoing Indication: Bipolar 1 disorder Quantity: 30 tablets Refill: Two Provider Signature: Dr. Nawbary, WallyDate: April 2, 2023 Medication: Depakene ER Strength: 250mg Formulation: Tablet Route: Oral Frequency: Twice (morning and bedtime) Duration: Ongoing Indication: Manic episodes linked to Bipolar 1 disorder Quantity: 30 tablets Refill: Two Provider Signature: Dr. Smith, Lakeycia
Conclusion
Bipolar I Disorder is a complex mental health condition that requires careful diagnosis and management. Pharmacological interventions have been shown to be an effective treatment option for individuals with Bipolar I Disorder, but it is important to consider potential side effects, FDA approvals and warnings, and what to monitor in terms of labs and comorbid medical issues. In addition, it is important to consider special populations and considerations such as children, adolescents, pregnancy/post-partum, older adults, and emergency care.
Effective treatment of Bipolar I Disorder can help individuals achieve stabilization of symptoms, prevent relapse, and improve overall quality of life. By understanding the neurobiology, diagnostic criteria, and pharmacological treatment options, healthcare providers can develop individualized treatment plans to help their patients manage their symptoms and achieve greater stability.
References
American Psychiatric Association. (2021). Practice guidelines for the treatment of patients with bipolar disorder. https://doi.org/10.1176/appi.books.9780890426760
Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66. https://doi.org/10.1056/nejmra1906193
Chen, P., Hsiao, C., Chiang, S., Shen, R., Lin, Y., Chung, K., & Tsai, S. (2021). Cardioprotective potential of lithium and role of fractalkine in euthymic patients with bipolar disorder. Australian & New Zealand Journal of Psychiatry, 57(1), 104-114. https://doi.org/10.1177/00048674211062532
Jain, A., & Mitra, P. (2022). Bipolar affective disorder. In StatPearls [Internet]. StatPearls Publishing. https://doi.org/10.1007/springerreference_33704
Latifian, M., Abdi, K., Raheb, G., Islam, S. M. S., & Alikhani, R. (2023). Stigma in people living with bipolar disorder and their families: a systematic review. International Journal of Bipolar Disorders, 11(1), 1-20. https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-023-00290-y
McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856. https://doi.org/10.1016/s0140-6736(20)31544-0
Ostacher, M. J. (2019). Ethical Issues in the Diagnosis and Treatment of Bipolar Disorders. The Journal of Lifelong Learning in Psychiatry, 17(3), 265-268. https://doi.org/10.1176/appi.focus.20190010
Ryan, K. A., Wilkins, K. M., & Huxley, N. A. (2020). Bipolar disorder in older adults: a critical review. The American Journal of Geriatric Psychiatry, 28(2), 166-178. Doi: 10.1016/j.jagp.2019.11.00
Wisner, K. L., Sit, D., O’Shea, K., Bogen, D. L., Clark, C. T., Pinheiro, E., … & Ciolino, J. D. (2019). Bipolar disorder and psychotropic medication: Impact on pregnancy and neonatal outcomes. Journal of affective disorders, 243, 220-225. DOI: 10.1016/j.jad.2018.09.045
Bipolar disorder has been a common illness in the recent past. The increase in the cases of patients suffering from this disorder has been compelling scientists to delve much into clinical and evidence-based practices that could be significant in addressing the health issue. Bipolar disorder is severe, affecting about 1 to 2% of adults. The symptoms of this disorder range contingent on the episode type.
While other patients could be showing signs and symptoms related to maniac bipolar, others might show signs related to depressive bipolar (Chen et al., 2015). Each episode or stage defines a definite change in the action and moods of an individual. The disorder could be defined by a sudden change in the patient’s general moods, thinking, and behavior. Therefore, a patient facing these bipolar symptoms needs close monitoring for a better outcome (Van Meter et al., 2019).
PMHNP nurses should therefore be able to assess their patients comprehensively to discover the prevailing symptoms resulting from developmental or psychological issues. Therefore, the purpose of this assignment is to look into a 26-year-old female with Korean ancestry presenting symptoms of bipolar and make decisions related to medications
Introduction to the Case
The case in question is about a 26-year-old female of Korean lineage. The client presented herself to the clinic after 21-day hospitalization with a condition of acute mania. bipolar 1 disorder was later confirmed. The patient reported a fantastic mood and a five-hour sleep at night. The patient’s hospital records showed good health.
The patient had genetic testing that showed that she was CYP2D6*10 positive. The patient is an alert and oriented person. She had rapid speech and denied visual or auditory hallucinations. The patient refutes being suicidal or murderous. A score of twenty two was shown on the YMRS
Decision #1
The selected decision
The first decision made on the patient was to begin the treatment with Risperdal 2mg taken orally in the morning and evening. Risperdal is one of the best medications for treating severe bipolar disorder.
This drug belongs to the chemical class of benzisoxazole derivatives, which is an antipsychotic (Nestsiarovich et al., 2021). The FDA has approved this drug, which helps patients think clearly and perform their daily activities normally. These features of Risperdal make it effective in treating bipolar disorder.
Why the Other Two Decisions were Not Selected
The other two decisions were to use lithium 300mg orally and Seroquel XR 300mg orally at HS. The patient had been introduced to lithium 300mg, and it did not change her condition. Again, Seroquel XR 300mg could not be used because of the immense side effects that would affect the patient’s condition because she is of Asian origin.
I selected Risperdal because it has been effective in treating schizophrenia, and evidence proves that its works effectively with the brain by enabling the brain to stabilize. For instance, Risperdal restabilizes serotonin and dopamine levels, further improving mood, thinking, and behavior (Hodkinson et al., 2021). While the drug belongs to the class of drugs called antipsychotics, it has been effective in treating patients diagnosed with bipolar disorder and irritability. The patient shows the severe effect of bipolar disorder that would first need a strong to stabilize her dopamine levels.
How Ethical Considerations May Impact the Treatment Plan
While the treatment plan focuses on improving the patient’s condition, the choice of the treatment plan is affected by ethical principles (American Psychiatric Association, 2018). For example, autonomy an
Order a similar assignment, and have writers from our team of experts write it for you, guaranteeing you an A
