Feb 23, 2024 NURS 6630 Examine Case Study Asian American Woman Diagnosis Bipolar Disorder
NURS 6630 Examine Case Study Asian American Woman Diagnosis Bipolar Disorder
A Sample Answer For the Assignment: NURS 6630 Examine Case Study Asian American Woman Diagnosis Bipolar Disorder
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.
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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.
NURS 6630 Examine Case Study Asian American Woman Diagnosis Bipolar Disorder
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.
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
BACKGROUND INFORMATION
The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.
Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”
She weights 110 lbs. and is 5’ 5”
SUBJECTIVE
Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”
You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. 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 CYP2D6*10 allele.
Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.
MENTAL STATUS EXAM
The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.
The Young Mania Rating Scale (YMRS) score is 22
RESOURCES
Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (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, 71(7), 835-841. doi:10.1007/s00228-015-1855-6
Decision Point One
Select what you should do:
Begin Lithium 300 mg orally BID
Begin Risperdal 1 mg orally BID
Begin Seroquel XR 100 mg orally at HS
Decision Point One
Begin Lithium 300 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client informs you that she has been taking her drug “off and on” only when she “feels like she needs it”
Today’s presentation is similar to the first day you met her
NURS 6630 Examine Case Study Asian American Woman Diagnosis Bipolar Disorder
Decision Point Two
Select what you should do next:
Increase Lithium to 450 mg orally BID
Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology
Switch to Depakote ER 500 mg orally at HS
Decision Point One
Begin Lithium 300 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client informs you that she has been taking her drug “off and on” only when she “feels like she needs it”
Today’s presentation is similar to the first day you met her
Decision Point Two
Increase Lithium to 450 mg orally BID
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client returns reports that she is still taking the medication when she feels that she needs it
She remains quite manic and reports that her family is getting really upset because she likes to play her new guitar at night
Decision Point Three
Select what you should do next:
Assess for rationale for non-compliance and educate client
Consider hospitalization
Change to abilify 10 mg orally at HS
Decision Point One
Begin Lithium 300 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client informs you that she has been taking her drug “off and on” only when she “feels like she needs it”
Today’s presentation is similar to the first day you met her
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Decision Point Two
Increase Lithium to 450 mg orally BID
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client returns reports that she is still taking the medication when she feels that she needs it
She remains quite manic and reports that her family is getting really upset because she likes to play her new guitar at night
Decision Point Three
Assess for rationale for non-compliance and educate client
Guidance to Student
You should further assess for dangerousness to self or others. The client should be assessed for self-care, to including hygiene, eating, sleeping, etc. Hospitalization may be indicated if the client remains non-compliant and is a danger to self. If the client is not a danger to self, and hospitalization is not indicated, you needs to assess for rationale for non-compliance. Many clients enjoy mania as it is a nice feeling to be consistently happy. When clients are successfully treated for mania, they often describe themselves as feeling ‘down’ or ‘flat.’
You need to assess for depression at this point as opposed to normalization of mood. Abilify is also FDA approved as monotherapy for mania and mixed presentations, but at a dose of 15 mg. day., so although you may be tempted to begin Abilify- be certain to use correct dose. Also, because it can be “activating” you need to dose this drug in the morning. However, the client is non-compliant and therefore, eliciting reasons for non-compliance is essential to the care of this client.
Decision Point One
Begin Risperdal 1 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client is accompanied today by her mother who must help the client into your office, the client looks very sedated and lethargic
Client’s mother explains that “she has been like this since about a week after the last office visit”
Decision Point Two
Discontinue Risperdal and start Lithium sustained release 300 mg orally BID
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client no longer lethargic after the end of the first week
Client has a slight decrease in her Young Mania Rating Scale (from 22 to 19)
Client reports that her sleep is again decreasing, but that overall, she is happy
Decision Point Three
Increase Lithium SR to 450 mg orally BID
Guidance to Student
Recall that the client is of Korean descent and is positive for CYP2D6*10 allele. As a result, she may be demonstrating slower clearance of Risperdal from her system, resulting in higher than normal levels of Ris
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