Feb 23, 2024 Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630
Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630
A Sample Answer For the Assignment: Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630
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.
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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.
Assignment Assessing and Treating Patients With Bipolar Disorder NURS 6630
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
Introduction to the Case Study
Bipolar disorder is one of the mental health problems with high prevalence globally. Bipolar disorder is characterized by the presence of episodes of neuropsychological deficits, mood disturbances, physiological changes, immunological deficiencies and disturbances in the normal functioning. Bipolar disorder has been considered to be among the leading cause of disability globally.
The disorder also contributes to premature mortality due to medical comorbidities as well as suicide (Rowland & Marwaha, 2018). Genetics has largely been considered to play the critical role in the development of bipolar disorder. The role of genetics can be seen in the high risk of the development of bipolar disorder in individuals born to families with history of the disease.
Environmental factors have also been shown to play a role in the development of bipolar disorder. For example, infectious agents during the prenatal period such as Epstein-Barr virus and varicella zoster virus have been shown to increase the risk of bipolar disorder. Additional factors such as childhood maltreatment, psychological stressors, substance abuse, and medical comorbidities also increase the risk of the development of bipolar disorder (Ferrari et al., 2016).
Therefore, this paper is an analysis of the decisions that should be adopted in treating a client with bipolar disorder. The client is a 26-year old Korean woman with a diagnosis of bipolar I disorder. The client reported having fantastic mood and hating sleep. The client tested positive for CYP2D6*10 allele. She stopped taking lithium after being prescribed two weeks ago.
Mental status examination showed that the client was alert, dressed oddly, with rapid speech and euthymic mood. The client also had a rating score of 22 in the Young Mania Rating Scale. These findings inform the diagnosis of the patient with bipolar I disorder.
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. 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.
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.
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).
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.
Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630
Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 4430
Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders.
Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.
To get ready for this assignment, do the following:
Examine this week’s Learning Resources, including the Medication Resources listed.Consider the psychopharmacologic treatments you might prescribe for the examination and treatment of bipolar patients.The assignment is 5 pages long.
Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 4430
Take a look at Case Study: An Asian American Woman. Bipolar Disorder was diagnosed. You will be required to make three decisions on the medication to be prescribed to this patient. Take into account any circumstances that may have an impact on the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, consider all choices before making your choice and continuing on with the activity. Choose certain that you have thoroughly examined each alternative and that you have evaluated the decision that you will make. Make careful to conduct primary literature study on each option.
The Case’s Introduction (1 page)
Explain and summarize the case for this Assignment in a few sentences. When recommending medication for this patient, make sure to note any specific patient variables that may influence your decision.First decision (1 page)
Which option did you choose?
Why did you make this choice? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.Why didn’t you choose the other two options presented in the exercise? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.What were your intentions in making this decision? Provide evidence and references to the Learning Resources to back up your response (including the primary literature).Explain how ethical issues may affect your treatment approach and patient communication. Provide specifics and instances.
Decision No. 2 (1 page)
Why did you make this choice? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.Why didn’t you choose the other two options presented in the exercise? Be detailed in your response and back it up with clinically relevant and patient-specific resources, such as original literature.What were your intentions in making this decision? Provide evidence and references to the Learning Resources to back up your response (including the primary literature).Explain how ethical issues may affect your treatment approach and patient communication. Provide specifics and instances.Third decision (1 page)
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