Feb 23, 2024 Assignment: Clients with With Bipolar Disorder
Assignment: Clients with With Bipolar Disorder
Assignment: Clients with With Bipolar Disorder
Bipolar disorder is one of the mental health problems with considerable impacts on the global population. Bipolar disorder patients experience distressing symptoms that affect their health, well-being, and functioning. Healthcare providers must adopt treatment interventions that address the prioritized health needs of their patients and promote safety, quality, and efficiency outcomes. Evidence-based data inform the care interventions for patients with bipolar disorder. Therefore, this essay examines the prevalence and neurobiology of bipolar I disorder, its differences from bipolar II disorder, special considerations, clinical practice guidelines, side effects, and monitoring patients prescribed different treatments.
Prevalence and Neurobiology of Bipolar I Disorder
Bipolar I disorder is the selected disorder for analysis in this paper. Bipolar I disorder is one of the subtypes of bipolar disorder. Patients who are affected by bipolar I disorder experience episodes of neuropsychological deficits, severe mood disturbances, functioning impairment, and physiological changes. Data obtained from epidemiological studies reveal that the lifetime prevalence of bipolar I disorder is about 1% in the entire population. The overall lifetime prevalence of an individual being affected by bipolar I disorder is 0.6% and 2.4% for bipolar spectrum disorders. When compared to other bipolar spectrum disorders, bipolar I disorder has the lowest prevalence of all (McIntyre et al., 2020). However, the United States of America has a 1% higher prevalence rate of bipolar disorder when compared to other developed countries.
Bipolar I disorder has a neurobiological basis. Studies agree that an interaction between genetic factors and environmental factors precipitate bipolar I disorder. Environmental factors such as traumatic events and stress trigger the development of bipolar I disorder in individuals with a genetic predisposition. Besides the interaction, dysfunction in different intracellular cascades in the brain also contributes to bipolar disorder. This includes an imbalance in the different neurotransmitters that regulate emotions in the brain (Scaini et al., 2020).
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Mitochondrial dysfunction and oxidative stress also increase the risk of bipolar I disorder. The dysfunction and stress cause considerable impairment in neuronal plasticity, hence, the damage and loss of brain tissue. Studies have also revealed that patients with bipolar disorders have altered peripheral biomarkers related to inflammation, neurotrophins, hormones, and oxidative stress (Young & Juruena, 2021). The alteration explains the physiological, emotional, immunological, and functional impairments seen in patients with bipolar disorders.
Differences Between Bipolar I and Bipolar II Disorders
Bipolar I disorder differs from bipolar II disorder. According to DSM-5, a diagnosis of bipolar I disorder is reached if a patient presents to the hospital with symptoms of a manic episode. The symptoms include abnormally and persistently elevated irritable or expansive mood and abnormal engagement in goal-directed activity with high energy levels lasting at least a week. The symptoms persist most days almost every day (McIntyre et al., 2020). Patients have symptoms such as inflated self-esteem, insomnia, talkativeness, flight of ideas, easy distractibility, and increased involvement in harmful activities during this period.
Patients with bipolar II disorder present to the hospital with symptoms that meet at least a major depressive and hypomanic episode. They also do not have a history of manic episodes. Hypomania and depressive episodes cannot be attributed to other causes such as schizophrenia, schizoaffective disorder, or delusional disorder among other mental health problems. The symptoms of hypomania episodes are similar to those of mania in bipolar I disorder. However, a difference lies in their duration. In bipolar II disorder, the hypomania symptoms should last at least four consecutive days, most of the days, and almost every day (Angst et al., 2019). In both disorders, the symptoms should not be attributed to other causes such as substance abuse, medication use, or other mental health problems.
Special Populations and Special Considerations
Children, adolescents, pregnant and post-partum mothers, and older adults are special populations that must be treated with care when diagnosed with bipolar I disorder. Diagnosis of bipolar I disorder in children and adolescents is difficult because of the existence of comorbidities. Often, they present to the hospital with mixed or atypical features of bipolar spectrum disorders such as irritability, rapid cycling of symptoms, and labile mood. They might also have other coexisting problems such as substance abuse, which makes it challenging to diagnose bipolar affective spectrum disorders. Adolescents might also present with symptoms such as paranoia, bizarre behaviors, and incongruent mood, which makes diagnosis difficult. Therefore, practitioners should emphasize the context of symptom occurrence during screening and use the DSM-5 diagnostic tool to develop accurate diagnoses (Gautam et al., 2019). In addition, tools such as the Kiddie Schedule for Affective Disorders and Schizophrenia should be used to overcome difficulties in diagnosis.
The typical onset of bipolar spectrum disorders is in the early twenties. This means that its occurrence overlaps with pregnancy and childbirth periods. The risk of bipolar I disorder relapse among pregnant and post-partum women is high because of hormonal factors, medication discontinuation, and distressing experiences such as sleep deprivation during these periods. Treatment of bipolar spectrum disorders during pregnancy and the post-partum period is also associated with considerable ethical and clinical issues (Singh & Deep, 2022). Healthcare providers must weigh the risks and benefits of bipolar treatments to the unborn fetus and relapse of bipolar I disorder.
A diagnosis of bipolar I disorder among older adults is challenging for most practitioners. This is because of the underestimated incidence of bipolar I disorder in this population and the limited applicability of DSM5 and ICD10 to this population. Practitioners might also misjudge older adults for other conditions since physical illnesses produce symptoms seen in most mental health problems. There is also an increased risk of harm from pharmacological treatments due to polypharmacy among the elderly population (Ljubic et al., 2021). Physiological changes with aging such as decreased drug absorption, metabolism, and elimination also affect bipolar I disorder treatment in older adults. For instance, older adults have diminished drug-binding ability to plasma due to low albumin, which increases the risk of adverse drug reactions among them. Therefore, practitioners must weigh the benefits and risks of the different treatments to ensure safety and quality outcomes in the treatment process.
Some of the ethical considerations that inform nurse practitioners’ decisions in treating bipolar I disorder in the above vulnerable populations include the promotion of patient autonomy, beneficence, non-maleficence, and data integrity. For example, weighing the risks of pharmacological treatments for bipolar I disorder on the developing fetus in pregnant women aims at ensuring safety, hence, non-maleficence. Practitioners must also provide care within their areas of specialization and by state laws to avoid legal issues such as malpractice in the care of patients with bipolar I disorder. Cultural practices affect the uptake and utilization of different treatments for bipolar I disorder. For example, practices during pregnancy rooted in culture might result in poor treatment adherence among mothers with bipolar I disorder (Singh & Deep, 2022). Practitioners should strive to address social determinants of health such as costs, access, and availability of mental health services to improve health outcomes for vulnerable populations.
FDA and/or Clinical Practice Guidelines
A range of drug options is available for treating bipolar I disorder. They include mood stabilizers, antidepressants, antipsychotics, and somatic treatments. Mood stabilizers include lithium, divalproex, lamotrigine, topiramate, and gabapentin. Antidepressants include tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, mirtazapine, and bupropion. Antipsychotics include first and second generation antipsychotics (Rhee et al., 2020). Clinical practice guidelines recommend the use of monotherapy or a combination of lithium, lamotrigine, quetiapine, olanzapine-fluoxetine combination, valproate+lithium, valpropate+antidepressant in the acute stage. It also recommends combination therapy comprising a mood stabilizer/antipsychotics+antidepressants for acute bipolar I disorder. Maintenance therapy is achievable with olanzapine, risperidone, and valproate or lithium, lamotrigine, and antipsychotics with a focus on dose optimization (Fountoulakis et al., 2020). The FDA has approved olanzapine plus fluoxetine combination, quetiapine, cariprazine, lurasidone, and lumateperone for treating bipolar spectrum disorders.
Side Effects, FDA Warnings, and Monitoring
Patients prescribed the above treatments should be monitored for side and adverse effects. Antidepressants are associated with side effects that include insomnia, decreased libido, and weight gain. Patients should be monitored for adverse effects such as suicidal thoughts and serotonin syndrome. Antipsychotics are associated with side effects such as dizziness, dry mouth, dyskinesia, and sedation. Patients should be monitored for adverse reactions such as heart rhythm changes through scheduled electrocardiography tests. Patients who have been prescribed lithium should be monitored for nausea, diarrhea, excessive urination, and vomiting since they predispose patients to lithium toxicity (Hedya et al., 2023).
Examples of Proper Prescription
Name:
Age: 55 years
Diagnosis: Bipolar I disorder
Treatment
Oral fluoxetine 20 mg once daily 1/12
Refills: None
Date:
Name and signature
Name:
Age: 25 years
Diagnosis: Bipolar I disorder
Treatment
Oral lithium 600 mg twice daily 2/52
Refills: None
Date:
Name and signature
Name:
Age: 34 years
Diagnosis: Bipolar I disorder
Treatment
Oral lamotrigine 200 mg once daily 1/52
Refills: None
Date:
Name and signature
Conclusion
In summary, this paper has examined the prevalence and neurobiology of bipolar I disorder. It is evident from the analysis that bipolar I disorder differs from bipolar II disorder. Practitioners should be aware of the special considerations for vulnerable populations. Different medications can be used in acute and maintenance treatment for bipolar I disorder. Patients should be monitored for side and adverse effects of the different treatments.
References
Angst, J., Rössler, W., Ajdacic-Gross, V., Angst, F., Wittchen, H. U., Lieb, R., Beesdo-Baum, K., Asselmann, E., Merikangas, K. R., Cui, L., Andrade, L. H., Viana, M. C., Lamers, F., Penninx, B. W., de Azevedo Cardoso, T., Jansen, K., Dias de Mattos Souza, L., Azevedo da Silva, R., Kapczinski, F., … Vandeleur, C. L. (2019). Differences between unipolar mania and bipolar-I disorder: Evidence from nine epidemiological studies. Bipolar Disorders, 21(5), 437–448. https://doi.org/10.1111/bdi.12732
Fountoulakis, K. N., Yatham, L. N., Grunze, H., Vieta, E., Young, A. H., Blier, P., Tohen, M., Kasper, S., & Moeller, H. J. (2020). The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder. International Journal of Neuropsychopharmacology, 23(4), 230–256. https://doi.org/10.1093/ijnp/pyz064
Gautam, S., Jain, A., Gautam, M., Gautam, A., & Jagawat, T. (2019). Clinical Practice Guidelines for Bipolar Affective Disorder (BPAD) in Children and Adolescents. Indian Journal of Psychiatry, 61(Suppl 2), 294–305. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_570_18
Hedya, S. A., Avula, A., & Swoboda, H. D. (2023). Lithium Toxicity. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK499992/
Ljubic, N., Ueberberg, B., Grunze, H., & Assion, H.-J. (2021). Treatment of bipolar disorders in older adults: A review. Annals of General Psychiatry, 20, 45. https://doi.org/10.1186/s12991-021-00367-x
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
Rhee, T. G., Olfson, M., Nierenberg, A. A., & Wilkinson, S. T. (2020). 20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings. American Journal of Psychiatry, 177(8), 706–715. https://doi.org/10.1176/appi.ajp.2020.19091000
Scaini, G., Valvassori, S. S., Diaz, A. P., Lima, C. N., Benevenuto, D., Fries, G. R., & Quevedo, J. (2020). Neurobiology of bipolar disorders: A review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings. Brazilian Journal of Psychiatry, 42(5), 536–551. https://doi.org/10.1590/1516-4446-2019-0732
Singh, S., & Deep, R. (2022). Pharmacological treatment of bipolar disorder in pregnancy: An update on safety considerations. Indian Journal of Pharmacology, 54(6), 443–451. https://doi.org/10.4103/ijp.ijp_407_21
Young, A. H., & Juruena, M. F. (2021). The Neurobiology of Bipolar Disorder. In A. H. Young & M. F. Juruena (Eds.), Bipolar Disorder: From Neuroscience to Treatment (pp. 1–20). Springer International Publishing. https://doi.org/10.1007/7854_2020_179
Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for clients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) clients 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 client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with bipolar disorder.
Learning Objectives
Students will:Assess client factors and history to develop personalized plans of bipolar therapy for clientsAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapyEvaluate efficacy of treatment plansAnalyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespan ..
Assignment: Clients with With Bipolar Disorder
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.
At each decision point stop to complete the following:
Decision #1Which decision did you select?Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?Decision #2Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?Decision #3Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?you can use my sample/ edit or do a new assignment.you can edit or use my sample with same medication therapy.
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2 Assessing and Treatment for Bipolar Disorder Patient Introduction Bipolar disorder is not an uncommon illness. It is a very chronic and severe mental disorder, affecting approximately 1-2% of the adult population. The signs and symptoms of bipolar disorder are different depending on the type of episode (i.e., manic or depressive). Each episode marks a critical change from the way a person usually acts and their typical mood, and can be characterized by a sudden change in the general attitude of the patient, the way the patient thinks and the behavior. 1 The changes will be sudden that it will be noticed by people around (Robert et al., 2017). This dangerous demonstrative unpredictability mood disorder can be found in all area of life, that is, from the poor to the rich, this disorder affects millions of people in all facets of life (Robert et al., 2017). Bipolar disorder can be seen mostly in the age starting at 25years or older, but it is not totally absent in the teenage age. It shows that about 2.6 percent of the population are diagnosed as bipolar. 3 (National Alliance on Mental Illness, 2017).
If not well treated ,Bipolar disorder can be critical; 1 early identification of symptoms with an appropriate treatment plan may include psychotherapy, medications, a healthy lifestyle and a regular schedule will keep the patient healthy (National Alliance on Mental Illness. (2017). 1 The NP should have a good understand of this disorder to be able to take care of this the patient because of its long-term management and how it affects the health in totality (National Alliance on Mental Illness. (2017). 1 My focus of this paper will look into an Asian American Woman with a bipolar disorder, symptoms management, diagnosing the symptom, and the complete treatment. The paper will consider the most safe and appropriate options of treatment and the outcome as the treatment, and care.
Decision Selected My patient is an Asian American woman age 39 years with 4 children and 3 ground children. The husband notices that sometimes she will be singing loud to the top of her voice and dancing not to the music she sang. In another time she will just fill like not doing anything and nothing will interest her, and she will lay on the bed for hours without going to the business she spent her years building and love so much.Patient is withdrawn and non-interactive. 4 She is diagnosed Bipolar disorder.
1 Decision # 1 Reason Selected My best treatment of choice for this disorder will be to begin Risperdal 2 mg orally twice a day. Risperdal is the best choice to treat bipolar disorder. (Lee et al., 2011). Risperdal called risperidone is in the chemical class benzisoxazole derivatives which are antipsychotic. It is an effective medication for bipolar disorder (Lee et al., 2011). The reasons of choosing Risperdal is because it is used to treat schizophrenia and the risperidone works with the brain to stabilize the brain (Lee et al., 2011). Risperidone rebalances dopamine and serotonin to improve thinking, mood, and behavior. Risperidone belongs to a class of drugs called atypical antipsychotics approved by U.S. Food and Drug Administration (FDA) The drug is also used to treat symptoms of bipolar disorder and irritability (NAMI, 2017).
Expected Results We will need to have some subjective and objective changes. 1Patient should be able to verbalize changes within the first month of the treatment.
During the next visit with the patient after one month, she is expected to express changes in the clarity of her brain. The freedom from indistinctness or ambiguity because of the medicine will help her to balance certain natural substances in her brain.She should also notice a change in her ability to concentrate on her activities (Lee et al., 2011). No side effects.
Differences between Expected outcome and Actual outcome Patient came back after a month (4 WEEKS) and report that she experiences some improvement in the symptom including some improvement with concentration. My patient reported some drowsiness. 1 Drowsiness is one of the side effect of high dose of Risperdal. The genetic testing, reveals that she is positive for CYP2D6. Asians are more likely to have decreased CYP2D6 activity compared to Caucasians (Lee et al., 2011). I will reduce the dosage of this medication. 1 A positive outcome should be that there was a little bit of improvement in symptoms, patient able to sleep, more concentration. Patient and family report drowsiness during the day time which is one the side effect of high dose Risperdal.
Decision Point Two Reason Selected The next best option is not to discontinue Risperdal, but to lower dose to Risperdal 1 mg orally at hours of sleep (HS) since expected outcome was not achieved based on decision one. My patient and , her family reported that patient has been drowsy during the day because of Risperdal 2mg. I will continue on Risperdal because the patient confirm improvement on the symptoms and the side effect observed was a regular adverse reaction because of her descendant background (American Psychiatric Association, 2017). The reduction to Risperdal 1mg BID to Risperdal 1 mg will be closely monitor.
Expected Results Risperdal 1mg orally at bedtime is a reduced dosage from the 2mg which is expected to eliminate the drowsiness and toxicity in the patient Stahl, (2013).The patient is expected to continue to have decrease in the bipolar symptom. The effect of the medication should be observable and notice by the family member as a testimony (American Psychiatric Association, 2017).
Differences between Expected outcome and Actual outcome During the patient four weeks follow up examination shows that the bipolar disorder symptom dissipated to noticeable level. This indicate a therapeutic effect of Risperdal 1mg at night brought about the therapeutic effect on the patient and patient is tolerating and adjusting to the medication in a positive way (Dean, 2017). The patient did not experience the drowsiness and there was no toxicity, therefore the expected result and the actual result were the same. Risperdal therapy will continue with this medication and the dosage, and a close monitoring will still be needed until the next four weeks appointment (Dean, 2017).
Decision Point Three Decision Selected Risperdal 1mg orally at HS will be continued Reason for Selection The decision to continue with the medication was because the desire result, and the actual result are in pari-passu. To change the current medication or tamper with the dosage may offset the patient and thereby destabilize the rate of her healing (Dean, 2017). The patient is still under assessment and close monitoring continue until the next appointment date.
Expected Results It is expected that the patient will increase in good mental stability and continue to maintain reduction in bipolar disorder symptom with the dosage of Risperdal 1mg at night (Robert et al., 2017). The patient is anticipated to having good sleep at night and well improve in her interaction with relatives and friends, with ability to concentrate on matters that concern her and carrier (Robert et al., 2017).
Differences between Expected outcome and Actual outcome The therapeutic decision is working in this patient in accordance to the expectation. The treatment agrees with the standard way of treatment of an Asian descendant, the starting procedural treatment for bipolar disorder to the maintaining of such patient that are been positive for CYP2D6.The side effect of drowsiness in the day and toxicity is agreement with Asian descent (Robert et al., 2017). The patient will have to be place on the same medication till the next visit for examination. The actual result is that the medication is achieving the therapeutic effect that is needed by the patient (Dean, 2017).
Ethical Considerations for Treatment plan Ethics demand that a patient should agree to treatment before it could be administering unto the patient. The law concerning patient’s preferences for treatment are overlook when the patient is in jeopardy of life threatening or severe psychiatric illness. Psychiatric advance directives are employing to make decision on the patient (Srivastava, 2011). When a practitioner treating a patient with bipolar is confronted with ethical conflicts of helping the patient to attain best result or their autonomy. The autonomy will be the choice of the practitioner (Srivastava, 2011). The law clearly stipulate that practitioners should always carefully consider what moral weight should be given to the values of doing well and avoiding harm (U.S. Food and Drug Administration, 2017).
2 Conclusion Psychiatric nurses should assess the function of the client not only during admission even during remission period and plan for rehabilitation services since functioning is a complex and demanding task. However, it is very important to bring back the client to his fullest possible level to normal life by planning effective psychoeducation about illness, communication training and teaching problem solving skills to client and family. 1 Many drugs are available for the treatment of bipolar disorder, but the professional will have to carefully select a medication that will be the best treatment for the patient. It is worth knowing that genetics influences the absorption of drugs, metabolism, excretion, and distribution. In the c
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