Assessing and Treating Clients with With Bipolar Disorder Essay

Posted: January 17th, 2023

Assessing and Treating Clients with With Bipolar Disorder Essay

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. To prepare for this Assignment: Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy. Assessing and Treating Clients with With Bipolar Disorder Essay. 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 #1 Which 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 #2 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 #2 and the results of the decision. Why were they different? Decision #3 Why did you select this decision? Support your response with evidence and references to the Learning Resources. Assessing and Treating Clients with With Bipolar Disorder Essay. 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? Also include how ethical considerations might impact your treatment plan and communication with clients. Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. Chapter 6, “Mood Disorders” Chapter 8, “Mood Stabilizers” Stahl, S. M., & Ball, S. (2009b). Stahl’s illustrated mood stabilizers. New York, NY: Cambridge University Press. To access the following chapters, click on the Illustrated Guides tab and then the Mood Stabilizers tab. Chapter 4, “Lithium and Various Anticonvulsants as Mood Stabilizers for Bipolar Disorder” Chapter 5, “Atypical Antipsychotics as Mood Stabilizers for Bipolar Disorder” Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-0060-3 Note: Retrieved from Walden Library databases. 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 Note: Retrieved from Walden Library databases. Assessing and Treating Clients with With Bipolar Disorder Essay

Introduction

Bipolar disorder is a common psychiatric illness that can be very severe in chronic form. It affects approximately 1-2% of both men and women. Its clinical symptoms are wide-ranging and each episode results in a critical change in the manner that a patient behaves, feels, their mood and attitude. The change can either be gradual or sudden and will easily be noticed by people in the surrounding environment. This paper discusses the management of an Asian American woman who had been diagnosed with bipolar disorder. Three decisions will be made regarding her pharmacologic management. In each decision made, a detailed discussion regarding the expected outcomes, the actual outcomes, any differences between the expected outcome and actual outcome will evidence from supporting literature will be provided. Assessing and Treating Clients with With Bipolar Disorder Essay

Decision # 1

Decision Selected

Begin Risperdal 2mg orally BID

Reason for Selecting This Decision

            Risperdal, also known as risperidone, is a benzisoxazole atypical antipsychotic derivative that has proven to be highly effective and approved by the FDA for the management of irritability and symptoms of bipolar disorder (Shah, Grover & Rao, 2017). It functions by rebalancing the levels of dopamine and serotonin in the brain to improve a patient’s ability to think, behavior and mood. Lithium 300mg wouldn’t be a good choice since the patient had previously defaulted it and can only lead to medication non-adherence (Bourin & Thibaut, 2013). Seroquel XR can also not be the best alternative since it causes severe additional weight and constipation which the patients wouldn’t like to experience (Bourin & Thibaut, 2013).

Expected Outcome

            All the symptoms of bipolar that currently manifest in the patient are expected to diminish by the next visit. Apart from being restful, it is expected that she will be able to perform most of her social, physical and occupational activities of daily life (Jann, 2014).  Besides, most of the self-destruction practices that the client demonstrates are expected to diminish. Assessing and Treating Clients with With Bipolar Disorder Essay

Difference between Expected Outcome and Actual Outcome

            After 4 weeks, the patient returned to the clinic with positive reports of significant improvement such as concentrating for longer periods of time. She had however noted that she was often lethargic and drowsy especially during the day. According to 111, sedation is a major side effect of Risperdal. Besides, based on information that the patient‘s CYP2D6*10 allele report that she is positive, the likelihood that her Risperdal clearance rate from body systems is low (Chen et al., 2015).  This results in high levels of blood Risperdal and explains the persistent drowsiness/lethargy.

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Decision #2

Decision Selected

Reduce the dosage of Risperdal to 1mg orally HS

Reason for Selecting This Decision

            During the previous visit, it was evident that the patient’s progress was remarkable but she reported persistent lethargy and drowsiness which from a scientific basis, were as a result of the high dose of Risperdal and the patient’s slow clearance rate (Chen et al., 2015).  This means that the only way to achieve therapeutic outcomes is to reduce the dosage and frequency. Therefore, reducing the dosage of Risperdal to 1mg HS   and closely monitoring the client would be the best course of action. Assessing and Treating Clients with With Bipolar Disorder Essay 

Expected Outcome

            By reducing the dosage, it is expected that the patient will no longer experience lethargy or drowsiness which were forms of Risperdal toxicity to the client. Besides, the severity of bipolar symptoms in the client is expected to continue diminishing and the outcomes of treatment should be able to be noticed by family members or close friends (Shah, Grover & Rao, 2017).

Difference between Expected Outcome and Actual Outcome

            There was no significant difference between the expected outcome and the actual outcome. After four weeks, the client returned to the clinic with reports of significant improvement, an indication of how effective the initially prescribed 1 mg Risperdal HS   was and the patient’s ability to positively tolerate and adjust to the medication that was prescribed (Jann, 2014).   She also didn’t report of any drowsiness or lethargy and didn’t illustrate signs of toxicity. Assessing and Treating Clients with With Bipolar Disorder Essay

Decision #3

Decision Selected

Continue with the current dosage of Risperdal I’m orally HS.

Reason for Selecting This Decision

            Based on the patient’s progress, it was undeniable that the expected outcomes of treatment and the actual outcomes matched.  Changing the current drug and its dosing has a high likelihood that it will only destabilize the client’s progress and hinder the achievement of therapeutic goals. The patient therefore only needs close assessment and monitoring until when therapy will be over (Jann, 2014).

Expected Outcome

            It is anticipated that after four weeks, the patient will have progressed immensely and her self-destructive behaviors will also decrease. She will also experience no side effects from Risperdal and that she will be able to efficiently tolerate any minimal side effects in case of any. Besides, her mental state, conduct, and thought patterns will significantly improve (Shah, Grover & Rao, 2017).

Difference between Expected Outcome and Actual Outcome

            Based on the patient’s progress, it was evident that the therapy was highly effective as expected. The treatment standards also met the FDA standards for patients who have a positive CYP2D6. Therefore, for the following weeks, the client continued with the same medications as her progress was closely monitored.Assessing and Treating Clients with With Bipolar Disorder Essay

How Ethical Considerations Might Impact The Treatment Plan and Communication With Clients.

Before treatment is initiated, it will be mandatory for the client to consent to it. In most clinical scenarios,   the laws related to prioritizing the patient’s preference to drugs are usually overlooked especially in cases where a patient suffers from a severe mental illness. In such instances, it is necessary that advance directives are implemented when making any decisions about the management of a patient (Ratheesh et al., 2017). Another ethical consideration is respect for patient autonomy. Patients with bipolar disorder may be some cognitive deficits which can hinder the ability of a patient to listen and understand details shared by a PMHNP. Even when they consent to treatment, the likelihood that they have understood whatever they are consenting to is not guaranteed. In such clinical situations, the PMHNP may have to make a decision on behalf of the patient, an approach that does not go by the patient’s autonomy (Ratheesh et al., 2017).   As stated by the law, in such cases, PMHNPs should consider the patient’s best interest and choose the therapy that causes no harm.

Conclusion

It is necessary for PMHNPs to assess mentally ill patients diagnosed with bipolar disorder during both the admission and remission phases. This will help in planning for rehabilitation since most of their functioning is often a demanding and complex task. However, the goal of therapy should be to ensure that the patients social, physical, mental and emotional functioning has been fully restored. This can also be achieved through a planned psychoeducation session on the client’s illness, training her how to communicate and teaching her some skills in problem-solving.  Many drugs are available for the management of bipolar disorder. However, the selected drug should only serve the patient’s best interest, have minimal side effects and be able to restore the patients social and physical functioning. However, it is worth understanding that genetics can potentially influence the rate of absorption, metabolism, excretion, and distribution of drugs. For instance, in this case, the client’s Asian descent and a positive CYP2D6 will influence the dosage and frequency of administration.Assessing and Treating Clients with With Bipolar Disorder Essay

References

Bourin, M., & Thibaut, F. (2013). How to assess drugs in the treatment of acute bipolar mania?. Frontiers in pharmacology, 4, 4. doi:10.3389/fphar.2013.00004

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.

Jann M. W. (2014). Diagnosis and treatment of bipolar disorders in adults: a review of the evidence on pharmacologic treatments. American health & drug benefits, 7(9), 489-99.

Ratheesh, A., Cotton, S. M., Davey, C. G., Adams, S., Bechdolf, A., Macneil, C., & McGorry, P. D. (2017). Ethical considerations in preventive interventions for bipolar disorder. Early intervention in psychiatry, 11(2), 104-112.

Shah, N., Grover, S., & Rao, G. P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian journal of psychiatry, 59(Suppl 1), S51-S66. Assessing and Treating Clients with With Bipolar Disorder Essay