Posted: July 17th, 2022

Assignment: Assessing and Treating Clients with Bipolar Disorder

Assignment: Assessing and Treating Clients with Bipolar Disorder
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 clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespan

To prepare for this Assignment:
• Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy.

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
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o 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.

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 the PMHNP should do:

Begin Lithium 300 mg orally BID Click to see options it will take you to decision point two and three with increase or decrease or change of medication and results

Begin Risperdal 1 mg orally BID Click to see options it will take you to decision point two and three with increase or decrease or changes of medication and results

Begin Seroquel XR 100 mg orally at HS Click to see options it will take you to decision point two and three with increase or decrease or change of medication and results

All references require creditable sources, nothing less than 5 years. References require doi or http. Please add a conclusion
Tips:
– Always use the choices given
– Continuation of psych meds may be needed before switching as they take time.
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-Free Essay Sample

Psychopharmacologic Approaches to Treatment of Psychopathology

Student’s Name
Institutional Affiliation
Course
Professor’s Name
Date

Psychopharmacologic Approaches to Treatment of Psychopathology
Introduction
Treatment of mental health patients is a task that requires accurate decision-making. The case study involves a 26-year-old Korean woman with bipolar disorder. In the decision, the selection of Risperdal was not effective since the patient did not take the medication consistently. The second and third decisions led to improvements in the quality of mental health. The patient demonstrated an improvement in aggression and irritability. Additionally, the treatment of patients requires ethical considerations which impact the communication with patients. Some of the ethical considerations include privacy, confidentiality, informed consent and readiness to provide emergency care services (Hamlat et al., 2016). Treatment of mental health issues should involve accurate decisions to improve the health condition of patients.
Decision #1
The first decision is to prescribe Risperdal 1mg orally BID to treat bipolar disorder. I selected Risperdal since it a superior and common drug in the treatment of the disorder. Risperdal is approved by the Food and Drug Administration (FDA) for the treatment of bipolar disorder (Chan et al., 2016). The drug is effective in reducing the severity of bipolar disorder symptoms in adolescents and adults (Weinstock et al., 2016). During the prescription, it is important to educate the patient about the side effects of the drug. For example, the patient is likely to experience weight gain and dizziness.
One of the expectations of prescribing Risperdal 1mg orally BID is to reduce the hyperactivity of the patient and help them to participate in daily activities (Weinstock et al., 2016). It will also help the patient to think clearly. For example, the patient explains they love singing, dancing and talking. The patient also demonstrates hyperactivity in the office and she does not believe she is bipolar. Risperdal will improve the symptoms and help the patient to participate in daily activities normally (Weinstock et al., 2016). Evidence-based practice shows that Risperdal is an antipsychotic drug essential in relieving irritability, hyperactivity, and helps patients to think clearly.
The client returns to the clinic after four weeks. According to the patient, she has not been taking the medication consistently. As a result, the presentation of the patient is similar to the first day the patient reported to the clinic. Initially, the patient had a Young Mania Rating Scale of 22. The rating scale has not changed which shows the patient has not made any improvement. For example, the patient is still demonstrating hyperactivity and irritability.
One of the reasons for the lack of improvement is poor consistency in taking the medication (Almeida et al., 2018). The patient confessed that she did not take the medication consistently. Another reason could be due to the low dosage of the drug (Weinstock et al., 2016). In the next decision, it will be recommendable to increase the dosage. Therefore, the clinician educated the patient on the importance of taking the medication consistently.
Decision #2
The second decision is to increase the dosage of Risperdal from 1mg orally BID to 2mg orally HS. Risperdal 6mg is the maximum recommended dosage for adult patients with bipolar disorder (Solé et al., 2017). Dosage exceeding 6mg is not effective in the treatment of bipolar disorder symptoms. The patient should take the medication for four weeks and report back to the clinic for further assessment. Evidence-based practice shows that Risperdal is effective in improving symptoms related to bipolar disorder (Conway & O’Connor, 2016). For example, the medication is effective in treating hyperactivity, mood changes, and aggression.
The expectations while prescribing the medication is that the patient will not experience hyperactivity and aggression. The mood changes should also return to normal helping the patient to participate in daily activities. Clinicians have used Risperdal 2mg orally HS to treat bipolar disorder symptoms (Weinstock et al., 2016). The drug is effective in altering the brain function to promote positive behavior, improved thinking and minimal mood changes.
When the patient reported to the clinic after four weeks, she confessed that she was taking the medication consistently. The presentation of the patient demonstrated significant improvement. For example, the patient had a Young Mania Rating Scale of 11 which is a 50 percent improvement of the symptoms. The patient had improved mood changes, hyperactivity, and aggression. For example, the patient was calm when she reported the office and she did not claim that she is a fun of talking, singing, and dancing. The client also indicated they had gained 3 pounds of weight.
The expectations and the results had various similarities due to an increase in the dosage. A high dosage had better therapeutic potential compared to a lower dosage. The patient also took the medication consistently which is essential in the treatment of bipolar disorder. Additionally, the medication was effective after four weeks since the improvements in mood changes can take time (Weinstock et al., 2016). Clinicians should thus not be discouraged when they do not see the expected changes in the first four weeks.
Decision #3
The third decision is to continue with the medication since it is effective in improving the symptoms significantly. The patient should continue taking Risperdal 2mg orally HS. Consistency in taking medication is critical especially for bipolar disorders since it promotes progressive improvement in the patient’s behavior (Weinstock et al., 2016). The medication has also demonstrated positive outcomes in the past four weeks.
The expectation of prescribing the medication for another four weeks is that the patient will improve significantly to resume a normal life. Risperdal is an effective medication approved by FDA for use among adults with bipolar disorder (Conway & O’Connor, 2016). For example, the patient should record a 100 percent improvement in the symptoms. Another expectation is that the patient will be calm when she comes back to the clinic. For example, when the patient reports back to the clinic, she should show minimal signs of aggression and irritability.
The outcome of decision #3 is that the patient demonstrated significant improvement in the symptoms. According to the Young Mania Rating Scale, the patient is resuming normal behavior. For instance, the patient is not aggressive or hyperactive. She is calm when she reports to the office without any intention to sing, dance or talk like before. She also does not interfere with the items on the table compared to the first time she reported to the clinic.
Expectations and outcomes have great similarities. For example, one of the expectations was that the patient will be calm which is realized in decision #3. The only difference is that the patient should continue taking the medication for another four weeks to suppress the symptoms completely.
Ethical Considerations
Ethical considerations are necessary for the treatment of mental health problems such as bipolar disorder. One of the ethical issues is the confidentiality of information shared by a patient. Patients should enjoy privacy and confidentiality when they share personal issues they are going through (Conway & O’Connor, 2016). All records and medications should be confidential to prevent legal issues in case the information is leaked to the public. Another ethical issue is informed consent which requires patients to accept the treatment. Clinicians or relatives should not assume that an individual is sick. The patient must give informed consent about their treatment (Conway & O’Connor, 2016). For example, Zinermon v. Burch is a case involving informed consent. A patient sued a health facility for prescribing and administering the treatment without informed consent. Clinicians should ensure patients are aware of the medication to avoid lawsuits.
Clinicians should provide full information about the treatment including the side effects. For example, Risperdal has side effects such as weight gain. When a patient is informed beforehand that the medication can cause weight gain, they will not be surprised when it occurs (Conway & O’Connor, 2016). Another ethical issue is respecting the patient and observing human rights. The medication prescribed by a clinician should not violate any human rights or dignity of a patient (Almeida et al., 2018). Despite the behavior of a patient during the treatment or examination of the medical condition, all human rights should be observed (Hamlat et al., 2016). For example, PMHNP should not take advantage of a patient due to their medical condition. When the patient is violent or aggressive, a clinician should utilize friendly means to calm them down.
PMHNP should be ready to provide care to mental health patients during an emergency. Emergency cases are common among mental health patients especially at the onset of the treatment (Solé et al., 2017). Failure to provide mental treatment during an emergency is regarded as a failure to provide care to needy patients (Hamlat et al., 2016). Additionally, PMHNP should ensure that conflict of interest does not interfere with the treatment. For example, a clinician should not treat a patient with whom they have other close relationships such as friendship, romantic relationship or a family member (Hamlat et al., 2016). The conflict of interest can interfere with the quality of services provided to a patient. PMHNP is also required to provide care to all patients while observing justice and fairness. They should not prioritize some patients while neglecting others to offer. It is the responsibility of a nurse to handle all patients equally (Weinstock et al., 2016). All the ethical considerations are important in improving the quality of care, promoting positive outcomes and reducing the risk of legal issues.
Conclusion
Mental health illnesses require PMHNP to make various decisions to prescribe and administer treatment. The decisions should be based on evidence-based practice and the patient factors that might impact the treatment. One of the best medications for bipolar disorder is Risperdal. Risperdal is approved by the FDA as a reliable and effective drug in the treatment of bipolar disorder. The first decision was to prescribe Risperdal 1mg orally BID. After four weeks, there were no tangible results since the patient did not record any improvement in the Young Mania Rating Scale. However, in the second decision, the PMHNP emphasized the need to take medication consistently. The medication was also upgraded to 2mg HS. The results in decision #2 and #3 are evident that Risperdal 2mg orally HS is an effective dosage. The treatment of the patient should also observe ethical considerations. The ethical considerations include confidentiality, observation of human rights, informed consent and readiness to provide care in emergency cases. All the considerations are important to boost the quality of care among mental illness patients.

References
Almeida, O. P., Hankey, G. J., Yeap, B. B., Golledge, J., & Flicker, L. (2018). Substance use among older adults with bipolar disorder varies according to age at first treatment contact. Journal of Affective Disorders, 239, 269-273. https://doi.org/10.1016/j.jad.2018.07.013
Chan, H. W., Huang, C. Y., Feng, W. J., & Yen, Y. C. (2016). Clinical outcomes of long-acting injectable risperidone in patients with bipolar I disorder; a 1-year write my essay retrospective cohort study. Journal of Affective Disorders, 205, 360-364. https://doi.org/10.1016/j.jad.2016.08.023
Conway, M., & O’Connor, D. (2016). Social media, big data, and mental health: current advances and ethical implications. Current Opinion in Psychology, 9, 77-82. https://doi.org/10.1016/j.copsyc.2016.01.004
Hamlat, E. J., O’Garro-Moore, J. K., Alloy, L. B., & Nusslock, R. (2016). Assessment and treatment of bipolar spectrum disorders in emerging adulthood: applying the behavioral approach system hypersensitivity model. Cognitive and Behavioral Practice, 23(3), 289-299. https://doi.org/10.1016/j.cbpra.2016.05.001
Solé, B., Jiménez, E., Torrent, C., Reinares, M., Bonnin, C. D. M., Torres, I., … & Sanchez-Moreno, J. (2017). Cognitive impairment in bipolar disorder: treatment and prevention strategies. International Journal of Neuropsychopharmacology, 20(8), 670-680. https://doi.org/10.1016/S0140-6736(16)00143-4
Weinstock, L. M., Melvin, C., Munroe, M. K., & Miller, I. W. (2016). Adjunctive behavioral activation for the treatment of bipolar depression: a proof of concept trial. Journal of Psychiatric Practice, 22(2), 149. DOI: 10.1097/PRA.0000000000000142

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