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Posted: September 7th, 2022

Assessing and Treating Patients with Bipolar Disorder

Assessing and Treating Patients with Bipolar Disorder
Introduction
Assessing and treating sufferers with bipolar is a dynamic course of that requires vital decision-making. The choice-making course of entails assessing the well being’s situation, prescribing remedy, and evaluating the outcomes. The case research of a 26-year-old lady of Korean descent with bipolar dysfunction is a chance to make numerous choices. The primary choice is to start Lithium 300 mg orally BID. The remedy is efficient in comparison with the opposite two choices because it has fewer uncomfortable side effects. Prescribing Lithium is important for the reason that affected person has been taking Lithium prior to now. The perfect consideration is why the affected person stopped taking the remedy. The anticipated outcomes are lowering within the severity and frequency of mania.
The second choice is to prescribe Lithium 450mg orally BID. Rising the dosage enhances the effectiveness of the drug. Rising the dosage is essential for the reason that consumer is adhering to the drug. The drug will cut back manic episodes and enhance high quality sleep.
The third choice is to vary the remedy to Depakote ER 500mg at HS. The extended-release formulation can forestall the signs whereas producing mood-stabilizing properties. Altering the remedy is essential for the reason that affected person exhibits sluggish progress after taking Lithium for over eight years. The anticipated consequence is that the affected person will expertise fewer manic episodes and uncomfortable side effects. Healthcare ought to observe the affected person once they return to the clinic after 4 weeks to find out the following choice.
The supply of care ought to observe moral concerns to make sure affected person’s dignity, rights, and a pleasant setting. The moral concerns embrace knowledgeable consent, affected person autonomy, justice, equity, and non-maleficence. Moral concerns are important in guaranteeing higher take care of sufferers with psychological issues.
Choice One
The primary choice is to start Lithium 300 mg orally BID.
Cause for Choosing Lithium 300mg
The rationale for choosing Lithium 300 mg orally BID is that it successfully addresses bipolar issues. Proof-based observe exhibits that Lithium has few uncomfortable side effects, making it sensible for the affected person within the case research (Malhi et al., 2017). The affected person ought to proceed taking the remedy, though she stopped two weeks in the past. Stopping to take the remedy could possibly be the rationale she is experiencing signs she presents through the go to. Therapy of psychological circumstances doesn’t require sufferers to mix drugs since they will set off hostile outcomes (Malhi et al., 2017). It’s not preferable to prescribe Seroquel XR 100mg orally at HS however to proceed with Lithium. Another excuse for prescribing Lithium is as a result of the genetic check reveals the affected person is constructive for the CYP2D6*10 allele (Beaupre et al., 2019). The outcomes point out the decreased metabolism of risperidone. It’s not preferable to prescribe Risperdal 1mg orally BID as a result of low metabolism.
Expectations
The anticipated outcomes embrace a discount within the severity and frequency of mania. For instance, when the affected person visits the healthcare facility, she is busy enjoying with issues on the desk. She additionally stories she likes to speak, dance, and cook dinner. Lithium can cut back the severity and frequency of the signs (Malhi et al., 2017). The drug will modulate glutamate neurotransmission resulting in regulation of temper, considering, and habits.
The affected person ought to return to the clinic after 4 weeks for additional analysis of the outcomes. In the course of the subsequent go to, the affected person ought to affirm adherence to the drug. The practitioner ought to tackle any problem associated to non-adherence to the drug.
Choice Two
The second choice is to prescribe Lithium 450mg orally BID.
Cause for Rising to Lithium 450mg
The affected person returns to the clinic after 4 weeks. The consumer states that she remains to be taking the remedy and liking it. Adherence to a drug is essential because it promotes remedy consistency (Velosa et al., 2020). The affected person states that she remains to be fairly manic and stories the household is sad when she performs her guitar tonight. The habits exhibits she is having fun with little time to sleep and has manic episodes.
The perfect choice is to extend the drug to Lithium 450 mg. Rising a drug’s dosage will increase the drug’s effectivity and enhances the outcomes (Velosa et al., 2020). The drug’s effectivity is important to boost the restoration of the affected person and aid from the extreme signs. Rising the drug is acceptable for the reason that affected person is adhering to the remedy. Another excuse is that the affected person is displaying constructive indicators of enchancment.
I didn’t choose the opposite two choices for the reason that affected person adhered to the present drug, Lithium, and likes the remedy. Altering the drug isn’t preferable for the reason that affected person exhibits constructive indicators of enchancment (Fung et al., 2019). Administering the drug for an additional 4 weeks will generate constructive outcomes. The enhancements will Help the affected person resume regular actions corresponding to having fun with ample sleep time and collaborating in day by day actions with out manic episodes.
Administering the opposite two medication isn’t acceptable since polypharmacy in treating psychological circumstances can set off hostile reactions (Fung et al., 2019). As an example, the affected person has a decreased metabolism for decreased metabolism of risperidone. Persevering with with Lithium is essential to boost the consistency of remedy.
Expectations
The anticipated consequence is that the affected person will display a big discount of manic episodes and enhance high quality sleep. Sleep is important to Help a affected person to take part in day by day actions. As an example, the affected person ought to cease enjoying guitar at night time when the opposite relations are asleep. One other expectation is that the affected person will proceed taking the remedy, even after the dosage enhance.
Choice Three
The third choice is to vary the remedy to Depakote ER 500mg at HS.
Causes for Altering the Drug
Altering the remedy is essential for the reason that affected person is displaying sluggish progress with Lithium. For instance, manic episodes are nonetheless evident after eight weeks of taking Lithium. Depakote ER is a extra important remedy than Lithium (Lopez-Munoz et al., 2019). Depakote ER is used to stop new manic episodes because it a fast-acting drug. Altering the drug will remove the uncomfortable side effects the consumer is experiencing, corresponding to nausea and diarrhea. The extended-release formulation can forestall the signs whereas producing mood-stabilizing properties (Lopez-Munoz et al., 2019). In the course of the change course of, it’s important to teach the affected person concerning the drug’s uncomfortable side effects and the explanations for altering the drug.
The opposite choices embrace persevering with with Lithium, beginning Seroquel XR 100mg orally at HS and Risperdal 1mg orally BID. Risperdal 1mg orally BID isn’t preferable for the reason that affected person has decreased metabolism.
Expectations
The anticipated consequence is that the affected person will expertise fewer manic episodes and uncomfortable side effects. The outcomes ought to Help the affected person to expertise higher sleep and lowered hyperactivity. One other expectation is that the affected person will expertise fewer or no uncomfortable side effects, together with nausea and diarrhea. The consumer ought to adhere to the brand new remedy regardless of the change.
Moral Concerns
Moral concerns are important in offering care to respect affected person’s dignity and rights, create an acceptable setting, and develop mutual belief. One of many concerns is knowledgeable consent. It’s important to tell the affected person concerning the well being situation, the drug, the uncomfortable side effects, and the remedy plan (McDermott-Levy et al., 2018). Knowledgeable consent is essential to help the affected person’s autonomy to say no or consent to remedy. Healthcare staff are answerable for educating the affected person concerning the medication (McDermott-Levy et al., 2018). As an example, I ought to educate the affected person concerning the medication, uncomfortable side effects, causes for altering the medication and examine non-adherence.
Justice and equity are essential within the provision of care. Healthcare staff ought to guarantee the availability of care with out bias. Provision of care ought to take into account multicultural ethnic teams and their beliefs (Rainer et al., 2018). Non-maleficence is one other moral consideration requiring practitioners to keep away from inflicting hurt deliberately (Rainer et al., 2018). For instance, the CYP2D6*10 alleles’ check outcomes are essential to keep away from prescribing a drug that may hurt a affected person or set off allergic reactions. Moral concerns are important to make sure high quality take care of the affected person.
Conclusion
The case research of a 26-year-old lady of Korean descent with bipolar dysfunction is a chance to make numerous choices. The case research entails three vital choices: starting Lithium 300 mg orally BID, prescribing Lithium 450mg orally BID, and altering the remedy to Depakote ER 500mg at HS. The purpose of prescriptions is to scale back manic episodes and enhance high quality sleep. Provision of care ought to observe moral concerns, together with knowledgeable consent, affected person’s autonomy, justice, equity, and non-maleficence.

References
Beaupre, L. M., Zai, C. C., Tiwari, A. Ok., Gonçalves, V., Mundo, E., & Kennedy, J. L. (2019). CYP2D6 metabolizer standing and HTTLPR variant of SLC6A4 related with antidepressant-induced mania in bipolar dysfunction. Customized Drugs in Psychiatry, 13, 6-10.
Fung, V. C., Overhage, L. N., Sylvia, L. G., Reilly-Harrington, N. A., Kamali, M., Gao, Ok., … & Nierenberg, A. A. (2019). Advanced polypharmacy in bipolar dysfunction: Aspect impact burden, adherence, and response predictors. Journal of Affective Issues, 257, 17-22.
Lopez-Munoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018). A historical past of the pharmacological remedy of bipolar dysfunction. Worldwide Journal of Molecular Sciences, 19(7), 2143.
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The usage of lithium for the remedy of bipolar dysfunction: suggestions from scientific observe tips. Journal of Affective Issues, 217, 266-280.
McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Moral ideas and tips of world well being nursing observe. Nursing Outlook, 66(5), 473-481.
Rainer, J., Schneider, J. Ok., & Lorenz, R. A. (2018). Moral dilemmas in nursing: An integrative overview. Journal of Scientific Nursing, 27(19-20), 3446-3461.
Velosa, J., Delgado, A., Finger, E., Berk, M., Kapczinski, F., & de Azevedo Cardoso, T. (2020). Threat of dementia in bipolar dysfunction and the interaction of lithium: a scientific overview and meta‐analyses. Acta Psychiatrica Scandinavica, 141(6), 510-521.

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