NURS 6630 Assessing and Treating Clients with Bipolar Disorder

NURS 6630 Assessing and Treating Clients with Bipolar Disorder

Introduction

Bipolar disorder is a major public health problem that is often diagnosed years after its

onset and it carries with it comorbid conditions that are not easily treatable. It is a major mood

disorder often characterised by an individual experiencing unexpected attacks of euphoria and

depression leading to abnormal activities that an individual undertakes, thereby putting a

limitation to an individual's normal life functioning, especially in some social settings

(McCormick, et al., 2015).

Bipolar disorder is usually managed with a lifetime multiple course of medications while

paying particular attention to psychosocial issues for patients and their families. The diagnosis of

bipolar disorder is usually difficult because of the shared similarity of the symptoms with other

mental illnesses such as schizophrenia. Therefore, clinician awareness that Bipolar disorder is

real may increase the likelihood of successful recognition and appropriate treatment. This case

study assignment will therefore analyze three treatment decisions as an intervention for the Asian

woman who has Bipolar disorder and the writer will come up with the best treatment option to

implement for treating this patient . This then brings us to the first treatment decision

Ideally , the first decision would have been to start the patient on lithium 300 mg twice a

day because it is the first (oldest) well known classic mood stabilizer used for the treatment of

manic episodes and maintenance of recurrence for manic and depressive episodes and has helps

prevent suicide in patients with mood disorders(López-Muño et al., 2018). However , this patient

has shown non adherence to lithium the last time she was hospitalised and lithium was

prescribed. Also it would have been a good idea to try and find out reasons for non compliance

but it is more important at this point to get the patient started on an alternative drug that will

help get her symptoms down as soon as possible.

Therefore, the first decision was made to start the patient on Risperdal one mg orally

BID. The rationale for this decision is because according to Bishop, & Pavuluri (2008), recent

studies have shown that Risperidone is effective in treating positive and negative symptoms of

schizophrenia and mania symptoms in bipolar disorder. This was supported by Sajatovic et al.,

(2006), who noted that many antipsychotic drugs have been deemed effective in treating manic

episodes and this includes Risperidone. From the case study scenario, it was obvious that the

patient was exhibiting bipolar confusion; thus, Risperdal is the best treatment option.

Although patient was known to be of Korean descent and her genetic testing reveals that

she is positive for CYP2D6*10 allele which decreases the metabolism of Risperdal and therefore

will predispose her to toxicity. However, Dean (2017) stated that genetic variations in the

CYP2D6 gene may contribute to an increased risk of adverse events associated with Risperidone

therapy but that there is little evidence to support an increase in side effects caused by the genetic

variation. He noted that genetic variation may lead to a decrease in the required maintenance

dose, although the effect on the dose is smaller than that of the normal biological variation and

that an action is not useful. Also, Risperdal was chosen because it belongs to the group of newer

Seroquel XR 100 mg orally at HS could have been a good alternative but it has the

greatest side effect of weight gain which may not be pleasing to the patient considering her age .

According to Dayabandara et al (2017 ), antipsychotic-induced weight gain is a major

management problem for clinicians and it has been shown that weight gain and obesity lead to

increased cardiovascular morbidity /mortality, reduced quality of life and most importantly to

poor drug compliance.With this in mind , Seroquel would not have been a good option since the

goal of therapy is to help the patient reduce the acute presentation of the symptoms. The

treatment plan is that within the first four weeks, the patient's mood and behavioral symptoms

would have stabilized and the patient would have been able to regain her premorbid normal

functioning . However, at the end of four weeks, the client came back to the office for a follow-

up visit, and apparently, the patient was sedated and lethargic to the extent that her mother had to

follow and assist her into the office. The over-sedation and lethargy can be