NURS 6630 week 5 Assignment: Assessing and Treating Patients With Bipolar Disorder
BACKGROUND INFORMATION
NURS 6630 week 5 Assignment. 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
Begin Risperdal 1 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client is accompanied today by her mother who must help the client into your office, the client looks very sedated and lethargic
Client’s mother explains that “she has been like this since about a week after the last office visit”
Decision Point Two
Decrease Risperdal to 1 mg at HS
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client is less sedate, less lethargic and shows symptom improvement
Young Mania Rating Scale has decreased from 22 to 16 (a bit more than a 25% decrease in symptoms)
Decision Point Three
Continue at same dose of Risperdal and reassess in 4 weeks
Guidance to Student
At this point, you may be wise to allow the client to remain at the same dose and reassess in 4 weeks. Recall that the client is of Korean descent and is positive for CYP2D6*10 allele. As a result, she may have slower clearance of Risperdal from her system, which may have resulted in higher than normal levels of Risperdal in the blood, which in turn resulted in sedation. Therefore, if we were to increase back to 1 mg orally BID, she may have the same side effects. Latuda is FDA approved for bipolar I depression, which is not the presentation we are attempting to treat. Additionally, it is quite expensive and many insurance companies will not pay for it until other agents have been attempted and failed.
Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients 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 patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring bipolar therapy.
The Assignment: 5 pages
Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
NURS 6630 week 5 Assignment Answer
Assessing and Treating Patients with Bipolar Disorders
Bipolar disorder is a prevalent psychiatric condition characterized by significant emotional instability during normal interactions with oneself and others. It involves dramatic shifts in mood, concentration, and energy, leading to episodes of depression and mania. Bipolar disorder is treatable through psychopharmacological approaches, self-management, and lifestyle adjustments. NURS 6630 week 5 Assignment
The case at hand involves a 26-year-old Asian American woman attending her first appointment after a 3-week admission for acute mania. The psychiatrist diagnoses her with bipolar 1 disorder based on subjective and objective data. The patient exhibits unsettling behavior, manic moods, sleep disturbances, and had discontinued lithium treatment prescribed upon her previous discharge. She presents as oriented, alert, and her mood is euthymic, although her speech is pressured and tangential. The Young Mania Rating Scale (YMRS) scores her at 22, and she denies hallucinations or delusional feelings. The patient does not report suicidal or homicidal ideation. NURS 6630 week 5 Assignment
Decision One
The initial decision is to prescribe Risperdal 1 mg orally for bipolar 1 disorder. Risperdal, or risperidone, is a second-generation antipsychotic medication used to manage bipolar disorder. It functions by regulating serotonin and dopamine re-uptake, which leads to mood improvement and positive behavior (Finocchio, 2021). Research supports the use of risperidone as a monotherapy for maintaining the treatment of bipolar 1 disorder, emphasizing its tolerability in both short-term and long-term clinical trials (Vasquez & Bobo, 2020). Restarting lithium or opting for Seroquel XR is not the preferred course of action due to side effects associated with these medications, such as constipation, weight gain, and sedation (Muneer, 2015).NURS 6630 week 5 Assignment
The expected outcome of this decision is an improvement in the patient’s mood within the first 30 days, a reduction in insomnia or hypersomnia episodes, and improved cognitive function. It should lead to the mitigation of mixed episodes characteristic of bipolar 1 disorder, including irritability, rapid speech and thoughts, overactivity, and agitation.NURS 6630 week 5 Assignment
Difference between Expected Results and Actual Results
When the patient returned to the hospital after four weeks, she appeared sedated and lethargic, requiring her mother’s support to reach the office. This was in contrast to the expected outcome of mood improvement. The actual results may have been influenced by the presence of positive CYP2D6*10 alleles, which are associated with reduced risperidone metabolism among the Asian population with psychiatric conditions (Cui et al., 2020). This reduced metabolism could have led to higher drug concentration and side effects. NURS 6630 week 5 Assignment. NURS 6630 week 5 Assignment
References:
Cui, J., Wang, L., Lui, S., Li, C., Li, X., Song, Y., … & Chan, R. C. (2020). Pharmacogenomics of risperidone in the treatment of acutely psychotic patients with schizophrenia. Journal of Clinical Psychopharmacology, 40(5), 435-441.
Finocchio, S. M. (2021). Risperidone. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK545217/
Muneer, A. (2015). Bipolar disorder: Role of inflammation and the development of disease biomarkers. Psychiatry Investigation, 12(4), 315-328.
Vasquez, G., & Bobo, W. V. (2020). Atypical Antipsychotic Medications. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK551588/
