A Mental Condition that Leads to Extreme Mood Swings
Marcus, an 18-year-old high school senior, presents with symptoms of difficulty sleeping and feeling sad, which result in an initial diagnosis of depression. His mother later reports, however, that Marcus exhibits symptoms of irritability and risk-taking behaviors. (His little brother reported to his mother that they were driving over 90 miles an hour on the highway.) After further evaluation, Marcus’ psychiatric nurse practitioner diagnoses him with bipolar disorder.
Cases like this are not uncommon with bipolar disorder, as initial assessments rarely provide all the information needed. In your role, as a psychiatric nurse practitioner, you must develop strategies for properly assessing and diagnosing these patients because treatments for bipolar disorder are significantly different than treatments for depression or other mood disorders.
This week, as you examine bipolar therapies, you explore the assessment and treatment of patients with bipolar disorder. You also consider ethical and legal implications of these therapies.
Learning Objectives
Students will:
Assess patient factors and history to develop personalized plans of bipolar therapy for patients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring bipolar therapy
Synthesize knowledge of providing care to patients presenting for bipolar therapy
Analyze ethical and legal implications related to prescribing bipolar therapy to patients across the life span
Learning Resources
Required Readings (click to expand/reduce)
Medication Resources (click to expand/reduce)
U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
Review the following medications:
|
amitriptyline bupropion citalopram clomipramine desipramine desvenlafaxine doxepin duloxetine escitalopram fluoxetine fluvoxamine |
imipramine ketamine mirtazapine nortriptyline paroxetine selegiline sertraline trazodone venlafaxine vilazodone vortioxetine |
Required Media (click to expand/reduce)
Case Study: An Asian American Woman with Bipolar Disorder
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources (click to expand/reduce)
Assignment: Assessing and Treating Patients With Bipolar Disorder
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.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at
https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
Bipolar disorder is a mental condition that leads to extreme mood swings ranging from emotional highs and lows. Individuals with bipolar disorder may have periods where they are overly happy and energized; at other times, they feel sad and hopeless. The period between those two periods is normal. The highs and lows can be viewed as “poles” of mood, hence the name “bipolar” disorder (Carvalho, Firth & Vieta, 2020). On the one hand, the term “maniac” indicates when patients feel overly excited. They can also be irritable and impulsive, something that can cause them to make reckless decisions. On the other hand, the word “depressive” refers to times when the same individual feels sad and depressed. Individuals with bipolar often experience persistent residual symptoms. Patients with bipolar disorder demonstrate excessive happiness, sudden changes from excitement to irritability, poor concentration, restlessness, easily distracted, poor judgment and less need to sleep, among others.
In this case, the patient is a 26-year-old woman of Korean descent who has been diagnosed with bipolar I disorder. The patient reports that she sleeps for given hours each night and hates sleep since “it’s no fun.” Lack of sleep is one of the major symptoms of bipolar disorder. The scenario is positive with the CYP2D6*10 allele, which plays a critical role in the metabolism where 20 to 30% of the important drugs contain antipsychotics, beta blockers and opioids. The genetic polymorphisms in CYP2D6 may lead to a variation in CYP2D6 enzyme activities. Her speech is rapid, pressured and tangential. While the patient’s judgment is grossly intact, her insight is impaired. The patient’s Young Mania Rating Scale (YMRS) score is 22. This paper aims to suggest three treatment options for the patient while demonstrating the rationale for the various choices.
Decision #1:
I selected starting with SEROQUEL XR 300 mg orally at HS. I selected SEROQUEL XR because it is indicated for the acute treatment of manic episodes that come along with the condition. It is suitable for treating bipolar I disorder as a monotherapy and adjunct to Lithium or Divalproex (Muneer, 2015). The efficacy of SEROQUEL XR has been established through various clinical trials for adults with manic episodes. At the same time, SEROQUEL XR should be swallowed whole instead of being split, chewed or crushed. Having the patient take the medication as a whole is critical in ensuring that she takes the correct dosage quantities. At the same time, SEROQUEL XR is administered once daily, preferably in the evening, which can assist in ensuring the patient complies.
I did not select Lithium 300 mg orally BID because of the high level of non-compliance. If I administer Lithium 300 mg orally BID, the client will likely return in four weeks with the same presentation as the day she came to the clinic. Taking this medication will not assist the client for the first four weeks. I also did not select Risperdal 1 mg orally BID because of the heavy sedation and lethargic effects it is likely to have on the patient (Stroup & Gray, 2018). Taking the medication means that the family, especially the mother, must be present to assist the patient. I do not wish for the client to become sedated since this will deny me the opportunity to evaluate her progress with the symptoms.
I chose SEROQUEL XR 300 mg orally at HS because I was hoping to reduce the symptoms of bipolar I disorder more effectively. I wanted a medication that could demonstrate that the client is making progress. When the client can see progress, she will be encouraged to take medication. Among the three decisions, SEROQUEL XR is the most effective in reducing the symptoms. For instance, unlike the other two drugs, it has allowed the client to sleep more, reduced the YMRS from 22 to 18 and led to a good mood.
Ethical considerations will ensure the informed consent of the patient. The administration of the medication will be with the consent of the client (Varkey, 2021). I will respect the client’s decision if she refuses treatment. When making any decision, I will inform the client and the family so that they understand the reason for a particular approach. For instance, I will let the family know the side effects of all the drugs available and demonstrate why SEROQUEL XR is the best option.
Decision #2
I wou...
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