Assessing and Treating Patients with Bipolar Disorder
Introduction
Assessing and treating patients with bipolar is a dynamic process that requires critical decision-making. The decision-making process involves assessing the health’s condition, prescribing medication, and evaluating the outcomes. The case study of a 26-year-old woman of Korean descent with bipolar disorder is an opportunity to make diverse decisions. The first decision is to begin Lithium 300 mg orally BID. The medication is effective compared to the other two options since it has fewer side effects. Prescribing Lithium is essential since the patient has been taking Lithium in the past. The best consideration is why the patient stopped taking the medication. The expected outcomes are reducing in the severity and frequency of mania.
The second decision is to prescribe Lithium 450mg orally BID. Increasing the dosage enhances the effectiveness of the drug. Increasing the dosage is crucial since the client is adhering to the drug. The drug will reduce manic episodes and improve quality sleep.
The third decision is to change the medication to Depakote ER 500mg at HS. The extended-release formulation can prevent the symptoms while generating mood-stabilizing properties. Changing the medication is crucial since the patient shows slow progress after taking Lithium for over eight years. The expected outcome is that the patient will experience fewer manic episodes and side effects. Healthcare should observe the patient when they return to the clinic after four weeks to determine the next decision.
The provision of care should observe ethical considerations to ensure patient’s dignity, rights, and a friendly environment. The ethical considerations include informed consent, patient autonomy, justice, fairness, and non-maleficence. Ethical considerations are essential in ensuring better care for patients with mental disorders.
Decision One
The first decision is to begin Lithium 300 mg orally BID.
Reason for Selecting Lithium 300mg
The rationale for selecting Lithium 300 mg orally BID is that it effectively addresses bipolar disorders. Evidence-based practice shows that Lithium has few side effects, making it practical for the patient in the case study (Malhi et al., 2017). The patient should continue taking the medication, although she stopped two weeks ago. Stopping to take the medication could be the reason she is experiencing symptoms she presents during the visit. Treatment of mental conditions does not require patients to combine medications since they can trigger adverse outcomes (Malhi et al., 2017). It is not preferable to prescribe Seroquel XR 100mg orally at HS but to continue with Lithium. Another reason for prescribing Lithium is because the genetic test reveals the patient is positive for the CYP2D6*10 allele (Beaupre et al., 2019). The results indicate the decreased metabolism of risperidone. It is not preferable to prescribe Risperdal 1mg orally BID due to low metabolism.
Expectations
The expected outcomes include a reduction in the severity and frequency of mania. For example, when the patient visits the healthcare facility, she is busy playing with things on the table. She also reports she likes to talk, dance, and cook. Lithium can reduce the severity and frequency of the symptoms (Malhi et al., 2017). The drug will modulate glutamate neurotransmission leading to regulation of mood, thinking, and behavior.
The patient should return to the clinic after four weeks for further evaluation of the outcomes. During the next visit, the patient should confirm adherence to the drug. The practitioner should address any challenge related to non-adherence to the drug.
Decision Two
The second decision is to prescribe Lithium 450mg orally BID.
Reason for Increasing to Lithium 450mg
The patient returns to the clinic after four weeks. The client states that she is still taking the medication and liking it. Adherence to a drug is crucial since it promotes treatment consistency (Velosa et al., 2020). The patient states that she is still quite manic and reports the family is unhappy when she plays her guitar tonight. The behavior shows she is enjoying little time to sleep and has manic episodes.
The best decision is to increase the drug to Lithium 450 mg. Increasing a drug’s dosage increases the drug’s efficiency and enhances the outcomes (Velosa et al., 2020). The drug’s efficiency is necessary to enhance the recovery of the patient and relief from the severe symptoms. Increasing the drug is appropriate since the patient is adhering to the treatment. Another reason is that the patient is showing positive signs of improvement.
I did not select the other two options since the patient adhered to the current drug, Lithium, and likes the medication. Changing the drug is not preferable since the patient shows positive signs of improvement (Fung et al., 2019). Administering the drug for another four weeks will generate positive results. The improvements will help the patient resume normal activities such as enjoying adequate sleep time and participating in daily activities without manic episodes.
Administering the other two drugs is not appropriate since polypharmacy in treating mental conditions can trigger adverse reactions (Fung et al., 2019). For instance, the patient has a decreased metabolism for decreased metabolism of risperidone. Continuing with Lithium is crucial to enhance the consistency of treatment.
Expectations
The expected outcome is that the patient will demonstrate a significant reduction of manic episodes and improve quality sleep. Sleep is essential to help a patient to participate in daily activities. For instance, the patient should stop playing guitar at night when the other family members are asleep. Another expectation is that the patient will continue taking the medication, even after the dosage increase.
Decision Three
The third decision is to change the medication to Depakote ER 500mg at HS.
Reasons for Changing the Drug
Changing the medication is crucial since the patient is showing slow progress with Lithium. For example, manic episodes are still evident after eight weeks of taking Lithium. Depakote ER is a more vital medication than Lithium (Lopez-Munoz et al., 2019). Depakote ER is used to prevent new manic episodes since it a fast-acting drug. Changing the drug will eliminate the side effects the client is experiencing, such as nausea and diarrhea. The extended-release formulation can prevent the symptoms while generating mood-stabilizing properties (Lopez-Munoz et al., 2019). During the change process, it is vital to educate the patient about the drug’s side effects and the reasons for changing the drug.
The other options include continuing with Lithium, starting Seroquel XR 100mg orally at HS and Risperdal 1mg orally BID. Risperdal 1mg orally BID is not preferable since the patient has decreased metabolism.
Expectations
The expected outcome is that the patient will experience fewer manic episodes and side effects. The outcomes should help the patient to experience better sleep and reduced hyperactivity. Another expectation is that the patient will experience fewer or no side effects, including nausea and diarrhea. The client should adhere to the new medication despite the change.
Ethical Considerations
Ethical considerations are essential in providing care to respect patient’s dignity and rights, create a suitable environment, and develop mutual trust. One of the considerations is informed consent. It is vital to inform the patient about the health condition, the drug, the side effects, and the treatment plan (McDermott-Levy et al., 2018). Informed consent is crucial to support the patient’s autonomy to decline or consent to treatment. Healthcare workers are responsible for educating the patient about the drugs (McDermott-Levy et al., 2018). For instance, I should educate the patient about the drugs, side effects, reasons for changing the drugs and investigate non-adherence.
Justice and fairness are crucial in the provision of care. Healthcare workers should ensure the provision of care without bias. Provision of care should consider multicultural ethnic groups and their beliefs (Rainer et al., 2018). Non-maleficence is another ethical consideration requiring practitioners to avoid causing harm intentionally (Rainer et al., 2018). For example, the CYP2D6*10 alleles’ test results are necessary to avoid prescribing a drug that can harm a patient or trigger allergic reactions. Ethical considerations are essential to ensure quality care for the patient.
Conclusion
The case study of a 26-year-old woman of Korean descent with bipolar disorder is an opportunity to make diverse decisions. The case study involves three significant decisions: beginning Lithium 300 mg orally BID, prescribing Lithium 450mg orally BID, and changing the medication to Depakote ER 500mg at HS. The goal of prescriptions is to reduce manic episodes and improve quality sleep. Provision of care should observe ethical considerations, including informed consent, patient’s autonomy, justice, fairness, and non-maleficence.
References
Beaupre, L. M., Zai, C. C., Tiwari, A. K., Gonçalves, V., Mundo, E., & Kennedy, J. L. (2019). CYP2D6 metabolizer status and HTTLPR variant of SLC6A4 associated with antidepressant-induced mania in bipolar disorder. Personalized Medicine in Psychiatry, 13, 6-10.
Fung, V. C., Overhage, L. N., Sylvia, L. G., Reilly-Harrington, N. A., Kamali, M., Gao, K., … & Nierenberg, A. A. (2019). Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. Journal of Affective Disorders, 257, 17-22.
Lopez-Munoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of bipolar disorder. International Journal of Molecular Sciences, 19(7), 2143.
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: recommendations from clinical practice guidelines. Journal of Affective Disorders, 217, 266-280.
McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing Outlook, 66(5), 473-481.
Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446-3461.
Velosa, J., Delgado, A., Finger, E., Berk, M., Kapczinski, F., & de Azevedo Cardoso, T. (2020). Risk of dementia in bipolar disorder and the interplay of lithium: a systematic review and meta‐analyses. Acta Psychiatrica Scandinavica, 141(6), 510-521.
