Case Study For Patients Diagnosed With Bipolar Disorder

Case Study For Patients Diagnosed With Bipolar Disorder

Bipolar disorder is a mental illness that is characterized with malfunction or disfunction of the brain leading to a series of episodes characterized with abnormal shifts in the activity level, the level of concentration, mood swings as well as inability to perform day to day activities. The abnormal changes in behavior is broadly classified as maniac episodes that can be irate, elated or even energized mood. In some instances, patients with bipolar disorder can present episodes of depression which can further affects their state of mind. The combination of these activities affects the social and economic lives of the patients because the individuals cannot function in a coherent manner (National Institute of Mental Health, 2021)Case Study For Patients Diagnosed With Bipolar Disorder.

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The patient in the case study is a female 26-year-old Korean patient who is to the clinic for the first appointment after a period of 21 days hospitalization since she was first diagnosed with bipolar I disorder after presenting signs of acute mania. All the lab tests carried out on the patients turned normal and the physician noted that the patient was in good health. Given that none of the medications that had been prescribed seemed to be effective, the patient underwent a Gene Sight testing. Before her discharge, the patient had indicated some movement based on the lithium medication which led to her discharge but failed to adhere to the prescribed medication after discharge.

On the Young Mania Scale, the patient had a score of 22 and measured 110lb and a height of 5’ 5”. she was alert and oriented in terms of time and place with a rapid speech which seemed to be pressured. The patient denied visual and auditory hallucinations but her insight seemed to be impaired. The patient also denied suicidal intentions Case Study For Patients Diagnosed With Bipolar Disorder.

Decision 1

The first decision is to administer Seroquel 100 XR mg at night

Seroquel is an antipsychotic drug that has been approved by the food and drug administration (FDA) for the treatment of schizophrenia and bipolar diseases (López-Muñoz et al., 2018). The drug is prescribed in two main options, as an immediate or extended release tablet. Its metabolism takes place majorly in the liver and it takes almost 5 hours for the plasma concentration to reach at the pick which allows for daily dosage prescription for the drug. Unlike other antipsychotic medications, Seroquel has minimal adverse effects. The drug is also of great benefit because it can be administered with other drugs to improve the outcomes because combined therapy is always better than monotherapy.

Another essential consideration was the fact that the patient had discontinued lithium two weeks before her visit and hence, there is no need to make her stay in hospital. To enhance the effectiveness of her treatment, it is essential to gradually decrease lithium dosage as opposed to discontinuing completely to prevent cases of reoccurrence. The option for lithium, should be considered with care because it is known to increase weight which can led to other lifestyle diseases such as obesity, hypertension or diabetes (Öhlund et al., 2018). Besides, the other option, Risperdal is associated with glucose intolerance and hence, can lead to diabetes (Tsai et al., 2021)Case Study For Patients Diagnosed With Bipolar Disorder.

Expected Outcome from the decision

One major expectation of the outcome from the decision above is a reduction of the Young Mania Rating Scale score by at least 50%. The Young Mania Rating Scale score is used as a measure for the severity of mania with the highest score of 60 showing severe mania while a lower score shows an improvement of the symptoms. Also, within a duration of at least four weeks, the patients genera symptoms are expected to improve and the patient can return to the clinic for further medication and at this point, the patient will be in a position to sleep more regularly because the sleeping duration is expected to increase from 5 hours. However, there are tow major side effects to monitor, weight gain that is associated with lithium and intestinal problems associated with both lithium and Seroquel.

Ethical Considerations that will impact the treatment Plan

The major ethical considerations impacting the treatment plan include beneficence, non-maleficence and involuntary treatment (Slade, 2017)Case Study For Patients Diagnosed With Bipolar Disorder. In the psychiatric unit, involuntary treatment is a major ethical issue influencing a treatment plan. For instance, the patient had discontinued lithium two weeks before visiting the clinic and did not have a reason as to why. Taking her back to the treatment is an ethical issue that must be solved by balancing the benefits associated with the treatment. In terms of non-maleficence, the use of Risperdal was objected because it is associated with impaired glucose tolerance and hence risks of diabetes.

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Decision 2

The second decision involves replacing Seroquel with another antipsychotic drug like Geodon 40 mg daily.

After the first intervention, it is necessary to replace Seroquel with another antipsychotic drug. Given that some of the symptoms presented by the patient after the use of Seroquel include increase in body weight and constipation, it is essential that the first antipsychotic element be replaced. One of the most appropriate alternatives is Geodon which is an antipsychotic drug that was approved in 2004 by the FDA for the treatment of maniac episodes (Nemergut & Sandra, 2019)Case Study For Patients Diagnosed With Bipolar Disorder. Because the patient is likely to be choosy towards the selected intervention, Geodon is likely to be essential because it does not lead to increased gain in body weight that may make the patient to reject it or fail to adhere to its prescription. One of the challenges of Geodon is that is affected by fasting and therefore, it is recommended that a rich calorie intake is essential to increase the absorption of the drug. Some of the effects of Seroquel are harmful on the patient and they may his social and economic performance which prevents increasing the dose when the signs do not improve in the first case.

Expected Outcomes due to the decision

After initiation of the second option it is expected that the maniac symptoms will significantly improve more so, at least two weeks after initiation of the second treatment with Geodon and a rich calorie intake. In addition, there is are high expectations that her the Young Mania Rating Scale score will reduce by at least 50%. The change of the antipsychotic agent is also set to address all the side effects that have been previously felt by the patient.

Ethical Considerations that will impact the treatment Plan

Alongside informed the principle of beneficence, informed consent is another critical ethical consideration that is likely to affect the treatment plan (Tate, 2019)Case Study For Patients Diagnosed With Bipolar Disorder. The patient must be aware of the treatment plan and other changes that will be done to ensure that the treatment plan will be adhered to appropriately. Also, the patient is an adult meaning she can make informed consent to her treatment options.

Decision 3

After the administration of Geodon, the symptoms improved because the drug did not have any negative side effects therefore indicating drug efficacy. The efficacy of Geodon in the treatment of bipolar diseases can be as long as four to six weeks if the dose will be consistency and there is no skipping of the medication.

After the state of the patient has been stabilized, it is not recommended to increase the dosage of Geodon because of the associated side effects such as the risk of respiratory issues and weight gain, both of which have detrimental effects on the patient (Sukkar & Cremonini, 2018)Case Study For Patients Diagnosed With Bipolar Disorder. Therefore, this implies that even though the drug is doing fine with the patient, it will be ideal to discontinue its usage to avert the risks associated with it. Also, lithium, is effective in this stage but owing to the fact that it was discontinued, it is not appropriate to reintroduce it at this stage given that it is associated with adverse effects including weight gain.

Expected Outcome

The expectation of the treatment option is that there will be an improvement of the general symptoms of the patient within at least four weeks. In addition, there will be no adverse effects because they have all been addressed. The general symptoms of the patient will improve including the Young Mania Rating Scale score.

Ethical Considerations that will impact the treatment Plan

The ethical issue at hand is to improve the patients condition while reducing the risk of harm to the patient. With the medication, the patient’s symptoms are to improve significantly which is likely to improve the patient-nurse relationship. In addition, the nurse has a moral obligation to communicate the treatment plans while highlighting possible risks and side effects.

Conclusion

Unlike other healthcare conditions, mental illnesses present a distinct category in the treatment regime that is specifically difficult to treat because most the mental illnesses present similar symptoms which must be addressed to avert the risk of increasing the burden of the disease. For instance, obese patients should avoid drugs that can increase the weight. Initially, the patient had started lithium therefore, it was appropriate to start with Seroquel 100 XR mg at night. Some of the side effects associated with with Seroquel that necessitated its replacement in the second decision include weight gain and constipation. With the introduction of Geodon and a rich calorie meal, the symptoms will reduce significantly with the side effects fading away Case Study For Patients Diagnosed With Bipolar Disorder.

Some of the ethical issues that were addressed in the case study include informed consent, involuntary treatment, beneficence and non-maleficence. One way to ensure that the ethical issues such as informed consent have been addressed is through effective communication with the patient.

References

López-Muñoz, 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.

National Institute of Mental Health (2021) https://www.nimh.nih.gov/health/topics/bipolar-disorder

Nemergut, G., & Sandra, J. (2019). Neuroleptics (typical/atypical antipsychotics). In Pain (pp. 255-260). Springer, Cham.

Öhlund, L., Ott, M., Oja, S., Bergqvist, M., Lundqvist, R., Sandlund, M., … & Werneke, U. (2018). Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC psychiatry, 18(1), 1-10.

Slade, M. (2017). Implementing shared decision making in routine mental health care. World psychiatry, 16(2), 146-153.

Sukkar, S. G., & Cremonini, A. L. (2018). Obesity and antipsychotics. Adv Obes Weight Manag Control, 8(2), 37-41.

Tate, A. J. M. (2019). Contributory injustice in psychiatry. Journal of Medical Ethics, 45(2), 97-100.

Tsai, H. P., Hou, P. H., Mao, F. C., Chang, C. C., Yang, W. C., Wu, C. F., … & Chang, G. R. (2021). Risperidone exacerbates glucose intolerance, nonalcoholic fatty liver disease, and renal impairment in obese mice. International Journal of Molecular Sciences, 22(1), 409. Case Study For Patients Diagnosed With Bipolar Disorder

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 patientâ€™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) Case Study For Patients Diagnosed With Bipolar Disorder

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)

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.

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