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Assessing and Treating Clients with Bipolar Disorder

Assignment: Assessing and Treating Clients with Bipolar Disorder

Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for clients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) clients 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 client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with bipolar disorder.

Learning Resources:

 

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

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· Chapter 6, “Mood Disorders”

· Chapter 8, “Mood Stabilizers”

Stahl, S. M., & Ball, S. (2009b). Stahl’s illustrated mood stabilizers. New York, NY: Cambridge University Press.

 

To access the following chapters, click on the Illustrated Guides tab and then the Mood Stabilizers tab.

· Chapter 4, “Lithium and Various Anticonvulsants as Mood Stabilizers for Bipolar Disorder”

· Chapter 5, “Atypical Antipsychotics as Mood Stabilizers for Bipolar Disorder”

Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-0060-3

 

 

 

To prepare for this Assignment:

· Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy.

The Assignment

Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

 

At each decision point stop to complete the following:

· Decision #1

· Which decision did you select?

· Why did you select this decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

· Decision #2

· Why did you select this decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

· Decision #3

· Why did you select this decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

 

 

Citation for book pages sent for Chapters 6 and 8:

Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved March 21, 2019 from

http://stahlonline.cambridge.org.ezp.waldenulibrary.org/essential_4th_chapter.jsf?page=chapter6_summary.htm&name=Chapter%206&title=Summary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  // Bipolar Therapy

Bipolar Therapy Client of Korean Descent/Ancestry

sian girl

 

BACKGROUND INFORMATION

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

 

   //  Bipolar Therapy

Bipolar Therapy Client of Korean Descent/Ancestry

sian girl

 

Decision Point One

 

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/04/mm/bipolar_therapy/img/pill-red.pngBe I started Lithium 300mg orally BID

gin Lithium 300 mg orally BID

RESULTS OF DECISION POINT ONE

·  Client returns to clinic in four weeks

·  Client informs the PMHNP that she has been taking her drug “off and on” only when she “feels like she needs it”

·  Today’s presentation is similar to the first day you met her

Decision Point Two

Be I decided to assess for rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology.t00

 

RESULTS OF DECISION POINT TWO

·  Client returns to clinic in four weeks

·  Client states that the drug makes her nauseated and gives her diarrhea

·  Client states that she stops taking it until these symptoms abate, at which point she re-starts only to experience the symptoms again

Decision Point Three

 

Be I decided to change Lithium to sustained release preparation at same dose and frequency.

RESULTS OF DECISION POINT THREE

 

Guidance to Student In this case, the client is having nausea and diarrhea, classic side effects of lithium therapy. Changing the client to an extended release formulation can often prevent these symptoms while at the same time affording the client the benefit of lithium’s mood stabilizing properties. Also, lithium is a good choice for control of mania and has also been shown to decrease risk of suicide, which adds to its overall benefits. Depakote may be an option if changing to sustained release lithium does not alleviate the side effects. Oxcarbazpine (Trileptal) is an option, but is a second line therapy and is not appropriate at this stage as the client has not had an adequate trial of first line agents.

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