Case Study OF A Woman Diagnosis With Bipolar Disorder

Case Study OF A Woman Diagnosis With Bipolar Disorder

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Bipolar disorder is a mental illness characterized by extreme mood changes. Individuals with bipolar disorder can experience both manic and depressive episodes. Manic episodes are characterized by feelings of elation, while depressive episodes are characterized by feelings of sadness and despair (Vieta et al., 2018). Bipolar disorder can also cause changes in sleep patterns, energy levels, and the ability to concentrate. Bipolar disorder affects about 1 in every five adults in the United States (Bessonova et al., 2020). It is more common in women than men and tends to run in families. While its cause is not fully understood, it is believed to be a combination of genetic and environmental factors. Some of the most common causes of bipolar disorder include genetics, a history of mental illness or substance abuse, and traumatic events (such as sexual abuse or a family member’s death)Case Study OF A Woman Diagnosis With Bipolar Disorder. Other causes may include brain chemistry abnormalities, lifestyle choices (such as excessive drinking or smoking), and stressors in life.

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This disorder is characterized by extreme mood, energy, and activity changes. People with bipolar disorder may have periods of great happiness, energy, and productivity followed by periods of intense sadness or depression. These mood swings can last for days, weeks, or even months. Treatment for bipolar disorder typically includes a combination of medication and psychotherapy. Medication is generally used to stabilize mood and reduce episodes of mania, while psychotherapy is used to help individuals understand and manage their emotions.

In some cases, a person may need to take medication for the rest of their life to maintain mood stability. This paper is centered on a case study of a 26-year-old Korean women diagnosed with Bipolar disorder. It discusses the three therapeutic decisions that would be more applicable for the patient based on her pharmacokinetic and pharmacodynamics process. The paper also discusses ethical factors that may impact patient treatment plans  Case Study OF A Woman Diagnosis With Bipolar Disorder.

Case Scenario

This case study involved a 26-year-old patient who reported to her first appointment following 21-day hospitalization with a cute onset of mania and was diagnosed with bipolar I. Upon arrival at the office, she became busy playing with staff on the taking while shifting her chair sideways. She questioned her diagnosis and said she only likes talking, singing, and dancing. The patient weighs 110lbs at 5’5 height. Her mood was fantastic, she reported sleeping for only five hours but hated it since it’s no fun. According to her health records, she is positive for the CYP2D6*10 allele. She reported taking her lithium since she was discharged in two weeks. On mental status examination, she is alert and oriented but wore oddly. She denies visual and auditory hallucinations, and any homicidal ideation. Scored 22 on YMRS. Case Study OF A Woman Diagnosis With Bipolar Disorder

Decision point 1#

In this decision, PMHNP has an option to start the client on lithium 300mg PO BID, Risperdal 1mg PO BID, and Seroquel XR 100mg PO HS. I started the patient on Risperdal 1mg because its FDA approved and being a long-acting antipsychotic, it’s preferred in treating bipolar disorder in cases of non-compliance, which was the case for the patient. Risperdal has a lower risk of side effects than other antipsychotic medications, making it a more tolerable option for patients who may experience adverse reactions to other medications. Besides, its effectiveness in managing both manic and depressive episodes of bipolar has been confirmed by many studies (Chopko et al., 2018)Case Study OF A Woman Diagnosis With Bipolar Disorder.

Seroquel XR is also an excellent option for managing bipolar but was not selected as first-line because of its potential to cause weight gain and other metabolic problems that can be difficult to manage in the patient who is already dealing with challenges of bipolar disorder. It’s also known to cause sedation and other cognitive effects that may make it difficult for people to live normally (Barton et al.,2020)Case Study OF A Woman Diagnosis With Bipolar Disorder. Besides, Seroquel is not always effective in cases of non-compliance. Lithium, however, was not chosen at this decision point because the patient had already repeated being non-compliant with it.

By making this decision, I hope the patient will report significant improvement in her symptoms. After four weeks of therapy, she returned to the clinic with her mother, who helped her get into the office looking sedated and lethargic. The client’s mother claimed she was in such a condition one week following the last office visit.

Decision 2#

At this decision point, the client, the PMHNP, has an option to discontinue Risperdal and start the client on lithium SR, decreasing Risperdal to 1mg at HS and changing Risperdal to 2mg at HS. I chose to decline Risperdal to 1mg at HS. This decision was made because the patient CYP2D6*10 allele was favorable, with studies showing that positive CYP2D6*10 is associated with reduced metabolism of Risperidone and thus the side effects such as sedation and lethargy which the client reported (Dodsworth et al.,2018)Case Study OF A Woman Diagnosis With Bipolar Disorder. Reducing the dose would be the most prudent approach to minimize impact and potentially increase the chances of treatment success. Increasing Risperdal to 2mg at HS would not be viable as it would not help eliminate side effects already caused by the current dosage.

By making this decision, the client is expected to report at least a 50% decrease in her symptoms and a significant decrease in drug side effects such as lethargy and sedation. After four weeks of therapy, she reported being less sedated, less lethargy and an improvement on her symptoms. Her YMRS also fall from 22 to 16.

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Decision 3#

At this decision point, the available options are to continue the client on the same dose of Risperdal, reassess after four weeks, increase Risperdal dosages back to 1mg and change the client’s prescription to Latuda 4omg PO. I chose to continue the client on the same dose of Risperdal and reassess after four weeks. This decision was made owing to the client’s positive response to the prescription. According to studies, when the client reports positive reactions to therapy and reduced symptoms, it is best to continue taking the medication and reassess for continual improvement (Begemann et al., 2020)Case Study OF A Woman Diagnosis With Bipolar Disorder. Furthermore, quitting Risperdal in a bipolar patient may aggravate symptoms and potentially result in death. Latuda is an outstanding bipolar drug; however, it is only approved for depressed periods, which the patient did not experience. Furthermore, many individuals are unable to afford it. By making this decision, it’s expected that the client will report a continual decrease in side effects and over 50% improvement in her symptoms.

Ethical consideration

Treatment of bipolar disease in Korean women may be challenging due to cultural and socioeconomic factors. A few ethical considerations must be considered when treating this population. First, consider the cultural context in which the women live (Ronningstam et al., 2018). It is essential to understand the values and beliefs of the Korean culture to provide the best possible care. Secondly, it is necessary to consider the social factors affecting women. This includes family dynamics, social support systems, and cultural expectations. Finally, it is crucial to consider the patient’s values and beliefs to best tailor treatment plans. Treatment plans should be tailored to meet the unique needs of this population while still maintaining adherence to scientific principles. Besides, seeking patient consent and respecting the patient’s decision is essential Case Study OF A Woman Diagnosis With Bipolar Disorder.

Conclusion

Bipolar disorder is a mental condition characterized by manic and depressive episodes. This sickness affects both men and women. Bipolar disorder is treated with medication and psychotherapy. Risperdal, for example, is effective in treating both manic and depressive episodes associated with bipolar illness. To be effective, it must be personalized to each patient. Nursing ethics, such as autonomy, must be considered when providing care Case Study OF A Woman Diagnosis With Bipolar Disorder.

References

Barton, B. B., Segger, F., Fischer, K., Obermeier, M., & Musil, R. (2020). Update on weight-gain caused by antipsychotics: a systematic review and meta-analysis. Expert opinion on drug safety, 19(3), 295-314.

Begemann, M. J., Thompson, I. A., Veling, W., Gangadin, S. S., Geraets, C. N., van‘t Hag, E., … & Sommer, I. E. (2020). To continue or not to continue? Antipsychotic medication maintenance versus dose-reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic multicenter single-blind randomized controlled trial. Trials, 21(1), 1-19.

Bessonova, L., Ogden, K., Doane, M. J., O’Sullivan, A. K., & Tohen, M. (2020). The economic burden of bipolar disorder in the United States: a systematic literature review. ClinicoEconomics and outcomes research: CEOR, 12, 481.

Chopko, T. C., & Lindsley, C. W. (2018). Classics in chemical neuroscience: risperidone. ACS chemical neuroscience, 9(7), 1520-1529.

Dodsworth, T., Kim, D. D., Procyshyn, R. M., Ross, C. J., Honer, W. G., & Barr, A. M. (2018). A systematic review of the effects of CYP2D6 phenotypes on risperidone treatment in children and adolescents. Child and adolescent psychiatry and mental health, 12(1), 1-10.

Vieta, E., Berk, M., Schulze, T. G., Carvalho, A. F., Suppes, T., Calabrese, J. R., … & Grande, I. (2018). Bipolar disorders. Nature reviews Disease primers, 4(1), 1-16. Case Study OF A Woman Diagnosis With Bipolar Disorder

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) Case Study OF A Woman Diagnosis With Bipolar Disorder

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.

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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 Case Study OF A Woman Diagnosis With Bipolar Disorder