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Assessing and Treating Patients With Bipolar I Disorder Assignment

Assessing and Treating Patients With Bipolar I Disorder Assignment

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For this assignment, you will write a 5–6-page paper on the topic of bipolar and bipolar and related disorders. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your paper, you will choose one of the following diagnoses: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, Bipolar and Related Disorder Due to Another Medical Condition. Your paper will include discussion for your chosen diagnosis of bipolar and related disorder on the following: Assessing and Treating Patients With Bipolar I Disorder Assignment

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Prevalence and Neurobiology of your chosen disorder
Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria
Discuss special populations and considerations (children, adolescents, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder; demonstrating critical thinking beyond basics of HIPPA and informed consent with discussion of at least one for EACH category: legal considerations, ethical considerations, cultural considerations, social determinants of health
Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder
Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings. What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy. Assessing and Treating Patients With Bipolar I Disorder Assignment

Assessing and Treating Patients with Bipolar I Disorder

Bipolar and Related Disorders constitute an important category of mental health conditions in the DSM-5-TR (APA, 2022; Boland et al., 2021). Of these, bipolar I (BD I) and bipolar II (BD II) disorders are very closely related, but also different in one important way. With the exception of mania, nearly every trait of the two is comparable. The aim of this paper is to present BD I as a condition and at the same time compare it with BD II.

The Epidemiology and Neurobiology of BD I

According to research, 2.8% of Americans have been diagnosed with BD I (NIMH, n.d.). About 6 people per 1,000 people in the US are estimated to have BD I annually (APA, 2022). Forecasts based on incidence indicate that roughly 5 out of 100 US citizens experience BD I symptoms at some point in their lives. Despite the graveness and high frequency of bipolar disorders, our comprehension of their neurological underpinnings is lacking, which hinders the advancement of novel treatments. Bipolar I illness like all other hereditary diseases will only show symptoms when the right external variables enable the genetic composition to show up clinically. Intracellular metabolic mechanisms have been known to impact neuronal plasticity in bipolar I illness (Harrison et al., 2018; Stahl, 2021)Assessing and Treating Patients With Bipolar I Disorder Assignment. Collectively, these elements cause cellular death and a toxic disturbance of normal brain function.

Comparing the Two Bipolar Disorders

For instance, bipolar I and II disorders might exhibit quite similar symptoms at first. There is one important difference, though: people with bipolar I disease never miss a manic episode in their lifetime, whereas people with bipolar II disorder never do. During manic periods, people with bipolar I illness often have more severe symptoms that interfere with their daily lives. People with bipolar I and II exhibit differently in both extremes during episodes (APA, 2022; Boland et al., 2021). While a person with bipolar I may or may not experience depression, a person with bipolar II will experience a significant depressive episode.

According to APA (2022), a person going through a manic episode could show signs of restlessness, inexplicable happiness, and an insatiable drive to get everything done. Continuous talking, quick speech, lack of sleep, hurried thinking, being quickly distracted, and hyperactivity are some signs of manic episodes (APA, 2022; Boland et al., 2021)Assessing and Treating Patients With Bipolar I Disorder Assignment. True mania is distinguished from hypomania by the need for hospitalization during the course of the symptoms, which can occur in less than a week. Dangerous activities, such as unprotected sex, dangerous business ventures, binge drinking, and reckless driving, are common among manic bipolar individuals.

Some Special Population Demographics

  1. Children

Bipolar disorder in young people can manifest as manic, depressive, or mixed episodes. Both manic and depressed manifestations are indicative of a mixed episode (APA, 2022; Boland et al., 2021)Assessing and Treating Patients With Bipolar I Disorder Assignment. During a manic episode, a kid or adolescent may exhibit intense joy for extended periods of time, get agitated, speak quickly, have trouble falling asleep, lose focus, have racing thoughts, participate in extremely unsafe but happy activities, and act impulsively.

Children and teenagers experiencing a depressive episode may experience widespread, spontaneous gloom, as well as a rise in frustration, dissatisfaction and discord. They may also start sleeping more, find it difficult to focus, feel irrelevant and powerless, struggle to maintain associations; eat excessively or not at all; show a lack of dynamism and involvement in activities they usually enjoy; and even consider suicide.

  1. Women who are Pregnant

Bipolar illness may be present in up to 20 out of every 100 pregnant women who screen positive for depression. Women with bipolar disorder who are pregnant or just gave birth are particularly vulnerable (Sharma et al., 2020). When a woman of age to reproduce first comes for evaluation, it is crucial to take into account the risks of the disease and possible adverse effects of therapy because 50% of pregnancies are unplanned.

  1. Senior Citizens

A significant portion of hospitalized elderly bipolar patients typically report sadness as their initial mood problem. Furthermore, bipolar depression may be a factor in eight to ten percent of senior mental hospitalizations. About 25% of people with bipolar disorder diagnosis are anticipated to be over 60 (NIMH, n.d.)Assessing and Treating Patients With Bipolar I Disorder Assignment. Senior bipolar folks encompass a wide range of individuals: those with a history of manic episodes before late life; those whose bipolar disorder started in their early adult years; and those experiencing a late-life manic phase.

Morality and Legality

To maintain autonomy, it is morally better to have informed consent (Haswell, 2019). In a same vein, any measure has to be beneficial to the patient and cannot in any way harm them; including giving them medications that could make their illness worse. Patients’ confidentiality and privacy need to be legally safeguarded. Additionally, emergency care may need involuntary commitment, even in cases where the patient objects. A peace officer will carry out the order if and when a court decides that you are a threat and need to be committed in an emergency (Disability Rights Texas, 2018)Assessing and Treating Patients With Bipolar I Disorder Assignment. The public’s safety as well as the patient’s is the main objective of this forced commitment method.

The Influence of Cultural Background

A person’s actions and facial expressions throughout either stage will invariably reflect their upbringing and cultural norms. Put another way, people will display signs and cues unique to their cultural environment. For instance, a devoted Muslim could abstain from the bad behavior of alcoholism, as binge drinking is socially taboo in their community. On the other hand, they could engage in risky behavior in other contexts, like taking on venturesome business ventures. The most notable influence on connections with mental health patients comes from those cultures in terms of diagnosis and recovery.

The Prevailing Social Determinants of Health

An individual’s birth, childhood, life, and death are influenced by characteristics known as the social determinants of health, or SDOH for short. These traits affect the start, course, and prognosis of diseases and mental health issues (Artiga and Hinton, 2018; McMaughan et al., 2020)Assessing and Treating Patients With Bipolar I Disorder Assignment. The access to top-notch medical facilities, individual academic achievement, living in a clean environment, and one’s socioeconomic status or family income present just a few examples of these SDOH. This SDOH also affects the course and progression of bipolar I disorder.

Clinical Practice Guidelines and Recommended Management

Lithium, also known as Eskalith, has been approved by the FDA to be used as the first-line treatment for bipolar I illness (Stahl, 2020; Volkmann et al., 2020). It has recognized adverse effects that are dose-dependent, just like any drugs. Lithium side effects include drowsiness, nausea, shivering, tired muscles, unsteadiness, and other problems with coordination or muscular control. These might be signs of toxicity or intoxication from lithium (Stahl, 2020)Assessing and Treating Patients With Bipolar I Disorder Assignment. Sometimes, lithium toxicity can cause brain damage, a coma, or even death. Another potentially fatal and devastating condition that lithium might cause is serotonin syndrome.

An individual’s medical record should be examined for physical conditions such as thyroid dysfunction, cardiac conduction abnormalities, and impaired renal function before starting lithium therapy (De Berardis et al., 2023). Analyzing the data to determine whether dermatological disorders exist is also essential. Knowing one’s LMP is crucial for female patients because they may be required to submit to a urine test. Additionally, patients should be made aware of the potential side effects of lithium, the necessity of a low-salt diet, and the necessity of quitting medications such as ACE inhibitors and diuretics prior to beginning lithium therapy.

Monitoring and Prescribing

Serum lithium levels need to be checked in a lab every few months (Stahl, 2020). Monitoring thyroid and kidney function testing is also essential. A person with bipolar I illness may be given any of the following prescriptions, to go hand in hand with group cognitive behavioral therapy or CBGT (David et al., 2018; Saunders et al., 2021; Stahl, 2020):

  • Lithium (Eskalith) 300 mg Tablet I tablet orally bid, for 30 days.

OR

  • Aripiprazole (Abilify) 10 mg Tablet 1 Tablet by mouth once daily, for 30 days.

OR

  • Valproate (Depakote ER) 500 mg Extended-Release Tablet 1 Tablet by mouth bid, for 30 days.

Conclusion

In the DSM-5-TR, bipolar disorder and related illnesses is the main diagnostic category for affective disorders. This list includes bipolar I disorder, which is classified under this diagnostic category. Its neurological cause is well-established, and lithium, an FDA-approved drug, can be used to treat it (Eskalith)Assessing and Treating Patients With Bipolar I Disorder Assignment. It also includes coexisting conditions. When discussing bipolar I disorder in the essay, each of these has been brought up.

References

American Psychiatric Association [APA] (2022). Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-5-TR), 5th ed. Author.

Artiga, S. & Hinton, E. (2018, May 10). Beyond health care: The role of social determinants in promoting health and health equity. https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/

Boland, R., Verdiun, M., & Ruiz, P. (Eds) (2021). Kaplan and Sadock’s synopsis of psychiatry, 12th ed. Wolters Kluwer.

David, D., Cristea, I., & Hofmann, S.G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9(4), 1-3. https://doi.org/10.3389/fpsyt.2018.00004

De Berardis, D., Fornaro, M., & Carmassi, C. (2023). Editorial: Comorbidity in bipolar disorder, volume II. Frontiers in Psychiatry, 14(0), 1-4. https://doi.org/10.3389/fpsyt.2023.1115357

Disability Rights Texas (August 16, 2018). Your legal rights under emergency commitment. https://www.disabilityrightstx.org/en/handout/your-legal-rights-under-emergency-commitment/

Harrison, P.J., Geddes, J.R., & Tunbridge, E.M. (2018). The emerging neurobiology of bipolar disorder. Trends in Neurosciences, 41(1), 18–30. https://doi.org/10.1016/j.tins.2017.10.006

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

McMaughan, D., Oloruntoba, O., & Smith, M. (2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health8. https://doi.org/10.3389/fpubh.2020.00231

National Institutes of Mental Health [NIMH] (n.d.). Bipolar disorder. https://www.nimh.nih.gov/health/statistics/bipolar-disorder

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Saunders, E.F.H., Mukherjee, D., Myers, T., Wasserman, E., Hameed, A., Krishnamurthy, V.B., McIntosh, B., Domenichiello, A., Ramsden, C.E., & Wang, M. (2021). Adjunctive dietary intervention for bipolar disorder: A randomized, controlled, parallel‐group, modified double‐blinded trial of a high n‐3 plus low n‐6 diet. Bipolar Disorders, 0(0), 1-14. http://dx.doi.org/10.1111/bdi.13112

Sharma, V., Sharma, P., & Sharma, S. (2020). Managing bipolar disorder during pregnancy and the postpartum period: A critical review of current practice. Expert Review of Neurotherapeutics, 20(4), 373-383. https://doi.org/10.1080/14737175.2020.1743684

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications, 5th ed. Cambridge University Press.

Stahl, S.M. (2020). Stahl’s essential psychopharmacology: Prescriber’s guide, 7th ed. Cambridge University Press.

Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium treatment over the lifespan in bipolar disorders. Frontiers in Psychiatry, 11(377), 1-11. https://doi.org/10.3389/fpsyt.2020.00377 Assessing and Treating Patients With Bipolar I Disorder Assignment

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