ASSESSING AND TREATING PATIENTS WITH BIPOLAR DISORDER NURS 6630

ASSESSING AND TREATING PATIENTS WITH BIPOLAR DISORDER NURS 6630

A Sample Answer For the Assignment: ASSESSING AND TREATING PATIENTS WITH BIPOLAR DISORDER NURS 6630

Bipolar I Disorder is a mental health condition characterized by episodes of mania and depression, with significant impact on the individual’s daily functioning. Effective treatment of this disorder is crucial to achieving stabilization of symptoms, preventing relapse, and improving overall quality of life. Pharmacological interventions have been shown to be an effective treatment option for individuals with Bipolar I Disorder.

This paper seeks to explore the prevalence and neurobiology of Bipolar I Disorder, as well as its diagnostic criteria and special populations and considerations. Additionally, we will explore the pharmacological treatment options, including the side effects, FDA approvals and warnings, and what to monitor in terms of labs and comorbid medical issues.

Prevalence and Neurobiology

Bipolar I Disorder is a serious mental health condition that is characterized by periods of manic episodes, depressive episodes, and sometimes mixed episodes. The prevalence of Bipolar I Disorder in the general population is estimated to be around 1% to 2%, making it a relatively rare condition. However, despite its rarity, it can have a significant impact on the lives of those who suffer from it and their loved ones.

Bipolar I Disorder affects men and women equally and typically develops in late adolescence or early adulthood (Carvalho et al., 2020). The neurobiology of Bipolar I Disorder is not yet fully understood, but research suggests that it may be caused by a combination of genetic, environmental, and biological factors.

Studies have shown that there are abnormalities in the structure and function of certain brain regions, including the prefrontal cortex, amygdala, and hippocampus, in individuals with Bipolar I Disorder. Additionally, imbalances in neurotransmitters such as dopamine, norepinephrine, and serotonin have been implicated in the development of this disorder.

Differences between Bipolar I Disorder and Bipolar II Disorder

Bipolar II Disorder is a related condition to Bipolar I Disorder, but the diagnostic criteria and symptom presentation differ. The main difference between these two disorders is the severity of the manic episodes (Jain & Mitra, 2022). In Bipolar II Disorder, the manic episodes are less severe and are classified as hypomanic episodes, while in Bipolar I Disorder, the manic episodes are more severe and can cause significant impairment in social, occupational, or other areas of functioning.

Another difference between these two disorders is the number of episodes required for diagnosis. Bipolar II Disorder requires at least one major depressive episode and at least one hypomanic episode, while Bipolar I Disorder requires at least one manic or mixed episode, which may be preceded or followed by a hypomanic or major depressive episode.

Special Populations and Considerations

Bipolar I Disorder is rare in children and adolescents, but it can occur. Holtzman et al. (2018) assert that diagnosing Biposal 1 in children and adolescents is challenging as the symptoms may overlap with other mental health conditions such as ADHD, conduct disorder, or substance use disorders. Treatment for children and adolescents with Bipolar I Disorder may include psychotherapy, medication, or a combination of both.

Individuals with Bipolar I Disorder may experience legal issues, such as arrest or incarceration, as a result of their symptoms. It is important for mental health professionals to be aware of the legal implications of this disorder and to advocate for their clients when necessary. For example, a person experiencing a manic episode may engage in impulsive and reckless behavior, which could lead to legal trouble. Mental health professionals may need to work with legal professionals to ensure that their clients are treated fairly and receive appropriate care.

Social determinants of health that might affect adolescents’ diagnosis and treatment of Bipolar 1 disorder include access to healthcare services, family support systems, poverty levels, educational attainment, cultural beliefs about mental health and stigma around seeking help. Additionally, social factors such as peer pressure can also have an impact on adolescents’ ability to seek proper diagnosis and treatment for their condition (Latifian et al., 2023).

Mental health professionals working with individuals with adolescents with Bipolar I disorder must ensure that they provide informed consent for treatment, respect their autonomy, and maintain confidentiality. Additionally, they should be aware of the potential for boundary violations in the context of manic or hypomanic episodes. For example, a therapist may need to set clear boundaries around communication during a manic episode to avoid blurring the professional relationship.

Women with Bipolar I Disorder may experience unique challenges during pregnancy and postpartum. Some medications used to treat this disorder may be harmful to a developing fetus, and women may be at increased risk of relapse during this time. Mental health professionals working with pregnant or postpartum women with Bipolar I Disorder must carefully balance the risks and benefits of medication use and provide support and resources to these women and their families.

Legal aspects such as balancing medication needs against risks posed toward the fetus must be considered alongside ethical concerns like drug transmitting through breast milk which could potentially impact infant development. Cultural elements such as fear of judgement or being stigmatized leading women to not seek medical attention when needed. Social determinants like access to healthcare services or lack thereof would also contribute towards a mother’s ability in managing her condition during these times according (Bergink et al., 2018).

Bipolar I Disorder can also occur in older adults, but it may be underdiagnosed and undertreated in this population. Symptoms of this disorder may be mistaken for normal age-related changes in cognition. Mental health professionals working with older adults with Bipolar I Disorder must be aware of the unique challenges and considerations in this population, including the increased risk of medication side effects and potential interactions with other medications.

Cultural challenges would encompass belief systems on mental health issues, and the effect of religiosity which could impede some individuals from seeking healthcare services. Social determinants of health such as insurance for older adults and limited access to care could affect delivery of care (Ryan et al., 2020).

When dealing with emergency care, legal considerations for bipolar 1 disorder include the need for involuntary commitment if the patient poses a danger to themselves or others. Ethical considerations may include balancing the patient’s autonomy with their treatment needs, and considering potential risks such as over-medication.

Social determinants of health that might affect diagnosis and treatment could include poverty levels, limited access to healthcare resources, social isolation, and stigma around mental illness in certain cultures. Cultural beliefs about mental health can also play a role in diagnosis and treatment decisions for individuals with bipolar 1 disorder (Ostacher, 2019).

FDA and Clinical Practice Guidelines Approved Pharmacological Treatment Options

The FDA and clinical practice guidelines have approved several pharmacological treatment options for Bipolar I Disorder. The choice of medication and treatment regimen will depend on the severity of symptoms and the phase of the illness. For acute manic or mixed episodes, mood stabilizers such as lithium, valproate, or carbamazepine are typically the first-line treatment.

These medications help to reduce the severity and duration of manic symptoms and prevent relapse. Second-generation antipsychotics such as risperidone, olanzapine, or quetiapine may also be used as adjunctive therapy or as monotherapy in cases where mood stabilizers are ineffective or not well-tolerated (American Psychiatric Association, 2021).

According to the American Psychiatric Association (2021), maintenance treatment for Bipolar 2 would have mood stabilizers as the first-line treatment to prevent future episodes of mania or depression. Lithium, valproate, and carbamazepine have all been shown to be effective in reducing the risk of relapse in individuals with Bipolar I Disorder. Second-generation antipsychotics such as aripiprazole and quetiapine are also effective in reducing the risk of relapse and may be used as an adjunct to mood stabilizers.

In addition to mood stabilizers and antipsychotics, antidepressants may also be used in the treatment of Bipolar I Disorder, but they must be used with caution due to the risk of inducing manic or mixed episodes. Antidepressants should only be used as adjunctive therapy to mood stabilizers or antipsychotics in cases of severe depressive symptoms.

Side Effects, FDA Approvals and Warnings

Medication treatment for Bipolar I Disorder can be effective, but it is important to be aware of potential side effects, FDA approvals and warnings, as well as what to monitor in terms of labs and comorbid medical issues. Side effects vary depending on the medication used. Lithium, for example, may cause side effects such as tremors, increased thirst and urination, weight gain, and kidney problems (McIntyre et al., 2020).

Valproate may cause nausea, tremors, hair loss, and liver problems. Second-generation antipsychotics may cause side effects such as weight gain, sedation, movement disorders, and metabolic changes. Patients should be informed of potential side effects and instructed to report any new or worsening symptoms to their healthcare provider.

FDA approvals and warnings also vary by medication. For example, lithium has an FDA-approved indication for the treatment of acute manic and mixed episodes of Bipolar I Disorder and for maintenance treatment of Bipolar I Disorder. However, it has a boxed warning for the risk of toxicity, particularly in the elderly and those with renal or cardiac impairment (McIntyre et al., 2020).

Antipsychotics have an FDA-Approved indication for the treatment of acute manic and mixed episodes of Bipolar I Disorder and for maintenance treatment of Bipolar I Disorder. However, they also carry warnings for potential metabolic side effects such as weight gain, hyperlipidemia, and hyperglycemia.

Lithium levels should be checked regularly to ensure that levels are within therapeutic range and to monitor for potential toxicity (Chen et al., 2021). Additionally, kidney function and electrolyte levels should be monitored. Valproate levels should also be monitored, along with liver function tests. Antipsychotics may require monitoring for metabolic side effects such as weight gain, glucose levels, and lipid levels.

Examples of Proper Prescription writing for Medications Used in Bipolar I Disorder for a Start Dose for Adults

Example 1	Example 2	Example 3
Date: April 2, 2023 Medication: Lithium Carbonate Strength: 300 mg Formulation: Tablet Route: Oral Frequency: 3 times per day Duration: Ongoing Indication: Bipolar 1 disorder Quantity: 60 tablets Refill: Thrice Provider Signature: Dr. Landon, Christine	Date: April 2, 2023 Medication: Quetiapine Fumarate Strength: 50mg Formulation: Tablet Route: Oral Frequency: Once at bedtime Duration: Ongoing Indication: Bipolar 1 disorder Quantity: 30 tablets Refill: Two Provider Signature: Dr. Nawbary, Wally	Date: April 2, 2023 Medication: Depakene ER Strength: 250mg Formulation: Tablet Route: Oral Frequency: Twice (morning and bedtime) Duration: Ongoing Indication: Manic episodes linked to Bipolar 1 disorder Quantity: 30 tablets Refill: Two Provider Signature: Dr. Smith, Lakeycia

Conclusion

Bipolar I Disorder is a complex mental health condition that requires careful diagnosis and management. Pharmacological interventions have been shown to be an effective treatment option for individuals with Bipolar I Disorder, but it is important to consider potential side effects, FDA approvals and warnings, and what to monitor in terms of labs and comorbid medical issues. In addition, it is important to consider special populations and considerations such as children, adolescents, pregnancy/post-partum, older adults, and emergency care.

Effective treatment of Bipolar I Disorder can help individuals achieve stabilization of symptoms, prevent relapse, and improve overall quality of life. By understanding the neurobiology, diagnostic criteria, and pharmacological treatment options, healthcare providers can develop individualized treatment plans to help their patients manage their symptoms and achieve greater stability.

References

American Psychiatric Association. (2021). Practice guidelines for the treatment of patients with bipolar disorder. https://doi.org/10.1176/appi.books.9780890426760

Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66. https://doi.org/10.1056/nejmra1906193

Chen, P., Hsiao, C., Chiang, S., Shen, R., Lin, Y., Chung, K., & Tsai, S. (2021). Cardioprotective potential of lithium and role of fractalkine in euthymic patients with bipolar disorder. Australian & New Zealand Journal of Psychiatry, 57(1), 104-114. https://doi.org/10.1177/00048674211062532

Jain, A., & Mitra, P. (2022). Bipolar affective disorder. In StatPearls [Internet]. StatPearls Publishing. https://doi.org/10.1007/springerreference_33704

Latifian, M., Abdi, K., Raheb, G., Islam, S. M. S., & Alikhani, R. (2023). Stigma in people living with bipolar disorder and their families: a systematic review. International Journal of Bipolar Disorders, 11(1), 1-20. https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-023-00290-y

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856. https://doi.org/10.1016/s0140-6736(20)31544-0

Ostacher, M. J. (2019). Ethical Issues in the Diagnosis and Treatment of Bipolar Disorders. The Journal of Lifelong Learning in Psychiatry, 17(3), 265-268. https://doi.org/10.1176/appi.focus.20190010

Ryan, K. A., Wilkins, K. M., & Huxley, N. A. (2020). Bipolar disorder in older adults: a critical review. The American Journal of Geriatric Psychiatry, 28(2), 166-178. Doi: 10.1016/j.jagp.2019.11.00

Wisner, K. L., Sit, D., O’Shea, K., Bogen, D. L., Clark, C. T., Pinheiro, E., … & Ciolino, J. D. (2019). Bipolar disorder and psychotropic medication: Impact on pregnancy and neonatal outcomes. Journal of affective disorders, 243, 220-225. DOI: 10.1016/j.jad.2018.09.045

Bipolar is a mental health disorder characterized by extreme mood changes that alter the behavior and normal function of a patient. The mood fluctuation is on extreme ends and may take days to weeks before change, accompanied by difficulties in performing daily tasks and social interactions. The mood changes are mania or hypomania; mania is a happy or irritable mood, and hypomania is a sad mood or depression (Ashok, et al, 2017).

These symptoms usually occur alternatively after weeks associated with a period of the normal state. There are types of bipolar which include bipolar 1, bipolar 2, and cyclothymic bipolar. Bipolar 1 has alternating episodes of mania, hypomania, and neutral mood. Bipolar two is associated with a major depressive mood disorder and hypomania state. Cyclothymic has frequent mood swings.

The signs and symptoms of the manic episode are diminished need for sleep, increased and faster speech, increased activity, increased risky behavior, distractibility, and uncontrollable racing thoughts. Hypomania presents with intense sadness or despair, loss of interest, fatigue, difficulties in concentration, frequent thoughts, and suicidal ideation. Common causes of bipolar are genetic predisposition, family history of bipolar, stressful environment, and substance abuse. The patient in the case study is a 26years old female with bipolar.

According to the American psychiatric association, she meets the DSM-5 criteria through her symptoms of the diminished need to sleep, excessive talking, increased distractibility, she is in a happy mood, rapid or pressured speech, and increased energy. She scores 22 on the young scale mania. The interventions for bipolar are the use of antipsychotics and psychotherapy.

Antipsychotics relieve the symptoms of the patient while psychotherapy enables the patient to change their thinking and behavior to improve cognitive functions and quality of life. The essay describes the three decisions made in treating the patient including the impact of ethical principles.

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Decision One

Which decision did you select?

Begin Seroquel XR 300mg orally at HS

Why did you select this decision?

Seroquel is a second-generation antipsychotic with a high affinity for dopamine and serotonin receptors. Its mechanism of action is by antagonizing these receptors and binding them to the norepinephrine transporter (Hamed, et al, 2017).

This helps in improving memory, mood, aggression, and the muscle movement that plays a vital role in the brain for pleasure. Seroquel is the best drug for the patient because it is FDA approved for acute manic episodes and bipolar. Moreover, the American psychiatric association proves it is efficient in treating bipolar in its studies.

Why did you not select the other two options provided in the exercise?

Risperdal is a second-generation antipsychotic for treating schizophrenia and maintenance treatment in bipolar. Its mechanism of action is by decreasing the serotonin and dopamine activity in the brain thus reducing the mood symptoms, agitation, and symptoms of schizophrenia. it has 94% bioavailability and is protein-bound with an active metabolite (Schoretsanitis, et al, 2017). It has a plasma half-life of three to twenty hours.

However, I did not select this drug for the patient because it has undesirable effects like drooling, nausea, weight gain, nausea, fatigue, and tiredness. Lithium is a commonly prescribed drug for prophylaxis and treatment of manic episodes. Its mechanism of action is by modulating the neurotransmitters and inhibiting the excitatory neurotransmitters like dopamine and glutamate.

It has neuro-proliferative and neuroprotective effects on the brain that helps in regulating mood. It is FDA approved for mood disorders and bipolar. However, I did not select the drug because the patient has not been compliant due to its unpleasant effects.

What were you hoping to achieve by making this decision?

The expectations of starting the patient on Seroquel XR 300mg are to relieve the symptoms and reduce the score of the young scale mania. The expected side effects are dry mouth, drowsiness, constipation, and weight gain.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Communication is the exchange of information from the sender to the recipient to understand and interpret and eventually respond. Communicating with a patient with bipolar can be hectic because they talk fast and have racing thoughts. Therefore, the nurse incorporates the principle of justice when assessing the patient. Justice is providing equal and quality services to all despite their underlying issues. Justice enables the nurse to communicate effectively with the patient.

Decision Two

Which decision did you select?

Discontinue Seroquel and begin Geodon 40mg

Why did you select this decision?

Geodon is a second-generation antipsychotic that inhibits the reuptake of norepinephrine and serotonin, blocking the alpha and antihistaminic activities. These decrease hallucinations, improve clear and positive thinking, reduces agitation, and improve activities of daily living (Findling et al, 2022).

It has 60% bioavailability and is 99% protein bound. The drug is initiated at a low dose and increased gradually within two weeks to reduce the side effects. I chose this drug because it is effective in treating bipolar and has no side effects on the patient.

Why did you not select the other two options provided in the exercise?

Increasing the dose of Seroquel to 400mg to improve the patient’s symptoms is not a good option because she previously complained of weight gain and constipation. Increasing the dose worsens the drug’s side effects. The use of dietary measures to control weight gain and obesity is ineffective because the drug has the effect of muscarinic cholinergic antagonism that induces gastrointestinal hypomotility and hence constipation and weight gain. Decreasing the dosage will not have positive effects on the patient’s symptoms and will still exhibit unpleasant side effects.

What were you hoping to achieve by making this decision?

The expectation of switching the patient’s treatment to Geodon is to improve the symptoms, decrease the young scale mania, and relieve constipation and weight gain.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

The nurse considers the principle of autonomy in this decision point. Autonomy is respect for a person’s decisions and preferences (Asl, et al, 2022). The patient is uncomfortable with Seroquel because it causes constipation despite the improvement of the symptoms. The nurse, therefore, changes the treatment to ensure patient satisfaction.

Bipolar disorder refers to a chronic psychiatric illness that causes a fluctuation in energy, mood, focus, concentration, and activity. Affected patients present with alternating episodes of mania or hypomania and depression as well as a mixture of manic and depressive features. It damages relationships, lower job performance, and increases suicidal ideations.

Bipolar can be managed but residual clinical symptoms and dysfunction can continue making it imperative to continuously reevaluate and treat affected patients. For a deeper understanding of Bipolar disorder, this paper will examine an Asian-American woman diagnosed with the disease and make three decisions regarding her medication. The decisions will be based on pharmacokinetic and pharmacodynamic processes.

Case Study

The presented case outlines a 26-year-old Korean woman. She has Bipolar I disorder a diagnosis made after 21-day hospitalization due to an onset of acute mania.  During her appointment, she is exceptionally “busy” as she shifts in her chair and plays with things on the desk (WU, 2022). She reports that she was informed of her bipolar diagnosis but she feels that it’s wrong because her hobbies are talking, dancing, singing, and cooking. Her BMI is normal because she weighs 110lbs and her height is 5’5”.

She indicates that her mood is ‘fantastic’ and adds that she sleeps for five hours each night although she hates sleep because it’s no fun. Her health and lab studies are non -remarkable although she is positive for the CYP2D6*10 allele since all her medications were not working (WU, 2022). Her discharge was authorized after responding positively to Lithium but she states that she no longer takes the prescription as instructed. Her reasons for non-adherence are not offered. Her mental status exam reveals odd dressing because she is wearing an evening gown.

She has a tangential, pressured, and rapid speech with a euthymic mood. Her affect is broad with no hallucinations, delusions, to suicidal ideations. She has intact judgment and impaired insight (WU, 2022). She scores 22 on the Young Mania Rating Scale (YMRS). Among the factors that will influence decisions made are her positive genetic test and her nonadherence history. It will be prudent to consider drugs that limit side effects to enhance compliance. The selected drug should also offer a positive therapeutic response to stabilize and manage her presenting symptoms.

Decision 1

Begin Seroquel XR 300 mg orally at HS

Reason for Selection

Seroquel XR 300 mg was selected because it is a bimodal mood stabilizer that effectively managed bipolar mania and depression. Seroquel blocks dopamine D2 receptors in the mesolimbic pathway resulting in an antipsychoti