Assessing and Treating Clients with Bipolar Disorder Paper

Assessing and Treating Clients with Bipolar Disorder Paper

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?Assessing and Treating Clients with Bipolar Disorder Paper. 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. when were they different?

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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.

Finally: 1. Complete the decision tree (keep track of what you selected. Assessing and Treating Clients with Bipolar Disorder Paper.come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).

2. Write paper addressing all section listed based on the decision tree.

Case Study: Bipolar Therapy for Client of Korean Descent/Ancestry:

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 weight 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.Assessing and Treating Clients with Bipolar Disorder Paper. 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.Assessing and Treating Clients with Bipolar Disorder Paper. 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

RESOURCES

§ Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype & affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype & activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6Assessing and Treating Clients with Bipolar Disorder Paper

Decisions Made and Outcomes (Needed to formulate the paper)

Choices for Decision 1: Select what the PMHNP should do: Begin Lithium 300 mg orally BID, Begin Risperdal 1 mg orally BID, or Begin Seroquel XR 100 mg orally at HS.

My decision: I chose to begin Lithium 300 mg orally BID.

Outcome: 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
Assessing and Treating Clients with Bipolar Disorder Paper

Choices for Decision 2: Select what the PMHNP should do:Increase Lithium to 450 mg orally BID, Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology, or Switch to Depakote ER 500 mg orally at HS.

My decision: I chose to switch to Depakote ER 500 mg orally at HS.

Outcome: RESULTS OF DECISION POINT TWO: Client returns to clinic in four weeks

Client reports that she has been compliant and you notice a marked reduction in manic symptoms. Young Mania Rating Scale was 11 (50% reduction from first office visit)

Client reports that she has gained 6 pounds over the last 4 weeks and wants to stop the medication because of this Client returns to clinic in four weeks

Choices for Decision 3: Decision Point Three Select what the PMHNP should do next: Educate client regarding diet/weight loss and continue client on the same drug/dose, Decrease Depakote ER to 250 mg orally at HS, or Switch medication to Zyprexa 15 mg orally daily at HS

My decision: I choose to educate client regarding diet/weight loss and continue client on the same drug/dose

Outcome: Guidance to Student

The PMHNP should begin by educating the client regarding weight loss/and importance of diet/exercise while taking Depakote which can cause weight gain. Assessing and Treating Clients with Bipolar Disorder Paper.Decreasing the dose of Depakote would not be appropriate as she still has symptoms and decreasing dose of Depakote may result in some weight loss, it may result in a return of manic symptoms. The PMHNP can switch to Zyprexa but if weight gain is the issue, then this will be compounded by Zyprexa which is associated with significant weight gain (up to 20 kg over a 24 month period).

***Write on each decision. Make sure that this paper has at least 5 References. Please use in-text citations. Don\'t forget the ethical considerations for this assignment. Make it a section by itself.***Assessing and Treating Clients with Bipolar Disorder Paper

Assessing and Treating Clients with With Bipolar Disorder

ACTUAL ASSIGNMENT

PLEASE Addressed each of the following numbers with a subtopic, all the references used must have an in-text citation in each paragraph. All Articles used should come from USA and must be within last five years only that is from 2014 to 2018. Please do not begin a paragraph with author name(s) (PLEASE USE parenthetical/in-text citations)Assessing and Treating Clients with Bipolar Disorder Paper

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)Assessing and Treating Clients with Bipolar Disorder Paper. 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 Objectives

Students will:

  • Assess client factors and history to develop personalized plans of bipolar therapy for clients
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapy
  • Evaluate efficacy of treatment plans
  • Analyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespan

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

 

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

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Assessing and Treating Clients with Bipolar Disorder Paper.Be sure to read all sections on the left navigation bar for each chapter.

  • 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

Note: Retrieved from Walden Library databases.

Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

Note: Retrieved from Walden Library databases.Assessing and Treating Clients with Bipolar Disorder Paper

Required Media

Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author

 

Note: This case study will serve as the foundation for this week’s Assignment.

 

Optional Resources

Mostafavi, A., Solhi, M., Mohammadi, M., Hamedi, M., Keshavarzi, M., & Akhondzadeh, S. (2014). Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Acta Medica Iranica, 52(10), 734-739.
Retrieved from http://acta.tums.ac.ir/index.php/acta

 

To prepare for this Assignment:

  • Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy.Assessing and Treating Clients with Bipolar Disorder Paper