Assessing and Treating Clients with Bipolar Disorder
Assessing and Treating Clients with Bipolar Disorder
Bipolar disorder is an extreme emotional unsteadiness with genuine results for everyday living of patients and their guardians. Mind as usual principally comprises of pharmacotherapy and reliable treatment. In any case, a substantial number of patients demonstrate a defective reaction to treatment and experience the ill effects of incessant scenes, steady inter-episodic side effects, and poor social working. Both psychiatric and physical comorbid issue are visited, particularly identity issue, substance mishandle, cardiovascular maladies and diabetes. The multidisciplinary coordinated effort of experts is expected to join all skill with a specific end goal to accomplish great-incorporated treatment (Fisher et al., 2017). A few reviews have demonstrated likely impacts of coordinated treatment programs for patients with bipolar disorder. In this paper, bipolar therapy is examined with considerations to making the right treatment choices amid ethical considerations.
Decision Point One
Selected Decision
Assessing and Treating Clients with Bipolar Disorder
Begin Risperdal 1 mg orally BID
Reason for the Selection
The drug, Risperdal (risperidone), is a second generation or atypical antipsychotic agent whose uses include management of bipolar disorder. Its main action is through rebalancing the dopamine and serotonin and thereby to improve mood, to think, and behavior. Given that the patient was diagnosed with bipolar disorder, Risperdal is the best choice considering the available medications. In the prior treatment, the patient defaulted in lithium, and so it may not be a moral idea to begin lithium 300 mg as the chances are that the patient may not comply (Hamlat, O’Garro-Moore, Alloy, & Nusslock, 2016). Seroquel XR may be a good choice, but its side effects may include weight gaining and constipation. This may not be well received by the patient who defaulted in using lithium which has a similar side effect of constipation.
Expected Results
The patient should be able to improve within the first four weeks. The symptoms should reduce significantly with an improvement in the patient’s mood. The patient should exhibit a good sleeping pattern. Risperdal is an effective medication for balancing mental activity and restore sanity in the way that the patient thinks (Wilson, Crowe, Scott, & Lacey, 2017). The suicidal thoughts should decrease as well as symptoms of anxiety.
The patient visited the hospital after four weeks, and she was lethargic and sedated. Her mum had to accompany her
Assessing and Treating Clients with Bipolar Disorder
into the office. It was stated that these symptoms appeared after one week of medication. This was contrary to the anticipated results of reduced the symptoms of bipolar. It was expected that the patient would have improved mood and appropriate thinking. The difference in the results is the side effects of the drug. The high amount of Risperdal in the blood leads to sedation. Given that the patient is of Korean ancestry and positive for CYP2D6*10 allele means that she may not have a swift clearance of Risperdal from the blood leading to accumulation (Demant, Vinberg, Kessing, & Miskowiak, 2015).
Decision Two
Selected Decision
Decrease Risperdal to 1 mg at HS
Reason for Selection
Risperdal 1 mg orally BID did not fail to work during the second visit; it only caused side effects. It is wise to alter the dosage to manage the side effects rather than cease the medication for another. Altering Risperdal to 2 mg at HS may still attest to be a lot, and the side effects may not be sufficiently managed. A choice to switch back to lithium is still not right as the patient still has an attitude towards it (Demant, Vinberg, Kessing, & Miskowiak, 2015). Furthermore, it might confuse the patient on drugs used. Helping her cope with different dosage of the same drug will increase her confidence in drugs and appreciate that it is all about the alteration of the dosage.
Expected Results
As mentioned previously, Risperdal is effective in balancing dopamine and serotonin in the brains and thus managing mood, behavior and thought problems. The adverse effects have been ascribed to the accumulation of Risperdal in the patient’s blood. Lowering the dosage to Risperdal 1 mg at HS will warrant no accumulation of the drug in the patient’s blood as the body will be able to excrete it quite quickly. By altering the dosage, the patient should begin being less sedated and less lethargic. The patient should also begin experiencing improvement in the mood, have proper behaviors as well as think well (Demant, Vinberg, Kessing, & Miskowiak, 2015). This is the effect of Risperdal when taken in the correct amount.
Difference between Expected Results and Actual Results
The patient visited after four weeks, and she was less lethargic and sedated. Furthermore, the Young Mania Rating Scale had reduced from 22 to 16. The patient reported that there were no other side effects. These outcomes are very similar to the anticipated results. The side effects diminished quite faster than it was assumed and this the only difference and luckily in a positive direction. The results are similar because just as stated earlier, Risperdal is a proper medication for bipolar disorder. The adverse effects could not be used as a reason for discarding the drug in this case.
Decision Three
Selected Decision
Continue the same dose of Risperdal and reassess in four weeks
Reason for Selection
The patient is responded quite well to the current medication. It is more sensible to persist with the dosage as the evaluation continues to note any need for altering the medication in any way. Also, Risperdal I mg orally BID already proved to be unbearable by the patient’s system. Going back to it may cause the side effects witnessed earlier. Shifting to Latuda, on the other hand, is not appropriate since FDA only qualifies it for treatment of bipolar type 1. The patient’s mental condition is not consistent with bipolar type 1. The drug is also very costly. Thus, it is wise to go on with the same dosage of Risperdal and only alter when necessary.
Expected Results
Given that the patient has appropriately responded to the treatment by Risperdal, it is anticipated that continual use of the drug will lead to even further reduction of the symptoms of bipolar. The first instant resulted in more than twenty-five percent reduction in symptoms; hence, the reduction should be close to fifty percent by the fourth week. The patient will have a good sleeping pattern, improved mood, rational behavior, and appropriate thinking (Fisher et al., 2017). The adverse effects experienced in the initial dosage are not expected to be seen again.
Difference between Expected Results and Actual Results
As per the advice given after the third decision, the expected results will be that the patient will have achieved a significant progressive reduction of the previous symptoms. It will result in managing the bipolar disorder if the Risperdal continues to be effective at this dosage. These are however similar results to those anticipated when the dosage was being used. Given consistency in the pharmacokinetics and pharmacodynamics, these should be the expected results and the goals of therapy will be achieved in a short time.
Impact of Ethical Considerations on Treatment Plan
In healthcare, ethical considerations play a huge role in the treatment plan. When handling patients having bipolar disorder, ethical considerations come centrally to the way the PMHNP approaches the treatment (Burdick, Ketter, Goldberg, & Calabrese 2015). The patient is mentally unstable, and therefore the PMHNP nurse has to know the appropriate way to present any info to them and the exact time to do that. Ethical contemplations affected the way the patient was counseled to go on using Risperdal in an altered dosage after the first one had caused sedation and lethargy side effects.
When choosing among the drugs to use, ethical considerations were at the core since some drugs are known for specific side effects to several descents of people. For example, Seroquel XL is known for constipation and dry mouth. The patient had complained of comparable side effects when she used lithium in her previous medication. Ethical considerations demand that the PMHNP considers the long-term effects this may bring about; like damage of the teeth (Goodwin et al., 2016). Hence, the medication had to be foregone for a better alternative with relatively fewer adverse effects.
Conclusion
Bipolar disorder is a complicated condition to diagnose because of the numerous symptoms that resemble symptoms for other mental disorders. In the treatment of this condition, due considerations ought to be made as to the side effects of the drugs used. Ethical contemplations are also vital to the treatment plan for bipolar disorder given the mental unsteadiness of the patient. There are drugs recognized for the treatment of bipolar disorder; nevertheless, the PMHNP need to be aware of which drug is suitable and the dosage for every specific bipolar disorder patient.
References
Fisher, A., Manicavasagar, V., Sharpe, L., Laidsaar-Powell, R., & Juraskova, I. (November 01, 2017). A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder. Community Mental Health Journal, 53, 8, 958-971.
Hamlat, E. J., O’Garro-Moore, J. K., Alloy, L. B., & Nusslock, R. (January 01, 2016). Assessment and Treatment of Bipolar Spectrum Disorders in Emerging Adulthood: Applying the Behavioral Approach System Hypersensitivity Model. Cognitive and Behavioral Practice, 23, 3, 289-299.
Wilson, L., Crowe, M., Scott, A., & Lacey, C. (2017). Psychoeducation for bipolar disorder: A discourse analysis. International Journal of Mental Health Nursing.
Goodwin Gm, Et Al. (2016). Evidence-Based Guidelines for Treating Bipolar Disorder: Revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology (Oxford, England). 30, 495-553.
Burdick Ke, Ketter Ta, Goldberg Jf, & Calabrese Jr. (2015). Assessing cognitive function in bipolar disorder: challenges and recommendations for clinical trial design. The Journal of Clinical Psychiatry. 76, 342-50.
Demant, K. M., Vinberg, M., Kessing, L. V., & Miskowiak, K. W. (2015). Assessment of subjective and objective cognitive function in bipolar disorder: Correlations, predictors and the relation to psychosocial function. Psychiatry Research. 229, 565-571.