NURS 6501 Bipolar Disorder
Walden University NURS 6501 Bipolar Disorder-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6501 Bipolar Disorder assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NURS 6501 Bipolar Disorder
Whether one passes or fails an academic assignment such as the Walden University NURS 6501 Bipolar Disorder depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NURS 6501 Bipolar Disorder
The introduction for the Walden University NURS 6501 Bipolar Disorder is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for NURS 6501 Bipolar Disorder
After the introduction, move into the main part of the NURS 6501 Bipolar Disorder assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NURS 6501 Bipolar Disorder
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NURS 6501 Bipolar Disorder
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
Stuck? Let Us Help You
Completing assignments can sometimes be overwhelming, especially with the multitude of academic and personal responsibilities you may have. If you find yourself stuck or unsure at any point in the process, don’t hesitate to reach out for professional assistance. Our assignment writing services are designed to help you achieve your academic goals with ease.
Our team of experienced writers is well-versed in academic writing and familiar with the specific requirements of the NURS 6501 Bipolar Disorder assignment. We can provide you with personalized support, ensuring your assignment is well-researched, properly formatted, and thoroughly edited. Get a feel of the quality we guarantee – ORDER NOW.
Sample Answer for NURS 6501 Bipolar Disorder
Bipolar II Disorder
Bipolar disorder is one of the manic-depressive illnesses. This disorder falls under the category of mental illnesses altering mood, energy, activity level, and the ability to perform daily operations. The symptoms of bipolar patients vary from one individual to the next. For example, a patient suffering from manic episode type of bipolar will have a high energy level while the person suffering from depressive bipolar will have little energy (Depp et al., 2017). Each of these manifestations has its effect on the patient. The purpose of this paper will be to review, summarize, and critique a scholarly article on how bipolar II disorder increases the chances of suicidal ideation among patients.
Article Summary
The study conducted by Depp et al. (2017) reveal that bipolar disorder is linked to increased chances of suicide among all psychiatric illnesses. The possibility that a bipolar patient would commit suicide or participate in activities that are likely to endanger life is 20-30 times compared to the average population. Besides, 5-10% of the people suffering from bipolar die from suicide, with a high percentage (50-60%) of these patients attempting suicide in their life (Depp et al., 2017). Patients who have bipolar disorder require extensive care because of the increased energy levels that might prompt them to engage in self-harm.
The increase in the number of bipolar patients dying from suicide signifies that care given to these patients does not compare with the value of their lives. Therefore, facts and figures from Depp et al. (2017) contend the truth about the connection of bipolar disorder to suicidal actions. The evidence used in this article impacts the nursing fraternity as it defines the level of care required for bipolar patients. The input of nurses plays an imperative role in reducing suicidal thoughts on bipolar patients because nurses can create a sense of belonging to their patients. The number of bipolar patients dying from suicide can reduce with the input of the nursing roles.
Article Critique
The strength of the article is on the use of factual data in connecting the increase of suicidal ideation on bipolar patients. The author proves that there is no ultimate treatment or drug that has been invented for this kind of disorder. However, some drugs and practices aim to reduce the effect of the disorder and make the patient assume a normal lifestyle. These therapies give the client mood stabilizers like lithium and divalproex sodium to stabilize mood (Pallaskorpi et al., 2017). The invention made on the drugs to reduce the effect of the disorder does not have a direct effect on the treatment. However, these drugs have a possible impact on the moods that would allow bipolar patients to limit suicide or killing other people out of anger. The environment that a bipolar inhabits would also affect their suicidal decisions. In situations where these patients are lonely and lack a sense of family belonging, they would pose a high likelihood of taking their lives.
The authors have been effective in outlining the remedy to suicidal thoughts in bipolar patients. Reducing subsequent suicidal thoughts and suicidal behaviors can enhance protective factors such as personal and social support resources. According to the unveiling information about suicidal thoughts of bipolar patients, they tend to have lower self-esteem that affects their decision when faced with hurtful situations (Pallaskorpi et al., 2017). The interventions often rely on the theoretical models that rest on improving the personal resources of such individuals. An enhanced personal resource triggers a sense of personal control, a developed decision-making process, and increased use of social support services. A raised self-esteem in bipolar patients will always compel them to have a positive perception of life. Transforming the loneliness among these people into desired freedom would be increasing their chances of developing trust within their social composition (Depp et al., 2017).
The strength of this article is also evident in the health care promotional strategies used in combating symptoms of mental disorders, including suicidality, which would be necessary for solving the genetic effects of suicide. The health promotion strategies would be effective in understanding the mental capability of the brain while offering effective clinical treatment that can suppress suicidal thinking among such people (O’Reilly et al., 2020). The cognitive management of these people plays a significant role in understanding the bipolar condition of each patient and offering them the most effective remedies that would affect their life in the end. A media campaign can be crucial in raising awareness of the issues facing bipolar patients. For instance, approaching bipolar youths via social media platforms would transform their thinking about the need to have control of emotions and moods when faced with heartening situations. The campaign aims to save soles of bipolar patients and limit them from terminating their lives and other people’s lives in the community.
The weakness of the article comes from the connection of bipolar thinking with the family history of patients. Genetics is another factor that explains an increase in suicidal thoughts among bipolar patients. Instances of suicidal thoughts that have been faced in the family history of bipolar patients would elevate the chances of committing suicide. This condition implies that a bipolar patient which a family history of a relative who died of suicide needs to communicate a message to the health care professionals (O’Reilly et al., 2020). A society suffering from hereditary suicidal risks requires more prevention strategies to reduce the number of bipolar patients who die by committing suicide. I would recommend this article to a colleague because of its effectiveness in understanding the connection of suicidal thoughts with bipolar disorder. The authors relay the information and effectively that heightens the understanding of a reader.
Conclusion
The connection discussed between bipolar and suicide ideation proves that healthcare professionals do not have a definite cure for the disorder. However, they have better interventions aimed at lowering the danger of the disorder on patients. The increase in cases of bipolar patients dying from suicide shows the reduction in prevention strategies for such conditions as defined in the article.
References
Depp, C. A., Thompson, W. K., Frank, E., & Swartz, H. A. (2017). Prediction of near-term increases in suicidal ideation in recently depressed patients with bipolar II disorder using intensive longitudinal data. Journal of affective disorders, 208, 363–368. https://doi.org/10.1016/j.jad.2016.09.054
O’Reilly, L. M., Kuja-Halkola, R., Rickert, M. E., Class, Q. A., Larsson, H., Lichtenstein, P., & D’Onofrio, B. M. (2020). The intergenerational transmission of suicidal behavior: an offspring of siblings study. Translational psychiatry, 10(1), 1-11. doi:10.1017/S0033291721001720
Pallaskorpi, S., Suominen, K., Ketokivi, M., Valtonen, H., Arvilommi, P., Mantere, O., … & Isometsä, E. (2017). Incidence and predictors of suicide attempts in bipolar I and II disorders: a 5‐year follow‐up study. Bipolar disorders, 19(1), 13-22. https://doi.org/10.1111/bdi.12464
Also Read:
NURS 6501 Acute Lymphoblastic Leukemia
NURS 6501 Immune Thrombocytopenia Purpura (ITP) Pathophysiology
Sample Answer 2 for NURS 6501 Bipolar Disorder
Scenario 2: Bipolar Disorder
A 44-year-old female came to the clinic today brought in by her husband. He notes that she has been with various states of depression and irritability over the past 3 months with extreme fatigue, has lost 20 pounds and has insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity.
DIAGNOSIS: bipolar type 2 disorder.
Question
1. How does genetics play in the development of bipolar 2 disorders?
Selected Answer: The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been fully identified, and there are no objective biologic markers that correspond definitively with the disease state. Twin, family, and adoption studies indicate that bipolar disorder has a significant genetic component. First-degree relatives of a person with bipolar disorder are approximately seven times more likely to develop bipolar disorder than the rest. The heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar individuals, who may exhibit psychotic behavior, have deficits in reelin expression linked to genetic loci located on chromosome 22, which confers susceptibility to schizophrenia. Given that, large variations in clinical symptoms still suggest that developmental and environmental factors are as important as genetic factors in contributing to the etiology of mood disorders.
Correct Answer:
The pathophysiology of bipolar disorder, also known as manic-depressive illness (MDI), is not fully understood, and there are no objective biologic markers that definitively correspond with the disease state. Twin, family, and adoption studies have all found a significant genetic component to bipolar disorder. First degree relatives of people with bipolar disorder are approximately 7 times more likely than the general population to develop bipolar disorder, and the heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar people, who may exhibit psychotic behavior, have reelin expression deficits linked to genetic loci on chromosome 22, which confers susceptibility to schizophrenia. Given this, the fact that clinical symptoms vary widely suggests that developmental and environmental factors are involved.
Response Feedback: [None Given]
https://nursingassignmentgurus.com/nurs-6501-knowledge-check-concepts-of-psychological-disorders/
In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
-
- Generalized anxiety disorder
- Depression
- Bipolar disorders
- Schizophrenia
- Delirium and dementia
- Obsessive compulsive disease
Photo Credit: agsandrew – stock.adobe.com
Complete the Knowledge Check By Day 7 of Week 9
To complete this Knowledge Check:
Module 6 Knowledge Check
What’s Coming Up in Module 7?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In Module 7, you will analyze processes related to women’s and men’s health, infections, and hematologic disorders through case study analysis. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, which may impact physiological functioning and altered physiology.
Week 10 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders
In the Week 10 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 7. This Knowledge
Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the
Learning Resources in their entirety prior to taking the Knowledge Check, since the resources cover the topics addressed. Plan your time accordingly.
Next Module
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6501 NURS 6501 Bipolar Disorder
Week 9: Concepts of Psychological Disorders
Among the many risk factors for mental disorders are genetics and other pathophysiological factors. While other factors, such as environmental factors or substance abuse, can also have an impact, it is important to recognize the connections between biological factors and psychological disorders.
Ranging from anxiety to schizophrenia, psychological disorders offer unique challenges in diagnosis and treatment. Clearly, the presence of these disorders can be life-altering for patients, but they can also significantly impact families and other loved ones.
This week, you examine fundamental concepts of psychological disorders. You explore common psychological disorders, and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.
Learning Objectives
Students will:
- Analyze concepts and principles of pathophysiology across the lifespan
Learning Resources
Required Readings (click to expand/reduce)
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 19: Neurobiology of Schizophrenia, Mood Disorders, Anxiety Disorders, and Obsessive-Compulsive Disorder, including Summary Review
Required Media (click to expand/reduce)
Module 6 Overview with Dr. Tara Harris
Dr. Tara Harris reviews the structure of Module 6 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check. (1m)
Concepts of Psychological Disorders – Week 9 (12m)
Generalized Anxiety Syndrome
Note: The approximate length of the media program is 5 minutes.
Sample Answer 3 for NURS 6501 Bipolar Disorder
-
Question 1
Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Questions
1. What are known characteristics of schizophrenia and relate those to this patient.
Selected Answer: Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in hallucinations, delusions, and extremely disordered thinking and behavior that impair daily functioning and can be disabling. Schizophrenia involves a range of problems with thinking (cognition), behavior, and emotions. Signs and symptoms of schizophrenia may vary but usually involve delusions, hallucinations, or disorganized speech and reflect an impaired ability to function.
1- Delusions: These are false beliefs not based on reality. For example, you think that you are being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you, or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
2- Hallucinations: These usually involve seeing or hearing things that do not exist. Nevertheless, the person with schizophrenia has the full force and impact of a normal experience. Hallucinations can be in any sense, but hearing voices is the most common hallucination.
3- Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that cannot be understood, sometimes known as word salad.
4- Extremely disorganized or abnormal motor behavior: This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, so it is hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
5- Negative symptoms: This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (does not make eye contact, does not change facial expressions, or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience a pleasure.
Certain factors seem to increase the risk of developing or triggering schizophrenia, including having a family history of schizophrenia; some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development; taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood.
In summary, Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, mind-reading, the delusion of reference, grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion, and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantiality, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyping, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution.
Correct Answer: 
Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, delusion of mind reading, delusion of reference, delusion of grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantially, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyped, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution.
Response Feedback: [None Given] -
Question 2
Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Question:
1. Genetics are sometimes attached to schizophrenia explain this.
Selected Answer: The causes of schizophrenia are not known. There are probably at least two sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biological relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes. However, the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.
Correct Answer: The causes of schizophrenia are not known. There are probably at least 2 sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biologic relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes, but the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.
Response Feedback: [None Given] -
Question 3
Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Question:
What roles do neurotransmitters play in the development of schizophrenia?
Selected Answer: Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first observable effective antipsychotic drugs, chlorpromazine, and reserpine, were structurally different, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine. D2 neurons are antipsychotic, and drugs that stimulate these neurons (e.g., amphetamines) exacerbate psychotic symptoms. Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. The newer antipsychotic drugs block dopamine D2 and serotonin (5- hydroxytryptamine [5-HT]) receptors. Clozapine, probably the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved.
Correct Answer: Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first observable effective antipsychotic drugs, chlorpromazine and reserpine, were structurally different from each other, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine D2 neurons are antipsychotic, and drugs that stimulate these neurons (eg, amphetamines) exacerbate psychotic symptoms. Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. The newer antipsychotic drugs block both dopamine D2 and serotonin (5- hydroxytryptamine [5-HT]) receptors. Clozapine, probably the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved.
Response Feedback: [None Given] -
Question 4
Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Questions:
Explain what structural abnormalities are seen in people with schizophrenia.
Selected Answer: Advances in neuroimaging studies show differences between the brains of those with schizophrenia and those without this disorder. In people with schizophrenia, the ventricles are somewhat larger, and there is decreased brain volume in medial temporal areas and changes in the hippocampus. Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and limbic regions and interconnecting white-matter tracts. Some studies using diffusion tensor imaging (DTI) to examine white matter found that two networks of white-matter tracts are reduced in schizophrenia. Brain imaging showed reductions in whole-brain volume and left and right prefrontal and temporal lobe volumes in many people at high genetic risk for schizophrenia. The changes in the prefrontal lobes are associated with the increasing severity of psychotic symptoms. MRI studies of schizophrenic patients show that structural brain abnormalities may progress over time. The abnormalities identified included whole-brain volume loss in both gray and white matter and increases in lateral ventricular volume.
Correct Answer: Advances in neuroimaging studies show differences between the brains of those with schizophrenia and those without this disorder. In people with schizophrenia, the ventricles are somewhat larger, there is decreased brain volume in medial temporal areas, and changes are seen in the hippocampus. Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and limbic regions and interconnecting white-matter tracts. Some studies using diffusion tensor imaging (DTI) to examine white matter found that 2 networks of white-matter tracts are reduced in schizophrenia. Brain imaging showed reductions in whole-brain volume and in left and right prefrontal and temporal lobe volumes in many people who are at high genetic risk for schizophrenia. The changes in prefrontal lobes are associated with increasing severity of psychotic symptoms. MRI studies of schizophrenic patients show that structural brain abnormalities may progress over time. The abnormalities identified included loss of whole-brain volume in both gray and white matter and increases in lateral ventricular volume.
Response Feedback: [None Given]
Question 5
|
Scenario 2: Bipolar DisorderA 44-year-old female came to the clinic today brought in by her husband. He notes that she has been with various states of depression and irritability over the past 3 months with extreme fatigue, has lost 20 pounds and has insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. DIAGNOSIS: bipolar type 2 disorder.Question1. How does genetics play in the development of bipolar 2 disorders? |
||||||
|
|||||||
Scenario 2: Bipolar DisorderA 44-year-old female came to the clinic today brought in by her husband. He notes that she has been with various states of depression and irritability over the past 3 months with extreme fatigue, has lost 20 pounds and has insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. DIAGNOSIS: bipolar type 2 disorder.Question1. How does genetics play in the development of bipolar 2 disorders? |
||||||
|
Sample Answer for NURS 6501 Bipolar Disorder
Bipolar disorder has continued to elicit different reactions from the medical and psychology field when it comes to its management. Initially referred to as manic-depressive illness, the condition results in abnormal alterations in the energy, activity levels, mood, and the ability to conduct daily undertakings by affecting certain neurochemicals within the brain. In order to successfully manage the condition, one needs to accurately diagnose it. However, accurately determining the existence of this condition is difficult as clients may have either manic or depressive symptoms or both (Swartz & Swanson, 2014). Moreover, the condition shares its symptomatology with several other brain disorders. In the event that an accurate diagnosis is achieved, a psychiatric nurse practitioner will use factors such as client history and factors to formulate a personalized plan as well as the role of certain factors that impact the pharmacokinetic and pharmacodynamics properties of the existing medication options. Even when a pharmacotherapy is elected, it becomes important for a nurse to evaluate the effectiveness of the same at various decision points, normally within four weeks, in order to tailor the therapy to efficacious levels. Thus, the purpose of the present paper is to examine a client of Korean descent who presents with symptoms of bipolar I disorder through the lenses of the above. In addition, given her ancestry, certain ethical considerations will be pertinent during the creation of the pharmacotherapy.
Decision Point One
Selected Decision
Begin Risperdal 1 mg orally BID
Reasons for Selecting Decision Point One
The symptoms presented by the 26-year-old Korean woman appear to be severe hence could be classified as Bipolar I Disorder. Given these symptoms, a nurse would be expected to prescribe appropriate pharmacological agents and from the given list, Riperidone (Risperdal) is the most appropriate. Risperidone, an atypical antipsychotic, is approved by the FDA as a monotherapeutic intervention for the management of mixed or acute manic episodes for bipolar I disorder (Cox, Seri, & Cavanna, 2014). The pharmacological agent has an excellent receptor binding profile that includes potent antagonism to alpha-adrenergic, serotonin 5-HT2A, and dopamine D2 receptors, hence giving the drug its effect on mood. Further, it is well-absorbed into the system and food does not impact the extent and rate of this absorption. Additionally, Risperdal has a bioavailability of 66% when taken through oral administration. Given that the patient was homozygous for the CYP2D6*10 allele, their response to Risperidone will be increased due to the higher steady-state concentration of the drug, which will be achieved within three hours (Vanwong, Ngamsamut, Hongkaew, & Nuntamool, 2016). The above occurs due to poor metabolism of the drug as a result of polymorphism to the CYP2D6 gene shown by the patient.
However, the other two drugs could not be used because of several reasons. The client had already been given Lithium but had compliance issues with the same due to its adverse effects. The CYP2D6*10 allele makes the patient a poor metabolizer of Lithium, which increases the levels of toxicity of the drug as it becomes highly available in the plasma, making it unsuitable for the present patient (Snzhez-Iglesia et al., 2016). Similarly, Seroquel 100 mg could not be prescribed because of the presence of the above polymorphism. Further, patients using Seroquel have reported increase in weight as well as constipation. The presence of the genetic variations in the CYP2D6 reduces the effectiveness of the cytochrome P450 enzyme, making individuals of Asian descent poor metabolizers of lithium and Seroquel, hence negatively affecting the safety profiles of the drugs. Given that studies have proven Risperdal as comparatively safer and more effective, the nurse will have to begin the therapy by prescribing it out of the given options.
Expected Results
After starting the client on Risperdal, the bipolar I disorder symptoms are anticipated to begin improving within the first 4 weeks of the therapy. Thus, when these weeks elapse, the patient should show improved sleep pattern. Also, her speech pattern should improve from the pressured, tangential, and rapid nature (Swartz & Swanson, 2014). In addition, the patient should show improved mood by the fourth week away from the euthymic one. Whereas the symptoms are expected to improve, the nurse also expects the presence of certain side-effects, given the genetic makeup of the patient.
Differences between Actual Results Expected Results
When the client came back to the clinic after four weeks, she looks in trouble since her mother has to help her to get to the office. A nurse’s observation reveals that she was sedated and lethargic. The mother explains that the current side-effects commenced a week after the initial clinic visit. The existence of side-effects were expected but not to this extent. Moreover, while the nurse had expected the presence of certain side-effects, the improvement of symptoms was the primary expectation during the formulation of the therapy. The absence of clearance of the drug due to the presence of genetic polymorphism exposed the client to the side-effects including sedation due to high levels of the drug in the system. Therefore, an evaluation of the pharmacotherapy needs to occur at this point.
Decision Point Two
Selected Decision
Decrease Risperdal to 1 mg at HS.
Reasons for the Selected Decision
During pharmacotherapeutic evaluations, several decisions such as increasing dosage, decreasing dosage or changing to another medications become under consideration. In the present scenario, the Risperdal 1 mg taken twice per day initiated adverse effects on the patient However, its effect on the symptoms of depression have not been revealed, meaning that the nurse only needs to alter the dosage to therapeutic level (Stahl, 2014b). To this end, reducing the dosage of 1 mg HS is the right decision. By doing this, the nurse is looking to manage the side-effects while having the drug at its therapeutic and tolerable levels. Further, prescribing Lithium to the patient will not work as she still has a poor attitude towards it given the experience when she was hospitalized (Stahl, 2014b). Thus, even if Lithium is prescribed, she will still not comply due to its side-effects. Also, changing to Risperdal 2 mg HS is not advisable as it will still have similar effects to the initial dosage. Therefore, counselling the patient and discussing with them the merits of reducing Risperdal to 1 mg HS is the right intervention at this decision point.
Expected Results
Risperdal works by ensuring that serotonin and dopamine in the brain are balanced. The effects experienced in the decision point one was due to increased levels of the drug in the patient since they are poor metabolizers of the same. Thus, reducing the dosage to 1 mg HS will not result in such accumulation, hence the sedation and lethargic effects of the drug will be eliminated (Paulzen et al., 2017). The patient should demonstrate further improvements in mood, behavior and thoughts. According to Stahl (2014b), these are the expected effects of the drug when taken in the right dosage.
Differences between Actual Outcomes and Expected Outcomes
When the client came back to the clinic after four weeks, she showed less sedation, lethargy and concomitant improvement in symptoms resolution. Further, the symptoms had decreased by 25% as shown by his Young Mania Scale reading that had also reduced to 16 from 22. Whereas the improvements were minimal, they were expected due to the half-strength nature of the decision point two Risperdal compared to the first one. This justifies the decision to maintain Risperdal but at a reduced dosage since it is effective when it comes to the management of Bipolar I symptoms. Given the ancestry of the patient, the only challenge was to determine the therapeutic dose, which is at 1 mg half strength.
Decision Point Three
Selected Decision
Continue at the same dose of Risperdal and assess after four weeks
Reasons for the Selection
The client in question of Korean descent, meaning that she has the CYP2D6*10 allele. People with this type of allele are poor metabolizers hence take long to clear drugs such as Risperdal from the system (Pei et al., 2016). Given that the Risperdal 1 mg HS dose is proving effective, it would be important to maintain it so that the client can benefit from its therapeutic effect. Restoring the 1 mg BID dosage is not recommended as it would reinstate the previous side-effects. Further, changing to Latuda is not advisable too since the U.S. Food and Drug Administration has not approved it for the management of Bipolar I condition as it has severe adverse effects. For these reasons, it would be prudent to maintain the dosage at 1 mg HS and only change when the client becomes unresponsive to the therapy.
Expected Results
Risperdal at 1 mg HS has already proven effective as the patient has responded favorably. Given that the first four weeks produced a 25% reduction, the nurse expects the symptoms to reduce by a further 25% to 50% in the ensuing four weeks. As such, the Korean girl is expected to show further mood, behavior, and thought improvements by the 12th week. Further, the side-effects she experienced with the first regimen are expected to be obliterated by the next time the clients comes back for assessment.
Differences between Actual Outcomes and Expected Outcomes
The patient is expected to continuously improve her bipolar I disorder symptoms progressively. If the dosage is maintained, then the resolution of the symptoms shown by the patient is expected. The consistency shown in the pharmacodynamics and pharmacokinetic properties of the drug implies that the objectives laid out at the first week of the pharmacotherapy are on course to be achieved.
Necessary Ethical Considerations
The ethnicity of a patient plays an important role in the manner in which they respond to medication. In the present case, the client had a genetic variation that made her susceptible to adverse effects of several drugs. Thus, during the formulation of the pharmacotherapy, collaborative efforts from the nurse were expected. To this end, the nurse would be morally expected to disclose the impact of the CYP2D6*10 allele on the metabolism of the drug, hence the associated side-effects (Paulzen et al., 2017). By doing this, the patient would understand when these side-effects kick-in. Further, the mental instability of the patient meant that the nurse was required to pick the information to share with the patient as part of ethical responsibility.
Conclusion
Whereas diagnosing Bipolar disorder is difficult, managing it is even more challenging if genetic variations exist to the CYP2D6*10 allele. The slow clearance of the drug due to that gene implies that a psychiatric nurse needs extra caution when formulating therapy including considering the ethics of a therapy. However, with the correct dosage and administration, the symptomatology of bipolar 1 disorder may resolve.
References
Cox, J. H., Seri, S., & Cavanna, A. E. (2014). Clinical Guidelines on Long-Term Pharmacotherapy for Bipolar Disorder in Children and Adolescents. Journal of clinical medicine, 3(1), 135-43. doi:10.3390/jcm3010135
Paulzen, M., Haen, E., Stegmann, B., Unterecker, S., Hiemke, C., Gründer, G., & Schoretsanitis, G. (2017). Clinical response in a risperidone-medicated naturalistic sample: patients’ characteristics and dose-dependent pharmacokinetic patterns. European Archives of Psychiatry & Clinical Neuroscience, 267(4), 325–333. https://doi.org/10.1007/s00406-016-0736-z
Pei, Q., Huang, L., Huang, J., Gu, J. K., Kuang, Y., Zuo, X. C., Ding, J. J., Tan, H. Y., Guo, C. X., Liu, S. K., … Yang, G. P. (2016). Influences of CYP2D6*10 polymorphisms on the pharmacokinetics of iloperidone and its metabolites in Chinese patients with schizophrenia: a population pharmacokinetic analysis. Acta pharmacologica Sinica, 37(11), 1499-1508.
Sánchez-Iglesias, S., García-Solaesa, V., García-Berrocal, B., Sanchez-Martín, A., Lorenzo-Romo, C., Martín-Pinto, T., Gaedigk, A., González-Buitrago, J. M., … Isidoro-García, M. (2016). Role of Pharmacogenetics in Improving the Safety of Psychiatric Care by Predicting the Potential Risks of Mania in CYP2D6 Poor Metabolizers Diagnosed With Bipolar Disorder. Medicine, 95(6), e2473.
Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Swartz, H. A., & Swanson, J. (2014). Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence. Focus (American Psychiatric Publishing), 12(3), 251-266.
Vanwong N., Ngamsamut N., Hongkaew Y., & Nuntamool N. (2016). Detection of CYP2D6 polymorphism using Luminex xTAG technology in autism spectrum disorder: CYP2D6 activity score and its association with risperidone levels. Drug Metab Pharmacokinet, 31(2):156–62.