Assessing and Treating Clients with With Bipolar Disorder

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? 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. Why were they different?

 

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. 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. 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. 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/s00228-015-1855-6

 

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

 

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. 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.***

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