NURS 6630 WEEK 5: Psychopharmalogical Approaches to Treat Psychopathology Assignment

NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology

Assignment: Assessing and Treating Patients With Bipolar Disorder


Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients.

NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology
NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology

Proper diagnosis of this disorder is often a challenge for two reasons:

  1. patients 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.


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Review the following medications:

  • amitriptyline
  • bupropion
  • citalopram
  • clomipramine
  • desipramine
  • desvenlafaxine
  • doxepin
  • duloxetine
  • escitalopram
  • fluoxetine
  • fluvoxamine
  • imipramine
  • ketamine
  • mirtazapine
  • nortriptyline
  • paroxetine
  • selegiline
  • sertraline
  • trazodone
  • venlafaxine
  • vilazodone
  • vortioxetine


Order a NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology Paper Today !

Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.


NURS 6630 Week 5: Assessing and Treating Patients with Bipolar Disorder

Bipolar disorder is a chronic disorder that manifests with recurring episodes of mania that alternate with episodes of profound depression. Patients with Bipolar present with a wide-range of mood symptoms, like depression, irritability, anxiety, fatigue, sleeping disturbances, and reduced ability to focus and concentrate (Jauhar & Young, 2019). The purpose of this paper is to outline the treatment interventions for a patient with Bipolar disorder and identify ethical considerations that will influence treatment and communication.

Introduction to the Case

The case study is about a 26-year-old female of Korean origin on her initial appointment after being hospitalized for 21 days due to bipolar I disorder. The patient is busy in the office, plays with items on the desk, and fidgets on the chair. She does not consider she has Bipolar since she just enjoys talking, dancing, singing, and cookimg. Her self-reported mood is “fantastic .”However, she states that she hates sleeping because it is not fun, and this results in sleeping roughly fives hour per night. The patient’s hospital records show that she has been having a medical workup, which showed that she is in overall good health. In addition, all lab results were within the normal range. A GeneSight testing was conducted and revealed that she the patient has CYP2D6*10 allele.

The patient admits to failing to comply with Lithium treatment after getting discharged. On mental status exam (MSE), the client is alert, oriented, strangely dressed, and her speech is fast, pressured, and tangential. She has a euthymic mood, broad affect, and intact judgment. The patient has no apparent hallucinations, paranoid thoughts, delusions,  or suicidal/homicidal ideations. However, insight is impaired. She scores 22 on the Young Mania Rating Scale (YMRS).

Patient factors that may affect decision-making when prescribing treatment include the previous medications used to treat Bipolar in the patient, response to these medications, and side effects associated with the past medications. Besides, the patient’s comorbidities, the severity of Bipolar symptoms, and treatment preferences will be considered when determining the appropriate medication.

Decision #1

Begin Lithium 300 mg PO BD.

Why This Decision Was Selected

Lithium was the ideal choice since it is the recommended medication in classical mania. It is recommended as the first-line monotherapy for Bipolar, and it delays the relapse of patients to any mood episode (Atagün & Oral, 2021). McKnight et al. (2019) found Lithium effective in treating acute mania and more effective than a placebo or anti‐epileptic drugs.

Why the Other Two Options Were Not Selected

Risperdal was not selected because it is contraindicated in individuals with the CYP2D6*10 allele. Cui et al. (2020) found that patients with positive CYP2D6*10 allele tend to have a low metabolism rate for Risperdal. This results in increased levels of the drug in the serum, causing increased sedation, which increases the patient’s risk of non-compliance. Seroquel was also not selected because of its associated side effects like hypertension and weight gain, which can worsen the patient’s condition. Jauhar and Young (2019) found that Seroquel has high rate of hypertension and 15% weight gain than Lithium.

What I Was Hoping To Achieve With This Decision

The PMHNP hoped that prescribing Lithium would alleviate and lower the severity of the manic symptoms within four weeks after beginning treatment. Lithium is the gold standard in achieving a high quality of life for patients, enabling them to participate in social activities, and preventing long-term disability (Volkmann et al., 2020). Kessing et al. (2018) established that lithium monotherapy is superior to monotherapy using other maintenance mood stabilizers.

Ethical Considerations

The ethical principle of beneficence may affect the treatment plan since the clinician must identify and prescribe the drug found to promote better outcomes in Bipolar. For example, Lithium was prescribed because evidence shows that it is superior in alleviating Bipolar symptoms. Besides, the patient’s right to autonomy may impact communication since the clinician must seek consent before starting treatment. For this case, the PMHNP obtained consent from the patient to initiate Lithium therapy.

Decision #2

Evaluate and identify the client’s reason for non-compliance and educate her on drug the effects and pharmacology.

Why This Decision Was Selected

The clinician chose this decision since the patient was non-compliant with medication, which can fail to achieve the desired treatment outcomes. It was crucial to evaluate the client’s reason for non-compliance, which puts patients at risk for exacerbation of symptoms and relapse, contributing to hospital visits and readmissions (Atagün & Oral, 2021). Loots et al. (2021) improve medication adherence and found that cognitive-behavioral therapy and psychoeducation enhance medication adherence in patients with bipolar disorders.

Why the Other Two Options Were Not Selected

Increasing Lithium to 450 mg was not ideal because it was prudent to identify and solve the issues causing non-compliance before increasing the dose. Loots et al. (2021) found that approximately 25% of Bipolar patients discontinue their treatment within the first week after discharge, which causes worsening symptoms and relapse. The decision to change therapy to Depakote was not also selected because it should only be prescribed when Lithium is unresponsive or the patient is resistant to treatment (Atagün & Oral, 2021).

What I Was Hoping To Achieve With This Decision

The clinician hoped that identifying the patient’s causes for non-compliance would help to increase treatment adherence by educating the patient on Lithium’s effects and pharmacology (Volkmann et al., 2020). Loots et al. (2021) found increased adherence to treatment in patients in a psychoeducation group after being educated on the impact of treatment.

Ethical Considerations

Ethical factors of nonmaleficence and confidentiality may impact treatment and communication with patients. The PMHNP upheld nonmaleficence by selecting a treatment decision with the least adverse effects to avoid causing harm to the patient. Besides, confidentiality impacted communication since the PMHNP had to assure the patient that her medical information would not be shared with a third party without her consent.

Decision #3

Switch Lithium to sustained-release formulation but the same dose and frequency.

Why This Decision Was Selected

Changing Lithium to sustained release was driven by the patent’s complaint of nausea and diarrhea associated with the initial Lithium formulation. Barbuti et al. (2021) found that fine tremors and GI symptoms occurred more frequently in patients on immediate-release Lithium than in prolonged-release patients. Thus, switching to sustained-release lithium therapy can present advantages over the previous immediate-release formulation (Kessing et al., 2018).

Why the Other Two Options Were Not Selected

The decision to change to Depakote was not selected since Lithium was not unsuccessful in alleviating the patient’s Bipolar symptoms. According to Atagün and Oral (2021), Depakote is associated with adverse side effects like hepatotoxicity and increased serum ammonia levels. Trileptal was not also selected because it is recommended as second-line therapy when first-line medications are ineffective (Jauhar & Young, 2019).

What I Was Hoping To Achieve With This Decision

The clinician hoped that switching Lithium from immediate-release to sustained-release would reduce the GI side effects. Barbuti et al. (2021) found that GI side effects were prevalent in patients on immediate-release compared to prolonged release. Therefore, changing to sustained release is expected to alleviate nausea and diarrhea (Kessing et al., 2018).

Ethical Considerations

Ethical principles of nonmaleficence and informed consent may impact treatment plan and communication. This is because the clinician must make decisions that will not harm the patient through adverse effects. For instance, the clinical changed the Lithium formulation to increase patient safety by minimizing side effects. Also, the PMHNP obtained consent from the patient before initiating treatment with a new formulation, which affected communication.


The factors that may influence treatment decisions for a patient with Bipolar disorder include the previous treatments, previous response to treatment, associated side effects, patient’s comorbidities, the severity of Bipolar symptoms, and treatment preferences.    The patient was started on Lithium 300 mg orally BD because it is recommended as a first-line agent in treating Bipolar disorder (Atagün & Oral, 2021). Risperdal was inappropriate for this patient because it is contraindicated in patients positive for the CYP2D6*10 allele due to slow metabolism that causes high serum drug levels and sedation Cui et al. (2020). Seroquel was not also ideal owing to its associated side effects of hypertension and weight gain, which may reduce the treatment compliance rate.

In decision two, the patient reported taking Lithium on and off, which led to the clinician assessing the causes for non-compliance and educating the client on Lithium effects and pharmacology. Increasing the dose was inappropriate because medication compliance had not been achieved yet (Loots et al., 2021). It was not also ideal to change the treatment to Depakote because it should be prescribed if Lithium was ineffective. In decision three, the patient complained of nausea and diarrhea associated with Lithium. Consequently, the PMHNP recommended changing Lithium from immediate-release to sustained-release because the latter is associated with minimal GI side effects (Barbuti et al., 2021).


Atagün, M. İ., & Oral, T. (2021). Acute and Long Term Treatment of Manic Episodes in Bipolar Disorder. Noro psikiyatri arsivi58(Suppl 1), S24–S30.

Barbuti, M., Colombini, P., Ricciardulli, S., Amadori, S., Gemmellaro, T., De Dominicis, F., Della Rocca, F., Petrucci, A., Schiavi, E., & Perugi, G. (2021). Treatment adherence and tolerability of immediate- and prolonged-release lithium formulations in a sample of bipolar patients: a prospective naturalistic study. International clinical psychopharmacology36(5), 230–237.

Jauhar, S., & Young, A. H. (2019). Controversies in bipolar disorder; role of second-generation antipsychotic for maintenance therapy. International journal of bipolar disorders7(1), 10.

Kessing, L. V., Bauer, M., Nolen, W. A., Severus, E., Goodwin, G. M., & Geddes, J. (2018). Effectiveness of maintenance therapy of Lithium vs. other mood stabilizers in monotherapy and combinations: a systematic review of evidence from observational studies. Bipolar disorders20(5), 419-431. doi: 10.1111/bdi.12623

Loots, E., Goossens, E., Vanwesemael, T., Morrens, M., Van Rompaey, B., & Dilles, T. (2021). Interventions to Improve Medication Adherence in Patients with Schizophrenia or Bipolar Disorders: A Systematic Review and Meta-Analysis. International journal of environmental research and public health18(19), 10213.

McKnight, R. F., Chesney, E., Amit, B. H., Geddes, J., & Cipriani, A. (2019). Lithium for acute mania. Cochrane database of systematic reviews, (6).

Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium treatment over the lifespan in bipolar disorders. Frontiers in Psychiatry11, 377.