Homework: Assessing and Treating Clients with Bipolar Disorder
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: i) clients often present as depressive or manic, but may have both; and ii) 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 Homework, 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
i. Assess client factors and history to develop personalized plans of bipolar therapy for clients
ii. Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapy
iii. Evaluate efficacy of treatment plans
iv. Analyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespan
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 weights 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
o 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
Decision Point One
Select what the PMHNP should do:
Begin Lithium 300 mg orally BID
Begin Risperdal 1 mg orally BID
Begin Seroquel XR 100 mg orally at HS
Decision Point Two
Select what the PMHNP should do next:
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
Switch to Depakote ER 500 mg orally at HS
Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology
Decision Point Three
Select what the PMHNP should do next:
Change to Depakote ER 500 mg at HS
Change Lithium to sustained release preparation at same dose and frequency
Change to trileptal 300 mg orally BID
Format your homework according to the following formatting requirements:
i) The answer should be typed, using Times New Roman font (size 12), double spaced, with one-inch margins on all sides.
ii) The response also includes a cover page containing the title of the homework, the student's name, the course title, and the date. The cover page is not included in the required page length.
iii) Also include a reference page. The Citations and references must follow APA format. The reference page is not included in the required page length.