Assessment: 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. 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. For this Assignment, as you examine the patient case study in this week's Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder. To prepare for this Assignment: • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring bipolar therapy. The Assignment: 5 pages 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. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) • Which decision did you select? • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Conclusion (1 page) • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature. 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 § 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 you should do: Beginning lithium 300 mg orally BIDgin Lithium 300 mg orally BID RESULTS OF DECISION POINT ONE • Client returns to clinic in four weeks • Client informs you 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 Begin Lithium 300 mg orally BID Decision Point Two Increase Lithium to 450 mg orally BID RESULTS OF DECISION POINT TWO • Client returns to clinic in four weeks • Client returns reports that she is still taking the medication when she feels that she needs it • She remains quite manic and reports that her family is getting really upset because she likes to play her new guitar at night Decision Point Three Assess for rationale for non-compliance and educate client Guidance to Student You should further assess for dangerousness to self or others. The client should be assessed for self-care, to including hygiene, eating, sleeping, etc. Hospitalization may be indicated if the client remains non-compliant and is a danger to self. If the client is not a danger to self, and hospitalization is not indicated, you needs to assess for rationale for non-compliance. Many clients enjoy mania as it is a nice feeling to be consistently happy. When clients are successfully treated for mania, they often describe themselves as feeling 'down' or 'flat.' You need to assess for depression at this point as opposed to normalization of mood. Abilify is also FDA approved as monotherapy for mania and mixed presentations, but at a dose of 15 mg. day., so although you may be tempted to begin Abilify- be certain to use correct dose. Also, because it can be "activating" you need to dose this drug in the morning. However, the client is non-compliant and therefore, eliciting reasons for non-compliance is essential to the care of this client. Begin Risperdal 1 mg orally BID These are other options below which I think is not the best.you can indicate why these other medications below are not the best. Begin Seroquel XR 100 mg orally at HS Decision Point One Begin Risperdal 1 mg orally BIDn Risperdal 1 mg orally BID RESULTS OF DECISION POINT ONE • Client returns to clinic in four weeks • Client is accompanied today by her mother who must help the client into your office, the client looks very sedated and lethargic • Client's mother explains that "she has been like this since about a week after the last office visit" Decision Point Two Decrease Risperdal to 1 mg at HS RESULTS OF DECISION POINT TWO • Client returns to clinic in four weeks • Client is less sedate, less lethargic and shows symptom improvement • Young Mania Rating Scale has decreased from 22 to 16 (a bit more than a 25% decrease in symptoms) Decision Point Three Continue at same dose of Risperdal and reassess in 4 weeks Guidance to Student At this point, you may be wise to allow the client to remain at the same dose and reassess in 4 weeks. Recall that the client is of Korean descent and is positive for CYP2D6*10 allele. As a result, she may have slower clearance of Risperdal from her system, which may have resulted in higher than normal levels of Risperdal in the blood, which in turn resulted in sedation. Therefore, if we were to increase back to 1 mg orally BID, she may have the same side effects. Latuda is FDA approved for bipolar I depression, which is not the presentation we are attempting to treat. Additionally, it is ite expensive and many insurance companies will not pay for it until other agents have been attempted and failed. Decision Point One Begin SeroquBegin Seroquel XR 100 mg orally at HSel XR 100 mg orally at HS RESULTS OF DECISION POINT ONE • Client returns to clinic in four weeks • Client is reporting that she sleeps a bit more at bedtime • Client states that she has gained about 2 or 3 pounds, which she does not like • Client also reports that she has been constipated since starting this medication • Client is also complaining of dry mouth which she does not like. • Client's score on the Young Mania Rating Scale has decreased from a 22 to an 18 • Client is reporting really good mood, but is asking for a different medication because of the weight gain Decision Point Two Select what you should do next: Increase Seroquel XR to 300 mg orally daily Discontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie meal Continue same dose of Seroquel and counsel client regarding ways to prevent constipation Note: I think the other medications such as Risperdal, Seroquel and Geodon are not good choices to treat Bipolar. Please focus on lithium and indicate why we think the others are not the best. Read: Treatment of Personality disorders

ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper Type	Case Study
Number of Pages	5 Page(s)/1375 words
Sources	6
Format	APA
Spacing	Double Spacing

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