Task: Assessing and Treating Patients with Bipolar Dysfunction
Bipolar dysfunction is a novel dysfunction that causes shifts in temper and power, which leads to despair and mania for sufferers. Correct prognosis of this dysfunction is commonly a problem for 2 causes: 1) sufferers usually current as depressive or manic however might have each; and 2) many signs of bipolar dysfunction are much like different issues. Misdiagnosis is frequent, making it important so that you can have a deep understanding of the dysfunction’s pathophysiology. For this Task, as you study the affected person case examine on this week’s Studying Sources, contemplate the way you would possibly assess and deal with sufferers presenting with bipolar dysfunction.
To organize for this Task:
· Evaluate this week’s Studying Sources, together with the Medicine Sources indicated for this week.
· Replicate on the psychopharmacologic remedies you would possibly advocate for the Assessment and remedy of sufferers requiring bipolar remedy.
The Task: 5 pages
Study Case Research: An Asian American Lady. Prognosis-Bipolar Dysfunction. You can be requested to make three choices in regards to the remedy to prescribe to this affected person. Make sure you contemplate components which may affect the affected person’s pharmacokinetic and pharmacodynamic processes.
At every choice level, it’s best to consider all choices earlier than deciding on your choice and transferring all through the train. Earlier than you make your choice, just be sure you have researched every choice and that you just consider the choice that you’ll choose. Make sure you analysis every choice utilizing the first literature.
Introduction to the case (1 web page)
· Briefly clarify and summarize the case for this Task. Make sure you embody the precise affected person components which will affect your choice making when prescribing remedy for this affected person.
Choice #1 (1 web page)
· Which choice did you choose?
· Why did you choose this choice? Be particular and help your response with clinically related and patient-specific sources, together with the first literature.
· Why did you not choose the opposite two choices offered within the train? Be particular and help your response with clinically related and patient-specific sources, together with the first literature.
· What had been you hoping to realize by making this choice? Help your response with proof and references to the Studying Sources (together with the first literature).
· Clarify how moral concerns might affect your remedy plan and communication with sufferers. Be particular and present examples.
Choice #2 (1 web page)
· Why did you choose this choice? Be particular and help your response with clinically related and patient-specific sources, together with the first literature.
· Why did you not choose the opposite two choices offered within the train? Be particular and help your response with clinically related and patient-specific sources, together with the first literature.
· What had been you hoping to realize by making this choice? Help your response with proof and references to the Studying Sources (together with the first literature).
· Clarify how moral concerns might affect your remedy plan and communication with sufferers. Be particular and present examples.
Choice #three (1 web page)
· Why did you choose this choice? Be particular and help your response with clinically related and patient-specific sources, together with the first literature.
· Why did you not choose the opposite two choices offered within the train? Be particular and help your response with clinically related and patient-specific sources, together with the first literature.
· What had been you hoping to realize by making this choice? Help your response with proof and references to the Studying Sources (together with the first literature).
· Clarify how moral concerns might affect your remedy plan and communication with sufferers. Be particular and present examples.
Conclusion (1 web page)
· Summarize your suggestions on the remedy choices you chose for this affected person. Make sure you justify your suggestions and help your response with clinically related and patient-specific sources, together with the first literature.
Notice: Help your rationale with a minimal of six educational sources. When you might use the course textual content to help your rationale, it is not going to rely towards the useful resource requirement. You have to be using the first and secondary literature.
Bipolar Remedy Consumer of Korean Descent/Ancestry
Asian lady
BACKGROUND INFORMATION
The shopper is a 26-year-old girl of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was recognized with bipolar I dysfunction.
Upon arrival in your workplace, she is kind of “busy,” enjoying with issues in your desk and shifting backward and forward in her chair. She informs you that “they stated I used to be bipolar, I don’t consider that, do you? I similar to to speak, and dance, and sing. Did I let you know that I appreciated to prepare dinner?”
She weights 110 lbs. and is 5’ 5”
SUBJECTIVE
Affected person studies “improbable” temper. Stories that she sleeps about 5 hours/evening to which she provides “I hate sleep, it’s no enjoyable.”
You reviewed her hospital information and discover that she has been medically labored up by a doctor who reported her to be in general good well being. Lab research had been all inside regular limits. You discover that the affected person had genetic testing within the hospital (particularly GeneSight testing) as not one of the medicines that they had been treating her with appeared to work.
Genetic testing reveals that she is constructive for CYP2D6*10 allele.
Affected person did properly sufficient on Lithium to be discharged from the hospital however admits she has not been taking it as prescribed. When additional questioned on the topic, she supplies no extra particulars.
MENTAL STATUS EXAM
The affected person is alert, oriented to individual, place, time, and occasion. She is dressed fairly oddly- carrying what seems to be a night robe to her appointment. Speech is speedy, pressured, tangential. Self-reported temper is euthymic. Have an effect on broad. Affected person denies visible or auditory hallucinations, no overt delusional or paranoid thought processes readily obvious. Judgment is grossly intact, however perception is clearly impaired. She is at present denying suicidal or homicidal ideation.
The Younger Mania Ranking Scale (YMRS) rating is 22
RESOURCES
§ Chen, R., Wang, H., Shi, J., Shen, Okay., & Hu, P. (2015). Cytochrome P450 2D6 genotype impacts the pharmacokinetics of controlled-release paroxetine in wholesome Chinese language topics: comparability of conventional phenotype and exercise rating methods. European Journal of Scientific Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6
Choose what the PMHNP ought to do:
Start Lithium 300 mg orally BID
Start Risperdal 1 mg orally BID
Start Seroquel XR 300 mg orally at HS
Choice Level One
Start Lithium 300 mg orally BID
RESULTS OF DECISION POINT ONE
· Consumer returns to clinic in 4 weeks
· Consumer informs the PMHNP that she has been taking her drug “off and on” solely when she “looks like she wants it”
· At this time’s presentation is much like the primary day you met her
Choice Level Two
Assess rationale for non-compliance to elicit cause for non-compliance and educate shopper re: drug results, and pharmacology
RESULTS OF DECISION POINT TWO
· Consumer returns to clinic in 4 weeks
· Consumer states that the drug makes her nauseated and offers her diarrhea
· Consumer states that she stops taking it till these signs abate, at which level she re-starts solely to expertise the signs once more
Choice Level Three
Change to Depakote ER 500 mg at HS
Steering to Scholar On this case, the shopper is having nausea and diarrhea, traditional unwanted effects of lithium remedy. Altering the shopper to an prolonged launch formulation can usually forestall these signs whereas on the similar time affording the shopper the good thing about lithium’s temper stabilizing properties. Additionally, lithium is an efficient selection for management of mania and has additionally been proven to lower threat of suicide, which provides to its general advantages. Depakote could also be an choice if altering to sustained launch lithium doesn’t alleviate the unwanted effects. Oxcarbazpine (Trileptal) is an choice, however is a second line remedy and is just not acceptable at this stage because the shopper has not had an enough trial of first line brokers.
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Assessing and Treating Patients with Bipolar Dysfunction is an project.
Bipolar dysfunction is a uncommon dysfunction that causes temper and power swings in individuals, leading to unhappiness and mania. Diagnosing this situation accurately could be troublesome for 2 causes: 1) Patients with bipolar dysfunction are continuously depressed or manic, however they are often each; and 2) lots of the signs of bipolar illness are much like these of different situations. Misdiagnosis is widespread, so you will have to know the whole lot there’s to know in regards to the dysfunction’s pathogenesis. Think about how you could assess and deal with sufferers who current with bipolar dysfunction as you look over the affected person case examine on this week’s Studying Sources for this Task.
To prepare for this project, do the next:
Evaluate the Studying Sources for this week, together with the Medicine Sources for this week.
Think about the psychopharmacologic remedies you would possibly counsel for the analysis and remedy of people that require bipolar remedy.
The Challenge: 5 pages
Think about the next case examine: An Asian American Lady. Bipolar Dysfunction is the prognosis. You may must make three choices in regards to the remedy it’s best to give this affected person. Take note of any potential influences on the affected person’s pharmacokinetic and pharmacodynamic processes.
At every choice level, it’s best to weigh all your prospects earlier than making your selection and persevering with with the train. Be sure to’ve completed your homework on every selection and that you’ve got thought of all your choices earlier than making a variety. Make cautious to conduct major analysis on every choice.
The case’s introduction (1 web page)
Clarify and summarize the case for this project in a couple of sentences. When prescription remedy for this affected person, make sure to contemplate the person affected person components which will affect your choice.
1st choice (1 web page)
Which choice did you select?
Why did you come to this conclusion? Make your response explicit, and again it up with therapeutically related and patient-specific sources, reminiscent of major literature.
Why did not you select one of many different two prospects within the train? Make your response explicit, and again it up with therapeutically related and patient-specific sources, reminiscent of major literature.
What had been your intentions once you made this choice? Proof and references to the Studying Sources ought to be used to again up your response (together with the first literature).
Describe how moral points might have an effect on your remedy strategy and affected person communication. Give cases and be particular.
Second selection (1 web page)
Why did you come to this conclusion? Make your response explicit, and again it up with therapeutically related and patient-specific sources, reminiscent of major literature.
Why did not you select one of many different two prospects within the train? Make your response explicit, and again it up with therapeutically related and patient-specific sources, reminiscent of major literature.
What had been your intentions once you made this choice? Proof and references to the Studying Sources ought to be used to again up your response (together with the first literature).
Describe how moral points might have an effect on your remedy strategy and affected person communication. Give cases and be particular.
third Selection (1 web page)
Why did you come to this conclusion? Make your response explicit, and again it up with therapeutically related and patient-specific sources, reminiscent of major literature.
Why did not you select one of many different two prospects within the train? Make your response explicit, and again it up with therapeutically related and patient-specific sources, reminiscent of major literature.
What had been your intentions once you made this choice? Proof and references to the Studying Sources ought to be used to again up your response (together with the first literature).
Describe how moral points might have an effect on your remedy strategy and affected person communication. Give cases and be particular.
closing ideas (1 web page)
Summarize your therapeutic suggestions for this affected person’s remedy options. Make cautious you defend your strategies and again them up with clinically related and patient-specific supplies, reminiscent of major analysis.
Notice: Embrace at the very least six educational sources to again up your argument. The course textual content could also be used to help your reasoning, however it doesn’t rely towards the useful resource requirement. It is best to make use of each major and secondary sources.
Consumer of Korean Descent/Ancestry in Bipolar Remedy
Asian girl
INFORMATION ON THE BACKGROUND
The shopper is a 26-year-old girl of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was recognized with bipolar I dysfunction.
Upon arrival in your workplace, she is kind of “busy,” enjoying with issues in your desk and shifting backward and forward in her chair. She informs you that “they stated I used to be bipolar, I don’t consider that, do you? I similar to to speak, and dance, and sing. Did I let you know that I appreciated to prepare dinner?”
She weights 110 lbs. and is 5’ 5”
SUBJECTIVE
Affected person studies “improbable” temper. Stories that she sleeps about 5 hours/evening to which she provides “I hate sleep, it’s no enjoyable.”
You reviewed her hospital information and discover that she has been medically labored up by a doctor who reported her to be in general good well being. Lab research had been all inside regular limits. You discover that the affected person had genetic testing within the hospital (particularly GeneSight testing) as not one of the medicines that they had been treating her with appeared to work.
Genetic testing reveals that she is constructive for CYP2D6*10 allele.
Affected person did properly sufficient on Lithium to be discharged from the hospital however admits she has not been taking it as prescribed. When additional questioned on the topic, she supplies no extra particulars.
MENTAL STATUS EXAM
The affected person is alert, oriented to individual, place, time, and occasion. She is dressed fairly oddly- carrying what seems to be a night robe to her appointment. Speech is speedy, pressured, tangential. Self-reported temper is euthymic. Have an effect on broad. Affected person denies visible or auditory hallucinations, no overt delusional or paranoid thought processes readily obvious. Judgment is grossly intact, however perception is clearly impaired. She is at present denying suicidal or homicidal ideation.
The Younger Mania Ranking Scale (YMRS) rating is 22
RESOURCES
§ Chen, R., Wang, H., Shi, J., Shen, Okay., & Hu, P. (2015). Cytochrome P450 2D6 genotype impacts the pharmacokinetics of controlled-release paroxetine in wholesome Chinese language topics: comparability of conventional phenotype and exercise rating methods. European Journal of Scientific Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6
Choose what the PMHNP ought to do:
Start Lithium 300 mg orally BID
Start Risperdal 1 mg orally BID
Start Seroquel XR 300 mg orally at HS
Choice Level One
Start Lithium 300 mg orally BID
RESULTS OF DECISION POINT ONE
· Consumer returns to clinic in 4 weeks
· Consumer informs the PMHNP that she has been taking her drug “off and on” solely when she “looks like she wants it”
· At this time’s presentation is much like the primary day you met her
Choice Level Two
Assess rationale for non-compliance to elicit cause for non-compliance and educate shopper re: drug results, and pharmacology
RESULTS OF DECISION POINT TWO
· Consumer returns to clinic in 4 weeks
· Consumer states that the drug makes her nauseated and offers her diarrhea
· Consumer states that she stops taking it till these signs abate, at which level she re-starts solely to expertise the signs once more
Choice Level Three
Change to Depakote ER 500 mg at HS
Steering to Scholar On this case, the shopper is having nausea and diarrhea, traditional unwanted effects of lithium remedy. Altering the shopper to an prolonged launch formulation can usually forestall these signs whereas on the similar time affording the shopper the good thing about lithium’s temper stabilizing properties. Additionally, lithium is an efficient selection for management of mania and has additionally been proven to lower threat of suicide, which provides to its general advantages. Depakote could also be an choice if altering to sustained launch lithium doesn’t alleviate the unwanted effects. Oxcarbazpine (Trileptal) is an choice, however is a second line remedy and is just not acceptable at this stage because the shopper has not had an enough trial of first line brokers.
