Assessing and Treating Bipolar Disorder
NURS 6630N Walden University
Bipolar Disorder Diagnosis and Treatment
Introduction
Bipolar disorder is a psychological condition that affects people of all ages, both male and female. Clinicians should choose the best treatment options based on the patient’s characteristics. For example, lithium is one of the most effective medications used to treat bipolar disorder. Clinicians should also inform patients about the dangers of lithium (Malhi et al., 2017). Long-term use of lithium has an effect on the kidney and thyroid systems. Clinicians should also think about various ethical issues in order to avoid lawsuits. Bipolar disorder treatment entails selecting the best medication and monitoring the patient as they take it.
First decision
The first decision is to compare the various medications available to determine the best option. Lithium 300mg orally BID, Risperdal 1 mg orally BID, and Seroquel XR 100 mg orally HS are among the available options. Lithium 300mg orally BID is the best choice among the three medications for treating bipolar disorder with manic episodes. Lithium is a commonly used medication to treat bipolar disorder (Malhi et al., 2017). It reduces the severity and frequency of mania and bipolar depression. Clinicians also advise patients to take the medication to avoid future manic episodes (Stahl, 2013). Another reason for choosing the 300mg Lithium dosage is that it is effective in female patients. Clinicians begin treatment with a low dose to monitor patients and reduce the severity of pharmacokinetic and pharmacodynamic side effects (Ketter et al., 2016). To avoid side effects, a kidney and thyroid system Assessment is required before prescribing the drug. The medication is prescribed with the expectation that the patient will reduce the frequency and severity of manic episodes. Another expectation is that lithium will suppress symptoms such as irritable mood, poor sleep quality, unusual frequency of talking, organized thoughts, and reduced distractions (Malhi et al., 2017). The patient should have a lower Young Mania Rating Scale, according to expectations. According to a clinical Assessment, the Young Mania Rating Scale is currently at 22. For example, the patient should record a low frequency of mood changes and irritability. After four weeks of taking the medication, patients’ interactions with peers and family members improve (Stahl, 2013). She should also be free to go about her daily activities, such as working, eating, sleeping, cooking, and doing housework. After four weeks, the patient returns to the clinic. She claims that she has seen little improvement since starting the medication. She admits, however, that she has not been taking the medication consistently. The patient still has 22 points on the Young Mania Rating Scale. As a result, she has made no progress. One of the reasons for the lack of progress is the drug’s inconsistent administration. Another reason could be the medication’s low dosage.
Decision No. 2
The second option is to increase the dosage to 450mg orally BID. Randomized controlled trials show that increasing the dosage is effective because it increases the drug’s therapeutic ability (Findling et al., 2019). The second decision entails educating the patient on the importance of taking Lithium medication on a regular basis. It is critical to determine why the patient is not taking the medication consistently while educating the patient (Stahl, 2013). Another decision is that the patient take the medication and return to the clinic four weeks later. According to the researchers, four weeks is enough time for the Lithium drug to suppress the symptoms of bipolar disorder. The patient’s symptoms should have improved four weeks after receiving a higher dose of the drug. The patient is still exhibiting symptoms like bipolar depression, hyperactivity, mood changes, and aggression (Findling et al., 2019). Other symptoms include poor sleep quality, poor interaction with peers, and a loss of appetite. Lithium is an effective medication for the treatment of bipolar disorder, allowing patients to improve their daily interactions and participation in basic tasks (Findling et al., 2019). As a result, it is expected that the symptoms will have significantly improved after four weeks. The expectation is primarily to Help the patient in participating in daily activities and improving their quality of life. After four weeks, the patient returned to the clinic. The patient’s presentation indicated that the expectations had been significantly exceeded. One of the outcomes was that the patient admitted to taking the medication on a regular basis after becoming aware. The patient was pleased that she had received the education and that the medication had relieved her symptoms. One of the patient’s improvements was a reduction in bipolar disorder, an improvement in sleep quality, appetite, a decrease in hyperactivity, and the ability to participate in daily activities. In addition, the patient’s Young Mania Rating Scale score decreased. The patient received 11 points on the scale, indicating a 50% improvement in symptoms. The patient also reported a weight gain, which was expected. Weight gain is a common side effect of lithium treatment for bipolar disorder. One of the differences between the outcome and the expectations is that the patient only improved by 50%. The difference could be due to time, and if the patient continues to take the drug for another four weeks, she will improve completely. – PhD Dissertation Writing Services USA
Third decision
Decision #3 is to keep taking the medication, Lithium 450mg orally BUD, because it is working well for the patient. According to research, it takes several weeks for lithium to make a significant difference in an individual. The only side effect is weight gain, which is a common side effect (Ketter et al., 2016). Changing the drug may be harmful to the patient’s health because it may result in weight loss. Losing weight is harmful to the patient’s health because it impairs their body’s functionality. As a result, it is critical to stick with the drug and change it to manage weight after treating bipolar disorder. Lithium 450mg is a useful medication because it prevents future manic and depressive episodes (Stahl, 2013). It is also used as maintenance therapy for long-term treatment. The drug is effective because it regulates mood by acting on the brain and central nervous system. During the drug prescription for another four weeks, it is important to notify the patient about other side effects during the long-term administration of the drug. Patients should take 8-12 glasses of water to avoid lithium from affecting the thyroid or kidney function (Ketter et al., 2016). The patient should also avoid exceeding normal salt levels. During the prescription, it was also important to check the level of lithium concentration in the patient. The reason is that Lithium is metabolized differently in female patients compared to male patients (Stahl, 2013). Therefore, the dosage can be reduced once the patient improves significantly to avoid adverse effects. The expectation is that the patient will manifest a 100 percent improvement in various symptoms after four weeks. For example, I expected the patient to report better quality of sleeping, improved interaction with other people and a reduction in mood changes. Research shows that the administration of Lithium for several weeks is effective in the treatment of the bipolar disorder (Ketter et al., 2016). It is also recommended for patients with symptoms such as delusions, hallucinations, hyperactivity, lack of sleep, and racing thoughts. The outcome of the treatment is that the patient recorded a 100 percent improvement in symptoms. When the patient returned to the clinic, the expressed their joy that they had experienced better quality of sleep with no hallucinations. The patient also participated in daily activities without hyperactivity, mood changes, and racing thoughts. The expectations of the treatment had been met. However, a lower dosage of the drug can be prescribed or a different drug for therapeutic maintenance purposes to prevent the reoccurrence of the symptoms.
Ethical Considerations and Treatment
Ethical considerations are important during treatment to enhance the quality of treatment and prevent lawsuits. One of the ethical considerations during the treatment is to educate the patient about the effects of Lithium drugs (Stahl, 2013). For example, the adverse effects of Lithium is adding weight. The explanation is essential to discard therapeutic misconception. A patient is also entitled to information about changes in medication or dosage and reasons for the changes. Another consideration is to get the informed consent of the patient regarding treatment (Muir et al., 2019). The patient should agree to receive treatment and comply with the treatment goals. Treatment of mental conditions also requires confidentiality. All the information about the patient should be kept confidential. Clinicians risk legal implications if they do not comply with the privacy and confidentiality requirements in the treatment of mental conditions. Clinicians should observe the human rights of a patient. Despite the medical condition of the patient, it is essential to avoid any violation of human rights or dignity. Healthcare providers should also provide care while observing justice and fairness (Muir et al., 2019). Fairness means caring for all patients without any bias. Consequently, clinicians are advised to avoid any conflict of interest such as providing care to patients with whom they have other relations (Stahl, 2013). For example, a PMHNP would be unethical for caring for a family member. Additionally, PMHNP should be ready to provide care to patients during emergencies. If a clinician fails to provide care, he would be deemed unethical (Muir et al., 2019). Therefore, the various ethical considerations are essential to improve the quality of treatment of mental health patients.
Conclusion
Treatment of bipolar requires a series of decisions. A series of decisions helps in monitoring the improvements in a patient. Lithium is one of the best medications used to treat bipolar disorders. During the prescription, it is important to educate a patient about the need to take the medication consistently. Patients should also adhere to the treatment to ensure better results. PMHNP should consider various ethical issues that affect the treatment of mental conditions such as bipolar disorder. Treatment of the bipolar disorder is effective when PMHNP choose the best medication among the available choices and assess the outcomes for appropriate changes.
References
Findling, R. L., McNamara, N. K., Pavuluri, M., Frazier, J. A., Rynn, M., Scheffer, R., … & Rowles, B. M. (2019). Lithium for the maintenance treatment of bipolar I disorders: a double-blind, placebo-controlled discontinuation study. Journal of the American Academy of Child & Adolescent Psychiatry, 58(2), 287-296.
Ketter, T. A., Miller, S., Dell’Osso, B., & Wang, P. W. (2016). Treatment of bipolar disorder: Review of evidence regarding quetiapine and lithium. Journal of Affective Disorders, 191, 256-273.
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: recommendations from clinical practice guidelines. Journal of Affective Disorders, 217, 266-280.
Muir, H. J., Coyne, A. E., Morrison, N. R., Boswell, J. F., & Constantino, M. J. (2019). Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems. Psychotherapy, 56(4), 459.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
