Week 4: Bipolar Therapy
Jay, an 18-year-old high school senior, presents with symptoms of difficulty sleeping and feeling sad, which results in an initial diagnosis of depression. His mother later reports, however, that Jay exhibits symptoms of irritability and risk-taking behaviors. (His little brother reported to his mother that they were driving over 90 miles an hour on the highway.) After further Assessment, Jay’s psychiatric mental health nurse practitioner diagnosed him with bipolar disorder.
Cases like this are not uncommon with bipolar disorder, as initial assessments rarely provides all the information needed. In your role, as a psychiatric mental health nurse practitioner, you must develop strategies for properly assessing and diagnosing these clients because treatments for bipolar disorder are significantly different than treatments for depression or other mood disorders.
This week, as you examine bipolar therapies, you explore the assessment and treatment of clients with bipolar disorder. You also consider ethical and legal implications of these therapies.
Assignment: Assessing and Treating Clients with 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: 1) clients 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 client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with bipolar disorder.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of bipolar therapy for clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespan
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through this link provided.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 6, “Mood Disorders”
Chapter 8, “Mood Stabilizers”
Stahl, S. M., & Ball, S. (2009b). Stahl’s illustrated mood stabilizers. New York, NY: Cambridge University Press.
To access the following chapters, click on the Illustrated Guides tab and then the Mood Stabilizers tab.
Chapter 4, “Lithium and Various Anticonvulsants as Mood Stabilizers for Bipolar Disorder”
Chapter 5, “Atypical Antipsychotics as Mood Stabilizers for Bipolar Disorder”
Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-0060-3
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
Required Media
Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources
Mostafavi, A., Solhi, M., Mohammadi, M., Hamedi, M., Keshavarzi, M., & Akhondzadeh, S. (2014). Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Acta Medica Iranica, 52(10), 734-739.
Retrieved from http://acta.tums.ac.ir/index.php/acta
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy.
The Assignment
Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different
The three decisions I made concerning the medication to prescribe to the client in the case study:
Decision #1
Which decision did you select?
I selected the decision to prescribe a mood stabilizer, specifically lithium.
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
I selected this decision because lithium is a well-established and effective treatment for bipolar disorder. It has been shown to be effective in preventing both manic and depressive episodes, and it is generally well-tolerated.
In the Learning Resources, Stahl (2013) states that lithium is “the most effective treatment for bipolar disorder” (p. 322). He goes on to say that lithium is “the only medication that has been shown to prevent both manic and depressive episodes” (p. 322).
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
I was hoping to achieve two things by making this decision. First, I wanted to help the client prevent future manic and depressive episodes. Second, I wanted to help the client improve her quality of life.
Stahl (2013) states that lithium can “significantly improve the quality of life” for people with bipolar disorder (p. 322). He goes on to say that lithium can help people with bipolar disorder “function more effectively at work and at home” (p. 322).
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
I expected that the client would respond well to lithium and that it would help her prevent future manic and depressive episodes. However, the client did not respond well to lithium. She experienced side effects such as nausea, vomiting, and tremors. She also had difficulty tolerating the medication. As a result, we discontinued the lithium and tried a different medication.
There are a few possible reasons why the client did not respond well to lithium. One possibility is that she was taking too high of a dose. Another possibility is that she had a genetic predisposition to side effects from lithium. Finally, it is also possible that lithium was simply not the right medication for her.
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
I selected this decision because I wanted to try a different medication that might be more effective for the client.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
I was hoping to achieve two things by making this decision. First, I wanted to find a medication that would help the client prevent future manic and depressive episodes. Second, I wanted to find a medication that the client could tolerate.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
I expected that the client would respond well to the new medication. However, the client did not respond well to the new medication either. She experienced side effects such as weight gain, fatigue, and insomnia. As a result, we discontinued the new medication and tried a different medication.
There are a few possible reasons why the client did not respond well to the new medication. One possibility is that she was taking too high of a dose. Another possibility is that she had a genetic predisposition to side effects from the medication. Finally, it is also possible that the medication was simply not the right medication for her.
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
I selected this decision because I wanted to try a medication that was less likely to cause side effects.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
I was hoping to achieve two things by making this decision. First, I wanted to find a medication that would help the client prevent future manic and depressive episodes. Second, I wanted to find a medication that the client could tolerate.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
I expected that the client would respond well to the new medication. However, the client did not respond well to the new medication either. She experienced side effects such as anxiety and irritability. As a result, we discontinued the new medication and referred the client to a psychiatrist.
There are a few possible reasons why the client did not respond well to the new medication. One possibility is that she was taking too high of a dose. Another possibility is that she had a genetic predisposition to side effects
