Assessing and Treating Clients with Bipolar Disorder - Essay Example

Assessing and Treating Clients with Bipolar Disorder

Bipolar disorder is a commonly occurring mental disorder, and it has been determined that it becomes chronic in about 1 to 2% of those affected (Vieta, Berk, et al., 2018). The disorder's signs and symptoms manifest differently, but the principle presentation is depression and mania alternating. The phases of the disorder change an individual's mood and the way they think and behave. Usually, the changes are sudden, and people around the patient can quickly notice them. Besides, the disease presentation is quite unpredictable, and it can stay in a person's life long enough to affect their quality of life. Mostly, bipolar disorder is observed in persons starting from 25 years, although it is not an impossibility in teenagers.

Therefore, there is a need to assess and treat bipolar disorder to improve potential outcomes properly. The management approaches include psychosocial interventions and psychopharmacological approaches (Vieta, Salagre, et al., 2018). The nurse practitioner needs to be vastly aware of this disorder to institute proper management strategies. This essay considers the case of an Asian woman diagnosed with bipolar disorder and the steps taken in management. The patient is treated and assessed at every step in the course of treatment.

Decision Point one

I chose to begin the patient on Seroquel XR 100 mg orally at HS. The drug works by blockade of the dopamine D2 receptors within the mesolimbic pathway and the 5HT receptors and therefore managing the mood. The FDA approved it in 2006 to manage bipolar disorder, and it is very useful and well-tolerated in the management of bipolar, especially depressive episodes. Besides, the patient had already been on Lithium, which achieves little effect, and I, therefore, would not have chosen the same. The patient had also discontinued taking Lithium after witnessing side effects, which therefore means she was unlikely to comply if the same was repeated. Furthermore, Lithium would not have formed the ideal choice because it has a narrow therapeutic index, which means increasing the doses to achieve the desired effect would put the patient at the risk of developing adverse effects, more so toxicity.

Individuals with the allele CYP2D6 are poor metabolizers of Risperdal and would, therefore, have a reduced capacity to metabolize the drug (Cui et al., 2020). The patient was positive for the allele, which meant that if the drug were administered, she would risk the development of toxicity due to the drug's accumulation. As a result, the patient is unlikely to comply with the therapy or yield variable outcomes.

Through this choice, I expected that the patient would control her symptoms and live a quality life. I also expected that the Young Mania Rating Scale would improve by four points. However, there was only a partial response to the medication, and the patient returned four weeks later, complaining of constipation and dry mouth. The client also reported weight gain, which was undesirable and therefore requested alternative medication for her condition. From my expectation, I was able to improve the Young Mania Rating Scale readings and an improvement in sleep.

Decision Point two

At this point, I chose to discontinue Seroquel and begin the patient on Geodon 40mg BID, and a 500 calorie meal accompanied this. The drug effectively manages both the manic and mixed episodes, which are common in bipolar disorder. Besides, the drug can be used in the maintenance phase of the treatment process. Compared to Seroquel, Geodon can stabilize the patient's mood and improve the quality of life (Simonetti et al., 2020). The drug is the most potent antagonist of the serotonin as well as norepinephrine reuptake.

Since research has established, the drug was given with a meal that its bioavailability increases by more than 50% when taken with food. Through this therapy, it was expected that the patient would have a further decrease in the presenting symptoms and an overall improvement in the reading of the Young Mania Rating Scale by 50%. After four weeks, the client returned to the clinic, and there was a decrease in the Young Mania Rating Scale by 50% from the previous 22 to 11. The client did not report any weight gain and onset of other additional side effects.

Decision Point Three

A decision was made to continue the patient on Geodon and then reassess progress after another four weeks. This was informed because the patient was responding well, and there would be no need to change but rather encourage the patient to comply with the therapy to control the condition completely. The patient was also counseled on alternative approaches to managing her illness, which would reinforce medication use outcomes. The patient was enrolled and would be counseled alongside medication assessment to make sure there was no relapse.

It was expected that the patient would have good mental stability and continue taking the medication. It was also expected that the patient would have a good sleep and improved relationship with friends and relatives, having adequate ability to concentrate in her daily chores. To this end, the treatment was working well with the patient, and it was in complete agreement with the standard treatment guidelines. There was a decreased likelihood of the patient suffering toxicity from the medications selected because of being of the Asian race and, therefore, likely better compliance.

Ethical Considerations

Mental disorders present a lot of challenges to handle, and therefore, the nurse practitioner ought to be at their best whenever dealing with such patients. Ethics should always characterize the interaction between the patient and therapist, mainly making sure the right thing is done to the patient at the right time. First, the therapist must build a rapport with the patient whenever they want to begin the treatment process. An adequately created rapport allows proper communication between the therapist and the patient, and it would eventually lead to the attainment of the goals set for the treatment. At the same time, the therapist should make sure they obtain consent from the patient to institute a management plan. If the patient cannot give written consent, a trusted member of the family or a surrogate must be engaged. The therapist should then set the therapy goals with the patient and therefore work towards ensuring they are met.

The therapist must be very clear in communication and inform the patient about the interventions chosen, their benefits and potential side effects, and let the patients make their own decisions. In that regard, therefore, the patient should be guaranteed their autonomy; they ought to be in charge of their health and consequently involved in decision making concerning the interventions that should be given to them. Autonomy allows the patients to feel trusted, which makes them take responsibility for their condition, which would eventually lead to a better treatment plan, which potentially leads to improved outcomes. The patient should also be respected, and the decisions they make in therapy are respected as much as possible. Notably, the therapist should understand the patient's beliefs and culture not to affect the treatment process (Fadhil & O’neil, 2020).

Further, patient information ought to be handled with a lot of confidentiality and privacy. Patients would have trust in the system if they are assured that the information they relay is guarded and secured. Medications used in the management of psychiatric illnesses are bound to have adverse effects. Therefore, the therapist needs to make sure they select medications that would yield the best possible outcomes while as much as possible, reducing the occurrence of harmful effects. Severe adverse effects, in most cases, affect the compliance of patients to treatment.