Assessing And Treating A Patient With A Mood Disorder essay

Author: NursingWriter

January 21st, 2023

Bipolar Disorder

Bipolar is a mental health disorder characterized by extreme mood changes that alter the behavior and normal function of a patient. The mood fluctuation is on extreme ends and may take days to weeks before change, accompanied by difficulties in performing daily tasks and social interactions. The mood changes are mania or hypomania; mania is a happy or irritable mood, and hypomania is a sad mood or depression (Ashok, et al, 2017). These symptoms usually occur alternatively after weeks associated with a period of the normal state. There are types of bipolar which include bipolar 1, bipolar 2, and cyclothymic bipolar. Bipolar 1 has alternating episodes of mania, hypomania, and neutral mood. Bipolar two is associated with a major depressive mood disorder and hypomania state. Cyclothymic has frequent mood swings. Assessing And Treating A Patient With A Mood Disorder essay

The signs and symptoms of the manic episode are diminished need for sleep, increased and faster speech, increased activity, increased risky behavior, distractibility, and uncontrollable racing thoughts. Hypomania presents with intense sadness or despair, loss of interest, fatigue, difficulties in concentration, frequent thoughts, and suicidal ideation. Common causes of bipolar are genetic predisposition, family history of bipolar, stressful environment, and substance abuse. The patient in the case study is a 26years old female with bipolar. According to the American psychiatric association, she meets the DSM-5 criteria through her symptoms of the diminished need to sleep, excessive talking, increased distractibility, she is in a happy mood, rapid or pressured speech, and increased energy. She scores 22 on the young scale mania. The interventions for bipolar are the use of antipsychotics and psychotherapy. Antipsychotics relieve the symptoms of the patient while psychotherapy enables the patient to change their thinking and behavior to improve cognitive functions and quality of life. The essay describes the three decisions made in treating the patient including the impact of ethical principles.

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Decision One

Which decision did you select?

Begin Seroquel XR 300mg orally at HS

Why did you select this decision?

Seroquel is a second-generation antipsychotic with a high affinity for dopamine and serotonin receptors. Its mechanism of action is by antagonizing these receptors and binding them to the norepinephrine transporter (Hamed, et al, 2017). This helps in improving memory, mood, aggression, and the muscle movement that plays a vital role in the brain for pleasure. Seroquel is the best drug for the patient because it is FDA approved for acute manic episodes and bipolar. Moreover, the American psychiatric association proves it is efficient in treating bipolar in its studies. Assessing And Treating A Patient With A Mood Disorder essay

Why did you not select the other two options provided in the exercise?

Risperdal is a second-generation antipsychotic for treating schizophrenia and maintenance treatment in bipolar. Its mechanism of action is by decreasing the serotonin and dopamine activity in the brain thus reducing the mood symptoms, agitation, and symptoms of schizophrenia. it has 94% bioavailability and is protein-bound with an active metabolite (Schoretsanitis, et al, 2017). It has a plasma half-life of three to twenty hours. However, I did not select this drug for the patient because it has undesirable effects like drooling, nausea, weight gain, nausea, fatigue, and tiredness. Lithium is a commonly prescribed drug for prophylaxis and treatment of manic episodes. Its mechanism of action is by modulating the neurotransmitters and inhibiting the excitatory neurotransmitters like dopamine and glutamate. It has neuro-proliferative and neuroprotective effects on the brain that helps in regulating mood. It is FDA approved for mood disorders and bipolar. However, I did not select the drug because the patient has not been compliant due to its unpleasant effects.

What were you hoping to achieve by making this decision?

The expectations of starting the patient on Seroquel XR 300mg are to relieve the symptoms and reduce the score of the young scale mania. The expected side effects are dry mouth, drowsiness, constipation, and weight gain.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Communication is the exchange of information from the sender to the recipient to understand and interpret and eventually respond. Communicating with a patient with bipolar can be hectic because they talk fast and have racing thoughts. Therefore, the nurse incorporates the principle of justice when assessing the patient. Justice is providing equal and quality services to all despite their underlying issues. Justice enables the nurse to communicate effectively with the patient.

Decision Two

Which decision did you select?

Discontinue Seroquel and begin Geodon 40mg

Why did you select this decision?

Geodon is a second-generation antipsychotic that inhibits the reuptake of norepinephrine and serotonin, blocking the alpha and antihistaminic activities. These decrease hallucinations, improve clear and positive thinking, reduces agitation, and improve activities of daily living (Findling et al, 2022). It has 60% bioavailability and is 99% protein bound. The drug is initiated at a low dose and increased gradually within two weeks to reduce the side effects. I chose this drug because it is effective in treating bipolar and has no side effects on the patient.

Why did you not select the other two options provided in the exercise?

Increasing the dose of Seroquel to 400mg to improve the patient’s symptoms is not a good option because she previously complained of weight gain and constipation. Increasing the dose worsens the drug’s side effects. The use of dietary measures to control weight gain and obesity is ineffective because the drug has the effect of muscarinic cholinergic antagonism that induces gastrointestinal hypomotility and hence constipation and weight gain. Decreasing the dosage will not have positive effects on the patient’s symptoms and will still exhibit unpleasant side effects.

What were you hoping to achieve by making this decision?

The expectation of switching the patient’s treatment to Geodon is to improve the symptoms, decrease the young scale mania, and relieve constipation and weight gain.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

The nurse considers the principle of autonomy in this decision point. Autonomy is respect for a person’s decisions and preferences (Asl, et al, 2022). The patient is uncomfortable with Seroquel because it causes constipation despite the improvement of the symptoms. The nurse, therefore, changes the treatment to ensure patient satisfaction.

Decision Three

Which decision did you select?

Increase Geodon to 60 mg orally BID with a 500-calorie meal

Why did you select this decision?

Geodon was effective during the initial stage of treatment. Increasing from 40mg to 60mg is effective in improving the symptoms. Additionally, the recommended dose is 60mg to 80mg with a gradual increment every two weeks. I selected this choice because it will hasten the improvement of the symptoms.

Why did you not select the other two options provided in the exercise?

I did not continue with the same drug dosage because the American psychiatric association recommends 60mg to 80mg to relieve the symptoms. I did not augment with lithium because it has unpleasant side effects. Additionally, augmentation is recommendable in the incidence of depression and hypomania. There is a contraindication for lithium augmentation with antipsychotics like olanzapine, haloperidol, and Geodon.

What were you hoping to achieve by making this decision?

The expectation for increasing the dosage is to hasten the improvement of the symptoms.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

The nurse uses the principle of beneficence and non-maleficence. Beneficence is doing what is right and non-maleficence is protecting the patient from harm. The nurse carefully analyzes the best treatment for the patient to improve the symptoms and prevent adverse effects.

Conclusion

Bipolar is a mood fluctuation disorder on the extreme ends and may take days to weeks before change, accompanied by difficulties in performing daily tasks and social interactions. The signs and symptoms of the manic episode are diminished need for sleep, increased and faster speech, increased activity, increased risky behavior, distractibility, and uncontrollable racing thoughts. Hypomania presents with intense sadness or despair, loss of interest, fatigue, difficulties in concentration, frequent thoughts, and suicidal ideation. Seroquel is a second-generation antipsychotic that antagonizes these receptors to improve memory, mood, aggression, and muscle movement that plays a vital role in the brain for pleasure. However, it causes weight gain and constipation. Geodon is an effective drug for treating bipolar because it is well tolerated. Ethical principles in nursing improve assessment and communication techniques. They are beneficence, autonomy, consent, justice, and non-maleficence.

Assignment: 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:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
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)

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. Assessing And Treating A Patient With A Mood Disorder essay
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.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at

https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

By Day 7
Submit your Assignment.

Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.
Click the Week 5 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 5 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved aOstacher, M. J., & Hsin, H. (2016). The use of antiepileptic drugs in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 93–98). Elsevier.

Perlis, R. H., & Ostacher, M. J. (2016a). Bipolar disorder. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 48–60). Elsevier.

Perlis, R. H., & Ostacher, M. J. (2016b). Lithium and its role in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 86–92). Elsevier.

Traeger, L., Brennan, M. M., & Herman, J. B. (2016). Treatment adherence. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 20–26). Elsevier.

American Psychiatric Association. (2010b). Practice guideline for the treatment of patients with bipolar disorder (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar.pdf

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. https://doi.org/10.1007/s00228-015-1855-6

Hirschfeld, R. M. A. (n.d.). Guideline watch: Practice guideline for the treatment of patients with bipolar disorder (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-watch.pdf

Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331–333. https://doi.org/10.1007/s40263-013-0060-3

Medication Resources (click to expand/reduce)U.S. Food & Drug Administration. (n.d.). [email protected]: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: To access the following medications, use the [email protected] resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:

amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
Required Media (click to expand/reduce)

Optional Resources (click to expand/reduce)

Introduction to the case (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)

https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

By Day 7
Submit your Assignment.

Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.
Click the Week 5 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 5 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.Bipolar Therapy
Client of Korean Descent/Ancestry
Asian girl

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 did well enough on Lithium to be discharged from the hospital but admits she has not been taking it as prescribed. When further questioned on the subject, she provides no additional details.

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 the PMHNP should do:

Begin Lithium 300 mg orally BID
Begin Risperdal 1 mg orally BID
Begin Seroquel XR 300 mg orally at HSACKGROUND 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.

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.”

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient did well enough on Lithium to be discharged from the hospital but admits she has not been taking it as prescribed. When further questioned on the subject, she provides no additional details.

MENTAL STATUS EXAM

The Young Mania Rating Scale (YMRS) score is 22

RESOURCES

Rubric Detail

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Name: NURS_6630_Week5_Assignment_Rubric
Grid View
List View
Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point range: 0–69
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.
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.
7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
Decision #1 (1–2 pages)

• 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.
Decision #2 (1–2 pages)