Bipolar disorder is a mental condition which impacts 1 to 4% of the public. The signs and symptoms will differ depending on the kind of disease present. Someone who is manic-depressive may be euphoric and ecstatic, whereas someone who is depressed might be sad or depressed. Each episode is marked by a significant shift in the patient’s conduct and behavior. Bipolar disorder is characterized by extreme variations in a person’s mood and energy levels throughout time. Changes in a person’s conduct are frequently noticed first by those closest to them. According to recent research, 69% of persons with bipolar illness are misdiagnosed as having unipolar depression instead of bipolar disorder (Bonnín et al., 2019). Misdiagnosis raises the risk of inadequate antidepressant medication, which might result in manic episodes in certain situations.
Doctors take time to diagnose most of their patients correctly. Consequently, diagnosing the disease is challenging since most individuals seek care when experiencing a depressive episode but remain silent when they have a manic episode. Patients are usually uninterested in their manic episodes. In some aspects, the symptoms of bipolar disorder are comparable to those of other mental diseases, such as borderline personality disorder (Jawad et al., 2018). Due to a significant delay in diagnosis, patients with bipolar illness have a prolonged time of stability in their life. Consequently, practicing nurses must be well-versed in the pathophysiology of the condition they’re treating.
In this case, the complainant is an Asian-American lady. It has been determined that bipolar disorder exists. The report outlines what is safe and suitable for the patient during the presentation.
Decision One
Which Decision Did You Select?
Risperdal 2 mg twice a day was recommended for the first two weeks.
Why Did You Select This Decision?
Risperdal was selected since it has been shown to help a wide range of bipolar disorder patients. It has been demonstrated to benefit persons with mixed episodes of type 1 bipolar illness. Because of its tolerability, the FDA has authorized Risperdal to treat schizophrenia. It is used to treat schizophrenia because of its efficiency in restoring brain stability. According to studies, the receptor-binding profile of risperidone efficiently balances dopamine and serotonin levels, resulting in improvements in mood and behavior in specific individuals. Second-generation (atypical) antipsychotics, maybe utilized as effective alternatives to standard stabilizers in the treatment of manic episodes (Chopko & Lindsley, 2018). Short-term adjunctive therapy with benzodiazepine drugs like Risperdal is effective.
Why Did You Not Select the Other Two Options Provided in The Exercise?
Due to the risk of side effects, starting with a lithium dose of 300 mg is not recommended. Starting with Seroquel XR 100 mg is not recommended because the patient has a positive CYP2D6 test. The patient’s safety should be the primary consideration when making decisions. Because the patient’s condition isn’t critical, you don’t need to start giving him lithium.
What Were You Hoping to Achieve by Making This Decision?
Patients taking Risperdal will notice that their mania symptoms are less severe. He should be able to sleep well and concentrate on his work, for example. This medication is expected to help restore brain balance and improve mood. Risperdal is a medication that helps people with bipolar disorder who have manic episodes (Jawad et al., 2018). According to a score of 22 on the Young Mania Scale, the patient has moderate mania symptoms and should be treated right away.
Explain How Ethical Considerations May Impact Your Treatment Plan and Communication with Patients.
Before administering any psychiatric medication, it is critical to obtain the patient’s consent. When patients were informed about the pharmacodynamics of their disease, they were more likely to give informed consent. Patients from minority ethnic groups require culturally sensitive care, starting with patient education and continuing throughout treatment.
Decision Two
Which Decision Did You Select?
Instead of stopping Risperdal, the best next step is to cut the dose to 1mg at bedtime every day.
Why Did You Select This Decision?
The patient expressed his exhaustion. Drowsiness is a common side effect of Risperdal. On the other hand, the patient’s CYP2D6 level was abnormally high, even more concerning. In comparison to Caucasians, Asians had lower CYP2D6 activity. Polymorphisms in the CYP2D6 enzyme have affected the pharmacokinetics and tolerability of traditional antipsychotics (Hirschfeld, n.d.). Drowsiness is a source of contention for patients throughout the day.
Why Did You Not Select the Other Two Options Provided in The Exercise?
Patients are encouraged to keep taking Risperdal because it effectively treats bipolar disorder symptoms. Lithium and Seroquel XR 100 mg have side effects that can harm a patient’s overall health (Rolin, Whelan & Montano, 2020). Remember that adding another drug to a drug combination increases the severity of side effects, toxicity, and drug-drug interactions that must be considered.
What Were You Hoping to Achieve by Making This Decision?
Lowering the Risperdal dose to 1 mg may help reduce side effects, and changing the patient’s bedtime may help them function better during the day. Patients will reap the drug’s benefits with the fewest possible side effects.
Explain How Ethical Considerations May Impact Your Treatment Plan and Communication with Patients.
Drug interactions with Asian medicines should be considered when making decisions. The Practitioner Nurse (NP) must take all reasonable precautions to protect the patient. Learning more about Risperdal’s psychodynamics in Asian patients can help Nurse Practitioners (NPs) improve patient safety (Hirschfeld, n.d.). Some antipsychotics have a different effect on Asians than they do on Caucasians. NPs must prescribe drugs that have been proven to work in various patients.
Decision Three
Which Decision Did You Select?
It was decided to keep using Risperdal 1 mg orally in high doses.
Why Did You Select This Decision?
The drug assists in achieving the desired result. Dosage adjustments are not clinically useful because they can affect the patient’s mood and destabilize their mental state.
Why Did You Not Select the Other Two Options Provided in The Exercise?
After this point, there is no reason in the treatment plan to change the drug or its dosage. In this case, the patient tolerated Risperdal well (Jawad et al., 2018). The other two options have too many unknowns, making patient treatment difficult. To keep the patient’s mental health stable, you must continue to use Risperdal.
What Were You Hoping to Achieve by Making This Decision?
According to the manufacturer, Risperdal treatment will help maintain a reduction in bipolar symptoms over time. Patients report no adverse side effects and long-term mood stability. The patient’s relationship with their family and friends is expected to improve. Patients will be able to devote more time to their professional pursuits. Furthermore, until their next doctor’s appointment, patients are expected to take the same medication.
Explain How Ethical Considerations May Impact Your Treatment Plan and Communication with Patients.
It is a moral obligation to consider the drug’s pharmacodynamics before and during the treatment of the bipolar disorder. The medication you choose should give you the best possible results. Patients should be aware of the drug’s side effects and the long-term consequences of taking it. In cases of severe psychiatric illness, the law allows the practicing nurse to disregard the patient’s care preferences (Chopko & Lindsley, 2018). The responsibility of the practicing nurse (NUR) is to think about the moral implications of any decision so that the patient does not suffer as a result of the care provided. Antipsychotic patients must be ethically monitored. The drug and any potential side effects should be explained to the patient’s family members. This makes it easier to keep track of the patient.
Conclusion
Several medicines may be utilized in treating bipolar disorder, all of which have been certified by the FDA. Nurse Practitioners (NURs) are specially trained to select the most appropriate medication for each patient (Bonnín et al., 2019). Genetics impacts the absorption, distribution, and metabolism of drugs. The adverse reaction that an Asian patient with a positive CYP2D6 gene has is different from the adverse reaction that a patient with a negative CYP2D6 gene has. Genetic testing should determine the appropriate dose for patients of Asian ancestry. Risperdal is a highly effective first-line treatment for bipolar disorder. It is more effective in the treatment of manic episodes. The patient received a 22 on the young mania scale applied to him.
The patient requires medication to relieve their mania symptoms. Some Asian patients have a low tolerance for traditional mood stabilizers like lithium and Seroquel XR, and they may experience unwanted side effects, prompting them to stop taking the medication. As a result, there may be inconsistencies. There have been fewer reports of side effects with this drug than with traditional antipsychotics. When treating Asian patients, the FDA’s regulations and recommendations should be followed. Nurses must always put the safety of their patients and their families first. Because of the balance of efficacy, safety, and cost-effectiveness, Risperdal is recommended to treat manic episodes.
References
Bonnín, C. D. M., Reinares, M., Martínez-Arán, A., Jiménez, E., Sánchez-Moreno, J., Solé, B., … & Vieta, E. (2019). Improving functioning, quality of life, and well-being in patients with bipolar disorder. International Journal of Neuropsychopharmacology, 22(8), 467-477.
Chopko, T. C., & Lindsley, C. W. (2018). Classics in chemical neuroscience: risperidone. ACS Chemical Neuroscience, 9(7), 1520-1529.
Jawad, I., Watson, S., Haddad, P. M., Talbot, P. S., & McAllister-Williams, R. H. (2018). Medication nonadherence in bipolar disorder: a narrative review. Therapeutic Advances in Psychopharmacology, 8(12), 349-363.
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/bip olar-watch.pdf
Rolin, D., Whelan, J., & Montano, C. B. (2020). Is it depression or is it bipolar depression?. Journal of the American Association of Nurse Practitioners, 32(10), 703-713.
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