Having bipolar disorder is a severe mental illness that may enormously impact a person’s quality of life. According to the National Alliance on Mental Illness (NAMI), it is estimated that more than 10 million individuals in the United States are affected by bipolar disorder, according to the National Alliance on Mental Illness (NAMI). It may occur at any age, although it is more prevalent in those over 25 years old. It is estimated that 4.4 percent of the population suffers from bipolar illness. There are now 2.8% of females and 2.9% of males suffering from bipolar illness at any one point in time (Reiser et al., 2017). The severity of your bipolar illness may increase if you don’t get treatment immediately. Patients with bipolar illness and those who care about them may benefit from treatment that includes medication and counseling. One patient with bipolar disorder is profiled in this study, their therapy choices, rationales for each, and moral quandaries encountered throughout treatment.
This case study features a 26-year-old Asian lady who suffers from bipolar type 1 disorder. She spent 15 days in the hospital after a severe attack of manic depression. Throughout the test, they seemed to be engrossed in intense mental exertion. While some individuals like sleeping, others despise it. She received a score of 22 on the Young Mania Rating Scale, the maximum achievable (YMRS). After being taken to the hospital two weeks before this encounter, she was given lithium. The patient’s BMI, which indicates obesity, and her medical history, may influence the medication administered. Due to the genetic variations between Asians and Caucasians, it will be crucial to consider the CYP2D6*10 allele while administering antipsychotic medication to him.
Decision 1: Seroquel 100 XR mg at night
Seroquel (quetiapine) is a second-generation dibenzothiazepine antipsychotic medication licensed to treat major depressive disorder and schizophrenia. The medication may be taken immediately or in the form of an extended-release (XR) tablet (IR). Both drugs have similar bioavailability. On the other hand, a 5-hour peak plasma concentration of XR enables daily dosing. The medication is metabolized mainly in the liver, with just a trace of metabolism occurring at the CYP2D6 enzyme (Lopez-Muoz et al., 2017).
Quetiapine seems to be associated with fewer adverse events than other antipsychotic medicines. Whether administered alone or in conjunction with other treatments for bipolar illness in adolescents, medication had a substantial effect on the outcome. Due to the patient’s discontinuation of lithium two weeks before admission, the hospital stay was judged unnecessary. To prevent a recurrence, it is suggested that you gradually decrease your lithium dosage over at least four weeks before discontinuing. If the patient has undesirable weight gain due to the lithium, her health may be compromised due to her high BMI. Risperdal has been linked to diabetes and impaired glucose tolerance due to the patient’s obesity, among other undesirable effects that may have a substantial impact on the patient’s quality of life. Because studies have shown that combining this medicine with another is more beneficial than monotherapy, using it alone in this case study is not recommended.
Expected Outcome
If the patient’s insanity symptoms improve within four weeks of being discharged from the clinic, they should be permitted to return. She should be allowed to unwind and sleep regularly. Her Young Mania Rating Scale score will decrease by at least 50%. (YMRS). Two possible adverse effects include weight gain and intestinal problems.
Ethical Considerations Impact on Treatment Plan
As a nurse, you must safeguard your patients’ health and well-being. As a result, the patient’s participation in therapeutic decision-making is critical (Reiser et al., 2017). Before making a selection, it is critical to have an open and candid conversation with the patient about all possible therapeutic options and their benefits and drawbacks.
Decision 2: Discontinue Seroquel and begin taking Geodon 40 mg daily. BID, with a 500-calorie meal
Quetiapine should be stopped after the first intervention and replaced with another antipsychotic drug. The patient suffered from weight gain, dry mouth, and constipation, among other adverse effects. Among the numerous alternatives, it is vital to begin employing Geodon, a medicine licensed in 2004 to treat manic episodes in persons with bipolar illness. According to studies, Geodon may be beneficial in treating acute manic episodes. A favorable result may be reached as the therapy does not induce weight gain, which is essential in making it acceptable to the patient. Even better, the maker of Geodon thinks that the patient’s CYP2D6 genotype makes it more quickly absorbed while concurrently minimizing toxicity (Haggarty et al., 2020). Fasting affects Geodon’s bioavailability by 50 percent. Hence a 500-calorie lunch is suggested for optimum absorption.
Seroquel’s side effects, such as weight gain, constipation, and dry mouth, may develop if the dose is raised, but the patient’s symptoms will improve (Haggarty et al., 2020). (Haggarty et al., 2020). Patients are already in tremendous agony due to these side effects, so finding a new drug that they can take is vital.
Seroquel’s treatment outcomes have indicated a poor degree of efficacy in reducing the patient’s symptoms. Weight gain and dry mouth will occur if the dosage is not altered. However, the treatment time will be prolonged. This is true even if you are taking a laxative. Because of these undesirable side effects, the patient may be required to skip work or school.
Expected Outcomes
After four weeks of treatment, the patient’s manic symptoms should be dramatically improved in just two weeks. According to the YMRS, her YMRS score is expected to decline by half the following year. Previous adverse effects are expected to be entirely addressed, with no additional harmful repercussions (Cotton et al., 2019).
The Treatment Plan and Ethical Considerations
In light of the preceding intervention’s findings, the nurse must give patient-centered care, including ensuring that the patient is comfortable with the pharmacological options. Because the patient is an adult with the right to informed consent, any modifications to the treatment plan must be agreed upon in writing (Haggarty et al., 2020).
Decision 3
The patient’s symptoms improved due to the previous treatment, which was a plus. According to the docs, the patient had no harmful side effects while using the medication. Geodon’s efficacy in treating bipolar illness in adults may take up to 4 to 6 weeks (Haggarty et al., 2020). Dose consistency is critical for reducing side effects and improving the patient’s ability to regulate bipolar symptoms. Furthermore, keeping a consistent dosage, the dose should not be modified after stabilizing the patient.
Lopez-Muoz et al. (2018) consider that raising the dose of Geodon to 60mg is not suggested due to the risk of respiratory issues, drowsiness, extrapyramidal syndrome, and weight gain. Patients’ health will be jeopardized due to side effects, and they will discontinue the use of the medicine even if it is helpful.
Geodon may have been administered lithium to help speed up the treatment of the patient’s symptoms, allowing for this intervention. There is no need to reintroduce lithium into the patient’s regimen since it was previously withdrawn (López-Muoz et al., 2018). A variety of side effects, including weight gain, have been linked to the medication. This may harm a patient’s quality of life.
Expected Outcome
If there are no adverse effects, the patient’s problems should resolve after four weeks. To be eligible for treatment, a patient’s YMRS score must be less than 12. Finally, as acceptance improves, the patient’s compliance should improve (Cotton et al., 2019).
Ethical Considerations Impact on Treatment Plan
Health-care providers have a moral and legal obligation to improve their patients’ well-being while minimizing harm. The patient’s symptoms improved significantly, indicating that the medicine was functioning thus far. As a consequence, the nurse’s relationship with the patient improves. As part of the patient’s education, the justification for the following procedure and the possible side effects of the drug utilized should be communicated (Reiser et al., 2017).
Conclusion
Mental diseases are notoriously difficult to manage since various elements must be addressed to get the greatest treatment results. The patient in this case study contains the CYP2D6*10 allele, which is involved in the metabolism of the majority of antipsychotic medications. Obese individuals should always avoid or use weight-gain drugs under the guidance of a physician. Because the patient had previously taken lithium, it appeared reasonable to begin with Seroquel 100 XR mg at night. The medicine has been linked to ineffectiveness and adverse effects, including weight gain, dry mouth, and constipation (Baldessarini et al., 2019).
The medication was changed to Geodon40 mg BID and delivered with a 500-calorie meal to mitigate the adverse effects. The patient’s symptoms were reduced in half after the second therapy, with just minimal side effects. The real outcome was excellent. After the first round of medication, the patient required four weeks of treatment to achieve complete symptom remission. Although psychotherapy was necessary to improve the patient’s symptoms and overall quality of life (López-Muoz et al., 2018), it was not given.
Numerous ethical issues were explored and resolved throughout the therapy. For instance, the patient may have been dissatisfied with the outcome of the first intervention. Stopping the drug was crucial for patient acceptance and increasing the likelihood of a happy result as an adult in charge of her own health decisions (Reiser et al., 2017). Additionally, the patient was informed of all available therapy alternatives and the benefits and drawbacks of each. Additionally, it was recommended that the patient be educated on the critical nature of adherence to accomplish treatment objectives.
References
Cotton, S. M., Berk, M., Jackson, H., Murray, G., Filia, K., Hasty, M., … & MacNeil, C. (2019).
Improving functional outcomes in early‐stage bipolar disorder: The protocol for the REsearch into COgnitive and behavioral VERsatility trial. Early intervention in psychiatry, 13(6), 1470-1479. https://doi.org/10.1111/eip.12797
Reiser, R. P., Thompson, L. W., Johnson, S. L., & Suppes, T. (2017). Bipolar disorder (Vol. 1). Hogrefe Publishing.
López-Muñoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of bipolar disorder. International journal of molecular sciences, 19(7), 2143. https://doi.org/10.3390/ijms19072143.
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular psychiatry, 24(2), 198-217. https://doi.org/10.1038/s41380- 018-0044-2
Haggarty, S. J., Karmacharya, R., & Perlis, R. H. (2020). Advances toward precision medicine for bipolar disorder: mechanisms & molecules. Molecular Psychiatry, 1-18. https://doi.org/10.1038/s41380-020-0831-4
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