An Asian American Woman with Bipolar Disorder
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An Asian American Woman with Bipolar Disorder
Introduction
Bipolar disorder can cause severe disruption to a person’s life, however, the impact varies from one individual to another. People who experience bipolar disorder often experience mood, energy, and activity levels (Akinhanmi et al., 2018). Mental illness can make day-to-day living difficult. Bipolar is a mental health condition that causes changes in mood, concentration, energy levels, and one’s ability to perform daily activities. In bipolar disorder, the high emotions are called mania or hypomania while the low emotions are depressions (Akinhanmi et al., 2018). Patients who are depressed show signs of sadness, loss of interest, lack of concentration, and others. Bipolar I disorder is one of the many types of bipolar. Other types include bipolar II disorder, and Cyclothymic disorder also known as cyclothymia. Mood episodes are very different from the moods and behaviors that are typical for the person (Akinhanmi et al., 2018). During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.
The case study is about a 26-year-old Asian woman who was diagnosed with bipolar during her previous hospitalization. The patient reported for her first appointment following a 21-day hospitalization for the onset of acute mania (Chen et al., 2015). When the psychiatric mental health nurse arrived in the office, the patient was busy playing with things on the table and moving from one side of her chair to another. He seemed happy, asking the psychiatrist if it is true that she has bipolar. The patient had a fantastic mood and stated that she sleeps 5 hours but hates sleep because it is no fun (Chen et al., 2015). The patient is oriented to person, time, and event. The purpose of this paper is to discuss decision points 1 to 3 that are relevant to improving the patient’s condition.
Decision Point One
Decision one is to Begin Seroquel XR 300 mg orally at HS. Seroquel XR is approved and widely used for the treatment of bipolar disorders. Seroquel XR is also used to treat other mental disorders such as schizophrenia and depression. Seroquel XR works by balancing neurotransmitters in the brain (Baldessarini et al., 2019). The medication is an atypical antipsychotic belonging to a chemical class, the dibenzothiazepine derivatives. Seroquel XR was selected because it is indicated for the acute treatment of depressive and manic episodes associated with bipolar disorder.
The other two decisions were not selected for one reason or the other. For example, Lithium 300mg orally BID was not selected because it did not result in positive outcomes earlier. The patient manifested a significant level of incompliance with lithium (Chen et al., 2015). Therefore, it was sensible to change the drug. On the other hand, Risperdal 1mg orally BID was a good option but not selected because the patient was diagnosed with the CYP2D6*10 allele, which slows the metabolism of the drug (Chen et al., 2015). As a result of this, the patient could have slower clearance of Risperdal from her system, which could result in severe sedation.
With the selected decision (Begin Seroquel XR 300 mg orally at HS) it was expected that more than 50% of the patient’s symptoms would resolve. For example, the manic episodes would resolve (DeRubeis & Strunk, 2017). The patient would improve her sleep and would begin to think straight. However, the results were different from the expectations. After four weeks, the patient returns to the clinic and reports improved sleep, a slight reduction in manic symptoms, and a good mood. However, she complains of rapid weight gain, constipation, and dry mouth (Chen et al., 2015). She asks for a different medication. The ethical considerations include patient autonomy and consent, beneficence, and non-maleficence.
Decision Point Two
Decision point two is to discontinue Seroquel and start Geodon 40mg orally BID; administered with a 500 calorie meal. This decision was selected because the patient asked to be given a new medication (Akinhanmi et al., 2018). Seroquel XR 300 mg orally at HS was associated with bad side effects such as rapid weight gain, constipation, and dry mouth that made the patient uncomfortable with the medication. Additionally, Geodon is widely used for the treatment of bipolar I disorder. The medication can be used alone or alongside other drugs (Baldessarini et al., 2019). It works by rebalancing dopamine and serotonin to improve thinking, mood, and behavior.
The other two decisions were not selected for various reasons. For example, Increasing Seroquel XR to 400 mg orally at HS would lead to more severe side effects. The patient was already experiencing side effects with 300mg, therefore, increasing the dose to 400mg would put the patient’s life and health in danger (Chen et al., 2015). Furthermore, continuing the same dose of Seroquel was not a good option because the patient requested another drug. Also, it had caused some side effects such as constipation, dry mouth, and weight gain.
The expected result was that about 50% of the symptoms would be resolved. The therapist expected that the Young Mania Rating Scale would show a decrease in the symptoms by 50%. Additionally, the new symptoms, which are side effects of Seroquel were expected to resolve (DeRubeis & Strunk, 2017). Therefore, weight gain would stop and dry mouth and constipation would also resolve. The actual results were favorable. After four weeks, the patient reported a 50% decrease in score on the Young Mania Rating Scale. The patient also denied additional weight gain and other side effects. During the treatment, the patient was educated about medication side effects and how to manage those problems (Akinhanmi et al., 2018). All decisions made were harmless and beneficial to the patient. The patient was informed about her treatment plan and possible alternatives.
Decision Point Three
The selected option three was to continue with the current dose and reassess in 4 weeks. The current dose is Geodon 40mg orally BID; administered with 500 calorie meal. This decision was selected because there was no tangible reason to change the current dose of medication (Chen et al., 2015). Geodon 40mg orally BID improved the patient’s situation by reducing the symptoms by 50%. This is considered as a full response, though not full recovery. This is a very good sign of improvement. The patient should receive counseling about medication side effects. Also, the therapist should purpose to reassess the patient in 4 weeks.
Augmentation with Lithium may be appropriate if the goal of therapy is to discontinue antipsychotic therapy and treat with Lithium monotherapy. The patient should be educated regarding the side effects of medications. Increasing Geodon 40mg to Geodon 60 mg orally BID was not selected because increasing the dose would lead to serious side effects (Akinhanmi et al., 2018). Geodon can lead to serious side effects such as drowsiness, dizziness, lightheadedness, weakness, nausea, vomiting, runny nose, and cough, especially when the doses are higher.
The expected results in the next four weeks include the full recovery of the patient. All the manic and depressive symptoms of bipolar are expected to completely resolve (DeRubeis & Strunk, 2017). She is expected to have improved sleep. Additionally, symptoms such as dry mouth, constipation, and weight gain are expected to have been resolved completely by the fourth week. Some of the ethical considerations include fairness and justice. The patient needs to be treated fairly, including equal distribution of resources. The patient is expected to be involved in all decision-making processes (Baldessarini et al., 2019). Additionally, the principles of beneficence and non-maleficence must be put into consideration. The patient needs to be educated about medication adherence to ensure efficient and effective recovery.
Conclusion
Patients suffering from bipolar disorder often experience a series of shifts in mood, energy, and behavior. Bipolar disorder is a mental health problem that causes high and low moods. It also interferes with concentration and the patient’s ability to carry out daily activities. The cases study was about a 26-year-old woman of Asian background. She was diagnosed with bipolar I disorder and hospitalized 21 days ago. The patient has come for her first appointment but her condition seems to be worsening. She states that she has been non-compliant with the medications.
As a result, the psychiatric nurse makes three decisions or treatment regimens to help improve her condition. Decision one is to Begin Seroquel XR 300 mg orally at HS. Seroquel XR is widely used to treat bipolar I disorder. Decision point two is to discontinue Seroquel and start Geodon 40mg orally BID; administered with a 500 calorie meal. The selected option three was to continue with the current dose and reassess in 4 weeks. The patient showed a good sign with decision two when 50% of the symptoms resolved. Various ethical issues such as beneficence, non-maleficence, patient consent and autonomy, and fairness and justice must be considered.
References
Akinhanmi, M. O., Biernacka, J. M., Strakowski, S. M., McElroy, S. L., Balls Berry, J. E., Merikangas, K. R., … & Frye, M. A. (2018). Racial disparities in bipolar disorder treatment and research: a call to action. Bipolar disorders, 20(6), 506-514.\
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular psychiatry, 24(2), 198-217.
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
DeRubeis, R. J., & Strunk, D. R. (2017). The Oxford handbook of mood disorders. New York, NY: Oxford University Press.