Introduction and Description of Bipolar DisorderThe client in this case study has been diagnosed with Bipolar I Disorder. The nature of this level of Bipolar Disorder includes manic episodes that last “at least 7 days, or…are so severe that the person needs immediate hospital care” (Bipolar Disorder, 2016). In addition to the mania that is often experienced, people who suffer from Bipolar I Disorder also have depressive episodes at times. It is also possible for cases of mixed mania and depression to occur in patients as well (Bipolar Disorder, 2016). Diagnosing this illness is often difficult, as the symptoms overlap with those of other disorders and illnesses. For example, Bipolar Disorder has similarly severe manic and depressive episodes that are usually associated with Psychosis. Along with Psychosis, Bipolar Disorder also shares the emotional anxiety and lack of focus those who have been diagnosed with ADHD and have problems with substance abuse.
Details of the Patient in the Case Study
The patient in this case study is a 26-year-old American woman of Korean descent. Before arriving for her first visit with a PMHNP, the client was hospitalized for 21 days after experiencing an onset of acute mania. After being hospitalized, she was diagnosed with Bipolar I Disorder. During the initial visit with the PMHNP, the patient exhibited a happy mood and stated that she did not agree with her Bipolar I diagnosis. Along with her disagreement with her diagnosis, the patient also stated that she does not like to go to sleep because it is not amusing. Her physician has reported that she is in good health, and that her lab results do not set off any red flags. An important detail to note is that the patient has stopped taking her Lithium medications ever since she was discharged from the hospital.
Purpose of this Assignment
The purpose of the following is to outline a process of decisions that the author would make when creating a treatment plan for this client. The treatment plan’s goal is to address the Bipolar I symptoms that the client is experiencing and remedy any side effects that the client may be experiencing because of her medication or non-compliance.
Decision 1
In the case study, the author’s first decision, after hearing the client’s initial presentation, was to prescribe 300mg of an oral dose of Lithium. The other two options to choose from were to begin a regimen of Risperdal or a regimen of Seroquel. The reason that the author decided to prescribe Lithium is widely regarded as a mood stabilizer that is effective against Bipolar I and other mood disorders (Hall-Flavin, 2015). In addition to the widely regarded acceptance of Lithium as an effective treatment, it was found that Seroquel and Risperdal were also effective treatments for children and adults who were at least ten years old (Risperdal, Seroquel, 2017).
The reason why the author chose to keep the client on the Lithium prescription was because she stopped taking it immediately after she was discharged from the hospital. The author is under the understanding that her supervising physician prescribed the Lithium dosage because that was the best option available for her. Since the client was simply being non-compliant, the author decided to choose the 300mg oral dosage of Lithium over the other two viable medications presented.
Decision 2
After continuing to take her Lithium, the client returned in four weeks and said that she was still only taking her medication when she felt like it. The second decision the author made was to educate the client on why she had to take her prescription. This education included the effects of the Lithium she was prescribed and the pharmacology behind the drug. The reasoning behind the author’s second decision was that non-compliance by patients can lead to many avoidable side effects and secondary conditions. Mitchell & Selmes (2007) write that patients who achieved less than 80% of ideal adherence were at least 50% more likely to be hospitalized (para. 7).
The other two options presented were to give the client a 450mg dosage of Lithium or a 500mg dosage of Depakote. The author decided against these methods because Depakote has been proven to have the same negative side effects that Lithium does, if not worse (Depakote (divalproex sodium) Tablets for Oral use, 2011). In the case of the increased Lithium dosage, side effects are present in every drug, and the client may not have been properly notified of this beforehand like she should have been (Wegmann, n.d.).
Option 3
The third and final decision that the author made in this treatment plan was to change the client to a sustained release dosage of Lithium. The alternatives to this were to prescribe the client a dosage of Trileptal or Depakote. A study by Marini & Sheard (1976) reported that diarrhea was infrequently reported when patients were given sustained release dosages of Lithium. This remedies the client’s side effects instead of worsening them, as Depakote may have done (Depakote (divalproex sodium) Tablets for Oral use, 2011). Also, Trileptal is viewed as a second line intervention, and would have been necessary in this scenario (Oxcarbazepine for Acute Affective Episodes of Bipolar Disorder, 2011). After this sustained dosage was decided upon, the case study informed the author that this was the best long-term solution. To conclude, in this case study, an initial consultation of the potential side effects of Lithium and a sustained release dosage of the medication may have saved the patient from her discomfort.
- 4 Key Reasons for Medication Non-Compliance and How You Can Help. (n.d.). Retrieved from https://www.pharmatherapist.com/articles/4-key-reasons-for-medication-non-compliance
- Bipolar Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml#part_145406
- Depakote (divalproex sodium) Tablets for Oral use. (2001). 018723s037lbl.pdf [PDF]
- Hall-Flavin, M. D. (2015, March 04). Bipolar treatment: Are bipolar I and bipolar II treated differently? Retrieved from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/expert-answers/bipolar-treatment/FAQ-20058042
- Marini, J. L., & Sheard, M. H. (n.d.). Sustained-release lithium carbonate in double-blind study: Serum lithium levels, side effects, and placebo response. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1262538
- Mitchell, A. J., & Selmes, T. (2007, September 01). Why don’t patients take their medicine? Reasons and solutions in psychiatry. Retrieved from http://apt.rcpsych.org/content/13/5/336#sec-1
- Oxcarbazepine for acute affective episodes of bipolar disorder. (1970, January 01). Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032930/
- Risperdal: Uses, Dosage & Side Effects. (2017, August 11). Retrieved from https://www.drugs.com/risperdal.html
- Seroquel: Drug Uses, Dosage & Side Effects. (n.d.). Retrieved from https://www.drugs.com/seroquel.html
