The first decision is to start Risperdal 1mg orally BID
Reason For Selecting This Decision
Risperdal, originally referred to as risperidone, is a typical antipsychotic that has proven to be highly effective in the management of bipolar disorders. It does so by trying to influence a rebalance in serotonin and dopamine thus resulting in good conduct. Since the patient was having bipolar confusion, Risperdal happens to be the best alternative also considering that it is readily accessible (Culpepper, 2014). In the past treatment therapy, the patient happened to default lithium. Therefore, it wouldn’t be a smart option to start lithium 300mg since the chances of the patient not adhering to treatment are high. Similarly, Seroquel XR could be a good alternative. However, its side effects of constipation and weight addition might contribute to non-compliance thus not achieving the therapeutic goals (John & Antai-Otong, 2016). This leaves Risperdal as the best option in this case. Assessing and Treating Clients with With Bipolar Disorder Essay.
Expected Outcomes
Within four weeks on treatment, the patient is expected to show immense progress. The current manifestations of bipolar disorder that she experiences are also expected to diminish to an extent that the patient has a peaceful state of mind. The patient should be restful and be able to conduct her activities of daily life with little or no difficulty (John & Antai-Otong, 2016) Risperdal is the best choice to influence mental action and improve the patient’s capacity to be of rational sound mind in the way she addresses issues. It is also expected that the patient’s self-destructive practices and tension would diminish and will respond to her environment and social interactions positively (Fang, et al., 2017).
Difference between Expected Outcomes and Actual Outcomes
After four weeks, the client returned to the clinic accompanied by her mother looking very lethargic and sedated. They, however, agreed that the patient’s self-destructive practices had significantly diminished. The client’s mother explained that the client had been lethargic for about a week after the last visit. Assessing and Treating Clients with With Bipolar Disorder Essay. It should be noted that one of the side effects of Risperdal is sedation (John & Antai-Otong, 2016) Similarly, based on the fact that the client is reportedly positive for CYP2D6*10 allele, it is probable that she might be having a slow rate of clearance of Risperdal from her systems leading to higher levels than normal of Risperdal in blood (Chen et al., 2015). Assessing and Treating Clients with With Bipolar Disorder Essay.
Decision #2
Selected Decision
Based on the client’s presentation and the initial decision, the second best decision, in this case, would be reducing Risperdal to 1mg HS.
Reason for Selecting This Decision
Based on the patient’s progress during the second visit, it was evident that Risperdal was effective in attaining therapeutic goals of treatment. However, the unwanted side effects were the major concerns. It is therefore wise to decrease the dosing to deal with the side effects rather than change to another drug. Decreasing the dosage to one mg HS would be the best alternative that will help to reduce the significant impact of the side effects (Culpepper, 2014). Assessing and Treating Clients with With Bipolar Disorder Essay. Changing the drug to lithium will possibly result in non-compliance since the client has already developed some demeanor towards it. Besides, the patient may turn out to generally have a negative attitude towards all medicines which may be prescribed by the mental health practitioner. Giving the patient support to adapt to an alternate dosage of the same medication will also improve their dedication, trust, and understanding to collaborate in achieving the treatment goals (John & Antai-Otong, 2016).
Expected Outcomes
As earlier stated, Risperdal has proven to be effective in managing the symptoms of bipolar disorder by influencing a balance in serotonin and dopamine to help address a patient’s self-destructive behaviors. Based on the fact that the client is positive for CYP2D6*10 allele, the initial dosage could have resulted in an accumulation of Risperdal which is slowly being cleared (John & Antai-Otong, 2016). Assessing and Treating Clients with With Bipolar Disorder Essay. Reducing the dosage to one mg HS will definitely reduce the amount of Risperdal accumulated in the body and subsequent side effects of lethargy and sedation. By adjusting this dosage, it is expected that the patient
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