Why This Decision Was Selected
The clinician chose this decision since the patient was non-compliant with medication, which can fail to achieve the desired treatment outcomes. It was crucial to evaluate the client’s reason for non-compliance, which puts patients at risk for exacerbation of symptoms and relapse, contributing to hospital visits and readmissions (Atagün & Oral, 2021). Loots et al. (2021) improve medication adherence and found that cognitive-behavioral therapy and psychoeducation enhance medication adherence in patients with bipolar disorders.
Why the Other Two Options Were Not Selected
Increasing Lithium to 450 mg was not ideal because it was prudent to identify and solve the issues causing non-compliance before increasing the dose. Loots et al. (2021) found that approximately 25% of Bipolar patients discontinue their treatment within the first week after discharge, which causes worsening symptoms and relapse. The decision to change therapy to Depakote was not also selected because it should only be prescribed when Lithium is unresponsive or the patient is resistant to treatment (Atagün & Oral, 2021).
What I Was Hoping To Achieve With This Decision
The clinician hoped that identifying the patient’s causes for non-compliance would help to increase treatment adherence by educating the patient on Lithium’s effects and pharmacology (Volkmann et al., 2020). Loots et al. (2021) found increased adherence to treatment in patients in a psychoeducation group after being educated on the impact of treatment.
Ethical Considerations
Ethical factors of nonmaleficence and confidentiality may impact treatment and communication with patients. The PMHNP upheld nonmaleficence by selecting a treatment decision with the least adverse effects to avoid causing harm to the patient. Besides, confidentiality impacted communication since the PMHNP had to assure the patient that her medical information would not be shared with a third party without her consent.
Decision #3
Switch Lithium to sustained-release formulation but the same dose and frequency.
Why This Decision Was Selected
Changing Lithium to sustained release was driven by the patent’s complaint of nausea and diarrhea associated with the initial Lithium formulation. Barbuti et al. (2021) found that fine tremors and GI symptoms occurred more frequently in patients on immediate-release Lithium than in prolonged-release patients. Thus, switching to sustained-release lithium therapy can present advantages over the previous immediate-release formulation (Kessing et al., 2018).
Why the Other Two Options Were Not Selected
The decision to change to Depakote was not selected since Lithium was not unsuccessful in alleviating the patient’s Bipolar symptoms. According to Atagün and Oral (2021), Depakote is associated with adverse side effects like hepatotoxicity and increased serum ammonia levels. Trileptal was not also selected because it is recommended as second-line therapy when first-line medications are ineffective (Jauhar & Young, 2019).
What I Was Hoping To Achieve With This Decision
The clinician hoped that switching Lithium from immediate-release to sustained-release would reduce the GI side effects. Barbuti et al. (2021) found that GI side effects were prevalent in patients on immediate-release compared to prolonged release. Therefore, changing to sustained release is expected to alleviate nausea and diarrhea (Kessing et al., 2018).
Ethical Considerations
Ethical principles of nonmaleficence and informed consent may impact treatment plan and communication. This is because the clinician must make decisions that will not harm the patient through adverse effects. For instance, the clinical changed the Lithium formulation to increase patient safety by minimizing side effects. Also, the PMHNP obtained consent from the patient before initiating treatment with a new formulation, which affected communication.
Conclusion
The factors that may influence treatment decisions for a patient with Bipolar disorder include the previous treatments, previous response to treatment, associated side effects, patient’s comorbidities, the severity of Bipolar symptoms, and treatment preferences. The patient was started on Lithium 300 mg orally BD because it is recommended as a first-line agent in treating Bipolar disorder (Atagün & Oral, 2021). Risperdal was inappropriate for this patient because it is contraindicated in patients positive for the CYP2D6*10 allele due to slow metabolism that causes high serum drug levels and sedation
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