Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. RUBRICS 1)Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. 2)Decision #1 (1 page) Which decision did you select?

sychopharmaclogic Treatment of a 26 Year-Old Woman of Korean Descent Diagnosed with Bipolar I Disorder

Bipolar I disorder is a neuropsychiatric condition that belongs to the diagnostic category known as ‘Bipolar and Related Disorders’. This is found in the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The other disorders in this diagnostic category include cyclothymic disorder and bipolar II disorder (Sadock et al., 2015; APA, 2013). The symptomatology of bipolar I disorder falls between that of depressive disorders and schizophrenia spectrum disorders and other psychotic disorders. As per the American Nurses Association or ANA standards of practice, bipolar I disorder is a condition that can be managed by the psychiatric-mental health nurse practitioner or PMHNP through assessment, prescription, therapy, and follow up (ANA, 2014). This paper is about the decision on psychopharmacologic management of a 26 year-old woman of Korean descent with a diagnosis of bipolar I disorder and a problem of non-compliance to treatment.Psychopharmaclogic Treatment of a 26 Year-Old Woman of Korean Descent Diagnosed with Bipolar I Disorder

Background

This 26 year-old woman is of Korean ancestry and just presented herself for her first follow-up visit after 21 days of hospitalization. She had been diagnosed with bipolar I disorder after presenting with acute mania. Objective observation in the office by the PMHNP revealed that she was hyperactive, talkative, and elated. Subjectively, she reported feeling ‘fantastic’ and admitted to insomnia. Laboratory tests and physical evaluation indicated that she was in good health with no underlying physical/ medical condition that could explain her symptoms. Psychopharmaclogic Treatment of a 26 Year-Old Woman of Korean Descent Diagnosed with Bipolar I DisorderGene testing had revealed that the client was positive for the CYP2D6*10 allele. This is the gene responsible for the translation of the cytochrome P450 isoenzyme 2D6 that metabolizes risperidone. In Asians, there is a pair of the gene that shows decreased function. For this reason, Asians (such as the client who has Korean ancestry) are susceptible to having higher plasma levels of risperidone even after therapeutic dose administration. This means that they are at risk of developing serious adverse effects of the drug such as sustained sedation (Dean, 2017).Psychopharmaclogic Treatment of a 26 Year-Old Woman of Korean Descent Diagnosed with Bipolar I Disorder

On discharge from the hospital, the client had been put on lithium. However, she was showing early signs of non-compliance to treatment as she claimed during this first follow-up visit that she had stopped taking the medication. It was now two weeks since she decided to stop taking the lithium. Her mental status examination is reflective of bipolar I disorder, with euthymic mood, rapid and tangential speech, inappropriate grooming, intact judgement and impaired insight. She denied homicidal or suicidal ideation during this visit. Psychopharmaclogic Treatment of a 26 Year-Old Woman of Korean Descent Diagnosed with Bipolar I DisorderThe PMHNP assessed the level of severity of her mania using the Young Mania Rating Scale or YMRS. She scored a baseline of 22 points which meant that she was having mild mania (Mohammadi et al., 2018; Clinicaltrials.gov, 2012). On this scale, scores range from 0 to 60. The higher the score, the more severe the mania and the lower it is the higher the likelihood of remission. Actual remission is shown by scores less of than 12, mild mania is 20-25 points, moderate mania 26-37 points, and severe mania 38-60 points (Mohammadi et al., 2018; Clinicaltrials.gov, 2012). The subsequent YMRS scores would be compared to the baseline score of 22 points to determine remission or otherwise. A decrease from this baseline would indicate an improvement in the symptoms of mania in the client.Psychopharmaclogic Treatment of a 26 Year-Old Woman of Korean Descent Diagnosed with Bipolar I Disorder

Decision Point 1: The Choice of Psychopharmacologic Agent

When it came to deciding on the best drug that would be prescribed for the client to reduce her manic symptoms, the decision was made to begin her post discharge on lithium (Eskalith) 300 mg orally twice daily. The reason why this decision was selected was that lithium is FDA-approved for the treatment of mania (Stahl, 2017). Available evidence-based practice (EBP) indicators also show that lithium has a higher chance of controlling the mania and also reduces the risk of suicidality substantially (Stahl, 2017; Stahl, 2013). The reasons as to why the other two options were not selected are also informed by evide

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