Bipolar disorder is a chronic disorder that manifests with recurring episodes of mania that alternate with episodes of profound depression. Patients with Bipolar present with a wide-range of mood symptoms, like depression, irritability, anxiety, fatigue, sleeping disturbances, and reduced ability to focus and concentrate (Jauhar & Young, 2019). The purpose of this paper is to outline the treatment interventions for a patient with Bipolar disorder and identify ethical considerations that will influence treatment and communication.
Introduction to the Case
The case study is about a 26-year-old female of Korean origin on her initial appointment after being hospitalized for 21 days due to bipolar I disorder. The patient is busy in the office, plays with items on the desk, and fidgets on the chair. She does not consider she has Bipolar since she just enjoys talking, dancing, singing, and cookimg. Her self-reported mood is “fantastic .”However, she states that she hates sleeping because it is not fun, and this results in sleeping roughly fives hour per night. The patient’s hospital records show that she has been having a medical workup, which showed that she is in overall good health. In addition, all lab results were within the normal range. A GeneSight testing was conducted and revealed that she the patient has CYP2D6*10 allele.
The patient admits to failing to comply with Lithium treatment after getting discharged. On mental status exam (MSE), the client is alert, oriented, strangely dressed, and her speech is fast, pressured, and tangential. She has a euthymic mood, broad affect, and intact judgment. The patient has no apparent hallucinations, paranoid thoughts, delusions, or suicidal/homicidal ideations. However, insight is impaired. She scores 22 on the Young Mania Rating Scale (YMRS).
Patient factors that may affect decision-making when prescribing treatment include the previous medications used to treat Bipolar in the patient, response to these medications, and side effects associated with the past medications. Besides, the patient’s comorbidities, the severity of Bipolar symptoms, and treatment preferences will be considered when determining the appropriate medication.
Decision #1
Begin Lithium 300 mg PO BD.
Why This Decision Was Selected
Lithium was the ideal choice since it is the recommended medication in classical mania. It is recommended as the first-line monotherapy for Bipolar, and it delays the relapse of patients to any mood episode (Atagün & Oral, 2021). McKnight et al. (2019) found Lithium effective in treating acute mania and more effective than a placebo or anti‐epileptic drugs.
Why the Other Two Options Were Not Selected
Risperdal was not selected because it is contraindicated in individuals with the CYP2D6*10 allele. Cui et al. (2020) found that patients with positive CYP2D6*10 allele tend to have a low metabolism rate for Risperdal. This results in increased levels of the drug in the serum, causing increased sedation, which increases the patient’s risk of non-compliance. Seroquel was also not selected because of its associated side effects like hypertension and weight gain, which can worsen the patient’s condition. Jauhar and Young (2019) found that Seroquel has high rate of hypertension and 15% weight gain than Lithium.
What I Was Hoping To Achieve With This Decision
The PMHNP hoped that prescribing Lithium would alleviate and lower the severity of the manic symptoms within four weeks after beginning treatment. Lithium is the gold standard in achieving a high quality of life for patients, enabling them to participate in social activities, and preventing long-term disability (Volkmann et al., 2020). Kessing et al. (2018) established that lithium monotherapy is superior to monotherapy using other maintenance mood stabilizers.
Ethical Considerations
The ethical principle of beneficence may affect the treatment plan since the clinician must identify and prescribe the drug found to promote better outcomes in Bipolar. For example, Lithium was prescribed because evidence shows that it is superior in alleviating Bipolar symptoms. Besides, the patient’s right to autonomy may impact communication since the clinician must seek consent before starting treatment. For this case, the PMHNP obtained consent from the patient to initiate Lithium therapy.
Decision #2
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