Bipolar Disorder
Decision Making When Treating Psychological Disorders
Bipolar disorder also known as manic depression is a mental disorder characterized by
wide mood swings from high (manic) to low (depressed). Periods of high or irritable mood are
called manic episodes. The person becomes very active, but in a scattered and unproductive way,
sometimes with painful or embarrassing consequences. A person in a manic state is full of energy
or very irritable, may sleep far less than normal, and may dream up grand plans that could never
be carried out (American Psychiatric Association, 2013). Bipolar disorder is divided into two
subtypes; bipolar I and bipolar II based on the symptoms of mania and hypomania presented. In
bipolar I disorder, a client presents at least one manic episode in bipolar II, the client reports at
least one hypomanic symptoms and at least one period of significant depression (American
Psychiatric Association, 2013). Therefore, this discussion will explore a case of a 26-year-old
woman of Korean descent presenting with symptoms of bipolar I disorder
Summary of the Case study
The client is a 26-year old Korean woman with an history of 21 day hospitalization for
acute mania. The client appears quite “busy” playing with thing at the office, and shifting from
side to side on her chair. She says she likes to talk and dance and reports a “fantastic mood. She
adds that she hate sleep and sleeps about 5 hour/night. Genetic testing reveals that the client is
positive for CYP2D6*10 allele. She was on lithium but she stopped two weeks ago. The Young
Mania Rating Scale (YMRS) score is 22 (Laureate Education, 2016f).
Decision Steps Selected For Treatment Plan
The firs decision point selected was to prescribe the client with lithium 300 mg orally
BID. Lithium been a mood stabilizer is considered as a first line treatment for bipolar disorder.
Based on the client’s medication history, she was previously on lithium which she stopped after
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she came out of the hospital. The medication was used to alleviate the symptoms during her
hospitalization and when she stopped she started experiencing the relapse of the symptoms. I did
not select Risperidone (Risperdal) is because, patient was tested positive for CYP2D6*10 allele.
As a result, the client may demonstrate slower clearance of Risperdal from her system, resulting
to higher than normal levels of Risperdal in the blood and causing sedation. This could be why
the patient received the genetic testing to ensure if she has the presence of this allele On the other
hand, Quetiapine (Seroquel) was not selected because of its side effects such as constipation,
stomach update, blurred vision, and dry mouth.
The second decision was to assess rationale for non-compliance to elicit reason for non-
compliance and education client on drug effects and pharmacology. Non-compliance can
produce severe implications such as recurrence and relapse of the illness. The most commonly
reported reasons for drug non-compliance in patients with Bipolar disorder include negative
attitudes towards the illness, manic symptoms, and substance abuse (Azadforouz et al., 2017).
The other two options were not selected because increasing lithium to 450mg would increase the
risk of non-compliance because of the increased side effects such as increased lithium toxicity in
the blood (Azadforouz et al., 2017). On the other hand, Depakote ER 500 is associated with side
effects such as increased weight.
The last decision was to change lithium to a sustained release preparation at same dose
and frequency. Since the client reported nausea and diarrhea as a result of the immediate release
of lithium it was important to change the formulation to sustained release. The sustained release
of lithium is associated with lower incidences of side effects as compared to the immediate
release (Gitlin, 2016). Depakote and Trileptal are second line treatment medicationma not
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appropriate for acute treatment phase until the patient has not had an adequate trial of the first-
line pharmacological agents such as lithium (Gitlin, 2016)
Impact of the Administration on the Patient’s Pathophysiology
Since the client exhibited symptoms of Bipolar I disorder including mania, insomnia, and
hyperactivity, lithium 300 mg orally would be the best option for the client. The mechanism of
action of lithium involves stabilizing the mood and reducing extremes in behaviors through
restorations of the neurotransmitters in the brain. Clinical studies have shown that lithium works
by altering the sodium transport in the muscle and nerve cells, leading to stabilization of the
moods (Girardi et al., 2016). Notably, a condition such as bipolar requires long-term treatments
and the patient should not stop taking lithium, even when she feels better. Lithium works by
reducing feelings of euphoria, hyperactivity, and other symptoms in patients with mania
episodes, without causing sedation.
How might these potential impacts inform how you would suggest treatment plans
for this patient?
Lithium is a first-line medication and the best choice for treating clients with Bipolar
disorder. The drug therapy is essential in assisting people to control their manic episode and is
also used as a long-term prophylaxis for preventing recurrence of mania. Mood stabilizers have
proven efficacy in relieving bipolar symptoms, preventing recurrence of the symptoms during
manic and depressive episodes, and preventing acceleration of the symptoms (Girardi et al.,
2016) This evidence makes lithium the best option to consider in future drug therapies for
patients presenting symptoms of bipolar
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author
Azadforouz, S., Shabani, A., Nohesara, S., & Ahmadzad-Asl, M. (2016). Non-Compliance and
Related Factors in Patients With Bipolar I Disorder: A Six Month Follow-Up
Study. Iranian journal of psychiatry and behavioral sciences, 10(2), e2448.
https://doi.org/10.17795/ijpbs-2448
Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder
[Interactive media file]. Baltimore, MD: Author
Girardi, P., Brugnoli, R., Manfredi, G., & Sani, G. (2016). Lithium in Bipolar Disorder:
Optimizing Therapy Using Prolonged-Release Formulations. Drugs in R&D, 16(4), 293–
302. https://doi.org/10.1007/s40268-016-0139-7
Gitlin, M. (2016). Lithium side effects and toxicity: prevalence and management strategies.
International journal of bipolar disorders, 4(1), 27. https://doi.org/10.1186/s40345-016-
0068-y
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