Assignment: Assessing and Treating Patients With Bipolar Disorder

12/19/21, 5:08 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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Bipolar Therapy Client of Korean Descent/Ancestry

Decision Point One

Begin Lithium 300 mg orally BID

RESULTS OF DECISION POINT ONE � Client returns to clinic in four weeks

� Client informs the PMHNP that she has been taking her drug “o� and on” only when she “feels like she needs it”

� Today’s presentation is similar to the �rst day you met her

12/19/21, 5:08 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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Decision Point Two

Switch to Depakote ER 500 mg orally at HS

RESULTS OF DECISION POINT TWO � Client returns to clinic in four weeks

� Client reports that she has been compliant and you notice a marked reduction in manic symptoms. Young Mania Rating Scale was 11 (50% reduction from �rst o�ce visit)

� Client reports that she has gained 6 pounds over the last 4 weeks and wants to stop the medication because of this

Decision Point Three

Educate client regarding diet/weight loss and continue client on

the same drug/dose

12/19/21, 5:08 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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Guidance to Student

The PMHNP should begin by educating the client regarding weight

loss/and importance of diet/exercise while taking Depakote which

can cause weight gain. Decreasing the dose of Depakote would not

be appropriate as she still has symptoms and decreasing dose of

Depakote may result in some weight loss, it may result in a return

of manic symptoms. The PMHNP can switch to Zyprexa but if

weight gain is the issue, then this will be compounded by Zyprexa

which is associated with signi�cant weight gain (up to 20 kg over a

24 month period).

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