Bipolar disorder is a mental health condition characterized by mood swings. It is a lifelong condition, but its symptoms can be managed using a suitable treatment plan. From the case presented, the client is a Korean descent lady aged 26 years, and she is 5′ 5″ high and weighs 110 lbs. She was diagnosed with bipolar I disorder; however, physically, she seems so talkative and unsettled because she shifts from one side of the chair to another while playing with various things on the desk. Her diagnostic reports indicate she sleeps for around five hours a night. Besides, her lab tests were all within normal limits; however, the GeneSight test indicates that she is CYP2D6*10 alleles positive. Also, her speech is tangential, rapid and pressured with a euthymic mood and no paranoid thoughts, auditory or visual hallucinations. Besides, the report indicates that the insight is impaired, but the judgment is sketchily intact. The patient had a score of 22 on the YMRS (Young Mania Rating Scale).

The purpose of the paper is to select the appropriate and effective pharmacotherapy that will improve the patient’s sleeping patterns and minimize her rate of speech. The client says that she hates to sleep, and sleeping is not fun. The treatment aims to improve her bipolar I symptoms within approximately three months, and its effectiveness will be measured after every two weeks. Further, I intend to choose the pharmacotherapy option to reduce the client’s YMRS score from 22 to below 12.  A score of 22 means that the client is in a mild mania state while a score of below 12 means that the client will be in remission. 

Decision point one

I chose Seroquel XR 100 mg orally at HS because FDA approves it, and it is used in treating bipolar disorder’s manic highs and depressive lows. Besides, it is an approved option for long-term treatment, especially for bipolar I disorder. It is among the most frequently prescribed treatment option for bipolar individuals, and it can be used throughout the disorder’s phases. According to Muneer (2015), Seroquel XR is metabolized by the liver to a larger extent, and only 1% is passed out as urine. The drug’s efficacy in treating anxiety and mood disorders makes it a multifunctional psychoactive treatment. The drug is essential in facilitating serotonergic transmission because it has a high affinity for 5HT1A receptors. The drug is also effective in improving sleeping behaviors among bipolar individuals.

I did not choose the other two options because the client was not experiencing severe disorder symptoms. For instance, Lithium effectively minimizes suicide risks among patients with bipolar. According to the mental status exam report, my client was not experiencing homicidal or suicidal ideation. Volkmann et al. (2020) studies argue that Lithium acts on an individual’s nervous system, and in most cases, it takes a long period to start working. Risperdal, on the other hand, is effective in treating acute bipolar mania, and my client has not yet developed acute bipolar.

By making this decision, I hoped to achieve improved sleeping behavior and an improved Young Mania Rating Scale Score in my patient within the first two weeks of medication (Muneer, 2015). According to research, Seroquel has sedating characteristics, and its sedative effect can play a crucial role in improving or restoring the quality of sleep, especially among patients with bipolar disorder.

Decision point two

Indecision point two I chose to break off Seroquel treatment and introduced Geodon 40 mg orally BID. Besides, the treatment is administered with a 500-calorie meal. I chose this treatment option to address side effects that the client might experience, like weight gain and constipation. Besides, the client was in a good mood and requested a different medication. Weight gain is linked to the action of the medication on serotonin 5-HT2A, histamine H1 and dopamine D2 because of the affinity difference between them. The FDA declared Geodon in 2009 as daily bipolar maintenance therapy. According to research, Geodon results in weight loss and reduces the levels of serum lipids in the body (Dayabandara, 2017).

I did not choose to continue with the same dose of Seroquel because the side effects could be severe. Also, the client’s condition and her positive response to medication contributed to my decision not to consider continuing with this drug. Besides, long-term usage of Seroquel can lead to other complications such as movement disorder. Also, I did not choose to augment the treatment with Lithium 300mg taken orally because the combination of these two drugs can lead to heart problems such as congenital long QT syndrome despite being effective in treating bipolar I disorder (Liu et al., 2020). Besides, the patient will continue experiencing weight gain and constipation, making her think that I am not considerate to her state and concerns.

I was hoping that the side effects of the Seroquel drug would decrease, thus minimizing other additional complications on the client’s health. Besides, considering the patient’s opinion on how she wants to be treated will improve her experiences and quality care (Molina-Mula & Gallo-Estrada, 2020).

Decision point 3

I will continue with the same dose of Geodon and reassess the patient in 4 weeks. I chose this option because there is a need to further assess the client’s well-being after showing a positive response to the medicine. Geodon does play a crucial role in re-balancing serotonin and dopamine, improving the client’s thinking and behavior. Thus I should maintain the 40mg dose because it was tolerable and effective in stabilizing the client’s condition (Depression and Bipolar Support Alliance, 2021). Besides, I intend to achieve one of our aims: to decrease the patient’s YMRS score to below 12. A relatively prolonged medication can improve the severity and frequency of future mental crises in the client. Lastly, dosage maintenance is essential as it allows me to conduct periodical reassessment for therapy maintenance.

I did not choose to increase the Geodon dosage to 6omg with a 500 calorie meal because it might increase the chances of the patient developing side effects like nausea, drowsiness, dizziness and headache. Thus increasing the Geodon dosage can destabilize the client’s conditions. Also, I did not choose to augment Geodon with Lithium 300mg because the combination of the two drugs increases side effects like confusion, dizziness, concentration challenges and drowsiness. Besides, augmenting Geodon with Lithium is specifically recommendable for clients who do not respond to one mood stabilizer, especially people with residual psychotic symptoms (Dubovsky & Dubovsky, 2012).

By making this decision, I was hoping to achieve stabilization of the client’s bipolar I condition. It is because the primary goal of healthcare providers is to promote health, relieve suffering and pain and prevent diseases by providing care whenever possible to those in need (Hashim, 2019)

Ethical considerations

One of the primary ethical dilemmas that would arise when dealing with my client is the patient’s rights. For instance, from the case provided, the patient stopped taking her prescribed bipolar medicine immediately after being discharged from the hospital. Prescribing the same medicine again can lead to patient-doctor conflict because, ethically, healthcare providers should respect patient autonomy and decisions regarding care delivery. Thus differences in treatment options can be an ethical challenge. Another major ethical dilemma is dealing with opposite sex patients, especially when examining them. In some Asian countries, female patients usually like to be attended by female physicians and vice versa. Religious rules reinforce the challenge and ethics thus; it will be challenging when a male doctor deals with female patients from such regions.

Bipolar disorder is treated effectively by combining psychotherapy and medication. In most cases, bipolar patients take more than one prescribed drug, such as an antidepressant and a mood-stabilizing drug. No single cure has been developed to treat bipolar; thus, the disorder needs a lifetime treatment because its symptoms can appear and disappear. Physicians need to prescribe appropriate medicines based on their diagnosis and assessment to avoid further complications. Thus the paper has discussed various treatment decisions based on the ultimate goal that a healthcare provider strives to achieve. Decision point one discusses why I chose Seroquel XR for the patient, why I did not choose the other care options and the ultimate goal of that treatment. Decisions two and three were also addressed using the same trend. Lastly, the paper discussed some ethical considerations that I might face while handling the client, including patients’ rights and handling opposite-sex patients.

References

Dayabandara, M., Hanwella, R., Ratnatunga, S., Seneviratne, S., Suraweera, C., & de Silva, V. A. (2017). Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatric disease and treatment. https://dx.doi.org/10.2147%2FNDT.S113099

Depression and Bipolar Support Alliance. (2021). Wellness after Hospitalization. https://www.dbsalliance.org/crisis/understanding-hospitalization-for-mental-health/wellness-after-hospitalization/

Dubovsky, S. L., & Dubovsky, A. N. (2012). Maintenance treatment of bipolar disorder with ziprasidone in adjunctive use with lithium or valproate. Clinical Medicine Insights: Therapeutics, 4, CMT-S7369. https://doi.org/10.4137%2FCMT.S7369

Hashim, M. J. (2019). The Art of Healing–Core Values and Goals of Medicine, Nursing and Healthcare. J. Coll. Physicians Surg. Pak, 29(4), 299-300. https://www.cpsp.edu.pk/jcpsp.pk/archive/2019/Apr2019/01.pdf 

Liu, Y., Liang, J., Xia, Q., Zhou, X., & Xie, X. (2020). Effects of Lithium Combined with Second-Generation Antipsychotics for the Treatment of Manic Episodes in Patients with Bipolar Disorder: A Naturalistic Study in China. Neuropsychiatric Disease and Treatment, 16, 2623. https://dx.doi.org/10.2147%2FNDT.S270596

Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International journal of environmental research and public health, 17(3), 835. https://dx.doi.org/10.3390%2Fijerph17030835

Muneer, A. (2015). Pharmacotherapy of bipolar disorder with quetiapine: a recent literature review and an update. Clinical Psychopharmacology and Neuroscience, 13(1), 25. https://dx.doi.org/10.9758%2Fcpn.2015.13.1.25

Volkmann, C., Bschor, T. & Kohler, S. (2020). Lithium Treatment Over the Lifespan in Bipolar Disorders. https://doi.org/10.3389/fpsyt.2020.00377