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An Asian American Woman With Bipolar Disorder Case Study.An Asian American Woman With Bipolar Disorder Case Study.The AssignmentExamine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.At each decision point stop to complete the following:Decision #1Which decision did you select?Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?ORDER A PLAGIARISM-FREE PAPER HEREAn Asian American Woman With Bipolar Disorder Case Study.Decision #2Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?Decision #3Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?Also include how ethical considerations might impact your treatment plan and communication with clients.Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).An Asian American Woman With Bipolar Disorder Case Study.2. Write paper addressing all section listed based on the decision tree.Case Study: Bipolar Therapy for Client of Korean Descent/Ancestry:BACKGROUND INFORMATIONThe client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.Upon arrival in your office, she is quite ”busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that ”they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”She weight 110 lbs. and is 5’ 5”SUBJECTIVEPatient reports ”fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds ”I hate sleep, it’s no fun.”You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.An Asian American Woman With Bipolar Disorder Case Study.Genetic testing reveals that she is positive for CYP2D6*10 allele.Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.MENTAL STATUS EXAMThe patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.The Young Mania Rating Scale (YMRS) score is 22An Asian American Woman With Bipolar Disorder Case Study.RESOURCES§ Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype & affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype & activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6Decisions Made and Outcomes (Needed to formulate the paper)Choices for Decision 1: Select what the PMHNP should do: Begin Lithium 300 mg orally BID, Begin Risperdal 1 mg orally BID, or Begin Seroquel XR 100 mg orally at HS.My decision: I chose to begin Lithium 300 mg orally BID.Outcome: RESULTS OF DECISION POINT ONE: Client returns to clinic in four weeksClient informs the PMHNP that she has been taking her drug ”off and on” only when she ”feels like she needs it”Today’s presentation is similar to the first day you met herAn Asian American Woman With Bipolar Disorder Case Study.Choices for Decision 2: Select what the PMHNP should do:Increase Lithium to 450 mg orally BID, Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology, or Switch to Depakote ER 500 mg orally at HS.My decision: I chose to switch to Depakote ER 500 mg orally at HS.Outcome: RESULTS OF DECISION POINT TWO: Client returns to clinic in four weeksClient reports that she has been compliant and you notice a marked reduction in manic symptoms. Young Mania Rating Scale was 11 (50% reduction from first office visit)Client reports that she has gained 6 pounds over the last 4 weeks and wants to stop the medication because of this Client returns to clinic in four weeksAn Asian American Woman With Bipolar Disorder Case Study.Choices for Decision 3: Decision Point Three Select what the PMHNP should do next: Educate client regarding diet/weight loss and continue client on the same drug/dose, Decrease Depakote ER to 250 mg orally at HS, or Switch medication to Zyprexa 15 mg orally daily at HSMy decision: I choose to educate client regarding diet/weight loss and continue client on the same drug/doseOutcome: Guidance to StudentThe 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 significant weight gain (up to 20 kg over a 24 month period).***Write on each decision. Make sure that this paper has at least 5 References. Please use in-text citations. Don’t forget the ethical considerations for this assignment. Make it a section by itself.***An Asian American Woman With Bipolar Disorder Case Study.Assessing and Treating Clients with With Bipolar DisorderACTUAL ASSIGNMENTPLEASE Addressed each of the following numbers with a subtopic, all the references used must have an in-text citation in each paragraph. All Articles used should come from USA and must be within last five years only that is from 2014 to 2018. Please do not begin a paragraph with author name(s) (PLEASE USE parenthetical/in-text citations)Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for clients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) clients often present as depressive or manic, but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with bipolar disorder.An Asian American Woman With Bipolar Disorder Case Study.Learning ObjectivesStudents will:Assess client factors and history to develop personalized plans of bipolar therapy for clientsAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapyEvaluate efficacy of treatment plansAnalyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespanLearning ResourcesNote: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.Required ReadingsNote: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.An Asian American Woman With Bipolar Disorder Case Study.Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.Chapter 6, “Mood Disorders”Chapter 8, “Mood Stabilizers”Stahl, S. M., & Ball, S. (2009b). Stahl’s illustrated mood stabilizers. New York, NY: Cambridge University Press.To access the following chapters, click on the Illustrated Guides tab and then the Mood Stabilizers tab.Chapter 4, “Lithium and Various Anticonvulsants as Mood Stabilizers for Bipolar Disorder”Chapter 5, “Atypical Antipsychotics as Mood Stabilizers for Bipolar Disorder”Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-0060-3Note: Retrieved from Walden Library databases.An Asian American Woman With Bipolar Disorder Case Study.Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6Note: Retrieved from Walden Library databases.Required MediaLaureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author Note: This case study will serve as the foundation for this week’s Assignment. Optional ResourcesMostafavi, A., Solhi, M., Mohammadi, M., Hamedi, M., Keshavarzi, M., & Akhondzadeh, S. (2014). Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Acta Medica Iranica, 52(10), 734-739.Retrieved from http://acta.tums.ac.ir/index.php/actaAn Asian American Woman With Bipolar Disorder Case Study.To prepare for this Assignment:Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy. Assessing and Treating Clients with Bipolar DisorderStudent’s NameInstitutional Affiliation Assessing and Treating Clients with Bipolar DisorderBipolar disorder (BD) isa chronicrecurrent mental health problem associated with high co morbidities that lead to poor health outcome and lower quality of life .It presents with episodes of mania, hypomania, and depression alternating with normal mood (euthymia).Also, it has high genetic predisposition and significantly affects patients, their family, and community. Effective management of BD requires that the PMHN understands the condition, its acute/immediate, maintenance and long term treatment. Management of acute episodes aims at symptom reduction and thereafter full remission. Maintenance therapy aims at preventing the recurrences. Assessment of bipolar patient is done to help choose treatment that is effective and safe(McCormick, U., Murray, B., &McNew, B., 2015).Mood stabilizers are the drugs of choice in the treatment of BD.In addition, psychotherapy is done for these patient and electroconvulsive therapy for severe depressive episodes.Ongoing assessment and follow up is important to monitor response to treatment, significant side effects, drug adherence, and other health related needs(Janusz K ,2017). The paper examines a case of 26-year-old woman of Korean descent with bipolar disorder 1and her medication prescription options. The treatment decision and outcome is carefully considered for proper management of this patient. Factors likely to affect the pharmacokinetic and pharmaco-dynamic processes are considered.An Asian American Woman With Bipolar Disorder Case Study.Late-life depression is a serious illness accompanied by medical morbidity, cognitive decline, and risk of suicide. Antidepressant medications are a cornerstone of treatment for depressed elders. Although they are optimally provided in conjunction with psychotherapy, in many cases they are used alone. In recent years concerns have developed about modern antidepressant medications, including concerns about their ultimate efficacy and particular risks that may be seen in older adult populations. Ultimately antidepressant medications are effective for many individuals and continue to play an important role in treating depressed elders, although the potential risks must be weighed with the patient and their families. An Asian American Woman With Bipolar Disorder Case Study.Current data do not support restriction of their use and untreated depression has serious negative health consequences. Our patients need treatments with better efficacy and safety, including new pharmacological options and better access to and dissemination of nonpharmacological treatment.Keywords: Depressive disorder, aging, geriatrics, antidepressant, adverse events, side effects, suicide, treatment, psychotropic medicationsDecision Point OneSelected DecisionBegin with lithium 300 mg orally BID.Reason for SelectionLithium is an effective prototype mood-stabilizer consideredspecifically in the treatment of BD. Research confirms that lithium has anti-suicidal, immune modulatory, and neuro-protective properties (Severus E, Taylor MJ, Sauer C, et al., 2014). Risperdal and seroquel are atypical antipsychotics drugs used in management of schizophrenia and bipolar disorder. They are not considered as the first line treatment of BD. Therefore, lithium 300mg orally BID is the best option for this patient.An Asian American Woman With Bipolar Disorder Case Study.Expected ResultsLithium is used in first line treatment for acute mania and prevention ofrecurrent BD episodes.The full clinical effects of lithium are felt after a few weeks when lithium plasma level is maintained between 0.6 and 1.0mmol/L. The patient was expected to have some improvements in the symptoms such as less pressured speech, normal mood, and normal sleeps patterns and improved insight (Severus E, Taylor MJ, Sauer C, et al., 2014).A less than 22 YMS score was expected with the use of lithium 300mg.An Asian American Woman With Bipolar Disorder Case Study.Differences between Expected Results and Actual ResultsFull clinical effects can be achieved when the patient complies with the medication and theplasma lithium levels in the body is kept at a constant levelof 0.6 and 1.0mmol/L. The patient returned after four week and reported that she had been taking medication off and on and when she feels like. This noncompliance could have been the reasons for the patient presenting with the initial features. Also, lithium has a narrow therapeutic index, increased risks for new manic or depressive episodes and significant side effects and a. These factors could have limited the clinical effectiveness of lithium in the patient(Janusz K, 2017). In lithium non response and dose related side effects, it’s recommended to reduce the dose or change to other medications (ShahN., GroverS., &Rao G. P., 2017). Non drug adherence greatly contributes to BD poor treatment outcome. Assessing reasons for non compliance and educating the patient on drug effects and pharmacology is important. However, since the patient is still in acute phase, has been on lithium for long and non-compliant, change of drug is required.An Asian American Woman With Bipolar Disorder Case Study.Decision Point TwoSelected DecisionChange to depakote ER 500mg orally at HS.Reason for SelectionDepakote (valproic acid) is efficacious in the management acute mania and mixed BD episodes. Despite not being robust in acute management compared to lithium,it is useful in maintenance phases for prevention of mania and depression (ShahN., GroverS., &RaoG. P., 2017). Genetic testing reveals that she is positive for CYP2D6*10 allele indicating that the body can metabolize and tolerate various drugs.An Asian American Woman With Bipolar Disorder Case Study.Expected ResultsThe patient had expected results.Depakene is efficacious in treatment acute mania phases and as a maintenance therapy .Its associated with less side effects compared to lithium, thus has less chances of non-adherence (ShahN., Grover, S., &RaoG. P., 2017).She reported compliance to the medication and marked reductions in the manic symptoms .The Young Mania Rating scale score was 11 indicating a 50% reduction.. Patient compliance to medication will improve.Differences between Expected Results and Actual ResultsDespite great improvements of the patient due to depakote, she reports a 6 pounds increase in weight over the last four weeks. This is undesired effect though expected. Dapakote is associated with weight gain and other metabolic abnormalities (Shah N., GroverS., &Rao G. P., 2017)An Asian American Woman With Bipolar Disorder Case Study.Decision Point ThreeSelected DecisionEducate the patient of side effects of depakote such as weight gain, importance of dietary changes and physical exercises, and continue with the same drug dosage.Reason for SelectionThis is a better decision because decreasing the depakote dosage to 250 mg may make the patient relapse into the initial acute mania phase. Usually dapakote is started in low doses of 250 mg BD and increased upwards to achieve the full clinical effects. Dietary restrictions are recommended for increase appetite and weight gain(ShahN., GroverS., &Rao G. P., 2017).Though decreasing the dosage may result to weight reduction. Zyrexa (olanzapine)is atypical antipsychotic. Changing the class of drug is not appropriate at this stage and at the same time, zyrexa may lead to significant weight gain.Weight gain is a serious and common side effect of mood stabilizers like depakote and lithium. It has been associated with non-compliance to medication and treatment cessation (McCormick U., MurrayB., &McNew B., 2015). Educating the patient on dietary changes and regular physical exercises is vital in weight reduction. Regular monitoring of lipid profile, blood glucose and anthropometric measurements is required (Shah N., Grover S., &RaoG. P., 2017).An Asian American Woman With Bipolar Disorder Case Study.Expected ResultsDietary changes and regular physical exercises while taking depakote helps in weight reduction. Therefore, the patient will have remission of manic symptoms due to continued use of depakene.YMR scale score is expected to reduce further to less than 11. Also, the patient is expected to reduce her weight back to normal.This will also help her achieve normal BMI range of 18.5 to 25. An Asian American Woman With Bipolar Disorder Case Study.Differences between Expected Results and Actual ResultsMaintaining depakote dosage and employing weight reduction strategies –dietary changes and regular physical exercises- will likely lead to remission of manic symptom and weight reduction respectively(Shah N., GroverS., &RaoG. P., 2017).Impact of Ethical Considerations on Treatment PlanThe purpose of treatment of BD is to do good to the patient and avoid harm thus PMHN seeks to help the patients get well. Bipolar medications have side effects. Therefore,the PMHN should carefully assess the patient and choose medications which are effective and safe. Also, the cognitive functioning of bipolar patient is usually affected. This makes the patient unable to provide informed consent to treatment posing the ethical and moral issue of forced treatment. The PMHN has the responsibility of providing information on treatment options, their indications and side effects information to improve the decision making ability and voluntarism of the patient (Gutheil TG, 2015). Also educating and involving the family members and caregiver at the initial of treatmenthelps establish trust and get informed consent dialogue with them in cases where the patient is unable to consent. Adoption of medication plan involves a complete thorough assessment of the patient to come up with evidence based efficacious and safe treatment options. The treatment plan for BDshould be closely monitored for effectiveness and any adverse effects and patientfollow up done regularly.An Asian American Woman With Bipolar Disorder Case Study.ConclusionBipolar disorder is a common debilitatingmental problem associated with substantial patient, and community burden. Accurate identification acute mania, hypomania, and depressive or mixed phases is essential in deciding the treatment options. Various pharmacological treatments are used for acute and maintenance management. Mood stabilizers are used as first line treatment of BD. Non pharmacological approaches such as ECT in depressive episodes and psychotherapy are used in the management of BD. Careful assessment of the individual patient is necessarily to help make decisions on the efficacious and safe treatment.Also, decision on dose increase or reduction, change of drug antidepressants should be made carefully to prevent relapseand treatment failures.An Asian American Woman With Bipolar Disorder Case Study. ReferencesGutheil TG.(2015). Ethical Issues in Psychopharmacology. Session presented at the U.S. Psychiatric and Mental Health Congress; San Diego, CA.An Asian American Woman With Bipolar Disorder Case Study.Rybakowski, J. K. (2017). Recent advances in the understanding and management of bipolar disorder in adults. F1000Research, 6, 2033.http://doi.org/10.12688/f1000research.12329.1McCormick, U., Murray, B., &McNew, B. (2015). Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses. Journal of the American Association of Nurse Practitioners, 27(9), 530–542. http://doi.org/10.1002/2327-6924.12275Severus E, Taylor MJ, Sauer C, et al. (2014). Lithium for prevention of mood episodes in bipolar disorders: systematic review and meta-analysis. Int J Bipolar Disord. 2014;2:15. 10.1186/s40345-014-0015-8[PMC free article] [PubMed] [Cross Ref] F1000 RecommendationShah, N., Grover, S., &Rao, G. P. (2017).Clinical Practice Guidelines for Management of Bipolar Disorder. Indian Journal of Psychiatry, 59(Suppl 1), S51–S66.http://doi.org/10.4103/0019-5545.196974An Asian American Woman With Bipolar Disorder Case Study.
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