Assessing and Treating Patients with Bipolar Disorder Case Study

Walden University NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology Photo Credit: Getty Images/iStockphoto Week 5: Therapy for Patients With Bipolar Disorders Marcus, an 18-year-old high school senior, presents with symptoms of difficulty sleeping and feeling sad, which result in an initial diagnosis of depression. His mother later reports, however, that Marcus exhibits symptoms of irritability and risk-taking behaviors. (His little brother reported to his mother that they were driving over 90 miles an hour on the highway.) After further evaluation, Marcus’ psychiatric nurse practitioner diagnoses him with bipolar disorder. Cases like this are not uncommon with bipolar disorder, as initial assessments rarely provide all the information needed. In your role, as a psychiatric nurse practitioner, you must develop strategies for properly assessing and diagnosing these patients because treatments for bipolar disorder are significantly different than treatments for depression or other mood disorders. This week, as you examine bipolar therapies, you explore the assessment and treatment of patients with bipolar disorder. You also consider ethical and legal implications of these therapies. Learning Objectives Students will: Assess patient factors and history to develop personalized plans of bipolar therapy for patients Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring bipolar therapy Synthesize knowledge of providing care to patients presenting for bipolar therapy Analyze ethical and legal implications related to prescribing bipolar therapy to patients across the life span Learning Resources Required Readings (click to expand/reduce) Ostacher, M. J., & Hsin, H. (2016). The use of antiepileptic drugs in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 93–98). Elsevier. Perlis, R. H., & Ostacher, M. J. (2016a). Bipolar disorder. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 48–60). Elsevier. Perlis, R. H., & Ostacher, M. J. (2016b). Lithium and its role in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 86–92). Elsevier. Traeger, L., Brennan, M. M., & Herman, J. B. (2016). Treatment adherence. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 20–26). Elsevier. American Psychiatric Association. (2010b). Practice guideline for the treatment of patients with bipolar disorder (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar.pdf 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. https://doi.org/10.1007/s00228-015-1855-6 Hirschfeld, R. M. A. (n.d.). Guideline watch: Practice guideline for the treatment of patients with bipolar disorder (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolarwatch.pdf Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331–333. https://doi.org/10.1007/s40263-0130060-3 Medication Resources (click to expand/reduce) IBM Corporation. (2020). IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess? source=deepLink&institution=SZMC%5ESZMC%5ET43537 Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments. Review the following medications: amitriptyline imipramine bupropion ketamine citalopram mirtazapine clomipramine nortriptyline desipramine paroxetine desvenlafaxine selegiline doxepin sertraline duloxetine trazodone escitalopram venlafaxine fluoxetine vilazodone fluvoxamine vortioxetine Required Media (click to expand/reduce) Case Study: An Asian American Woman with Bipolar Disorder Note: This case study will serve as the foundation for this week’s Assignment. Optional Resources (click to expand/reduce) Mostafavi, 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. http://acta.tums.ac.ir/index.php/acta Assignment: Assessing and Treating Patients With Bipolar Disorder Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients 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 patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder. To prepare for this Assignment: Review this week’s Learning Resources, including the Medication Resources indicated for this week. Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring bipolar therapy. The Assignment: 5 pages Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Conclusion (1 page) Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patientspecific resources, including the primary literature. Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature. Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting. By Day 7 Submit your Assignment. Submission and Grading Information To submit your completed Assignment for review and grading, do the following: Please save your Assignment using the naming convention “WK5Assgn+last name+first initial. (extension)” as the name. Click the Week 5 Assignment Rubric to review the Grading Criteria for the Assignment. Click the Week 5 Assignment link. You will also be able to “View Rubric” for grading criteria from this area. Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click Open. If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. Click on the Submit button to complete your submission. Grading Criteria 3/29/2021 Rubric Detail – Blackboard Learn Rubric Detail Select Grid View or List View to change the rubric’s layout. Name: NURS_6630_Week5_Assignment_Rubric Grid View EXIT List View Introduction to the case (1 page) Brie y explain and summarize the case for this Assignment. Be sure to include the speci c patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1–2 pages) • Which decision did you select? • Why did you select this decision? Be speci c and support your response with clinically relevant and patientspeci c resources, including the primary literature. • Why did you not select the other two options Excellent Good Fair Point range: 90– 100 Point range: 80– 89 Point range: 70– 79 Point range: 0–69 9 (9%) – 10 (10%) 8 (8%) – 8 (8%) 7 (7%) – 7 (7%) 0 (0%) – 6 (6%) The response accurately, clearly, and fully summarizes in detail the case for the Assignment. The response accurately summarizes the case for the Assignment. The response inaccurately or vaguely summarizes the case for the Assignment. The response inaccurately and vaguely summarizes the case for the Assignment, or is missing. The response accurately and clearly explains in detail the speci c patient factors that impact decision making when prescribing medication for this patient. The response accurately explains the speci c patient factors that impact decision making with prescribing medication for this patient. The response inaccurately or vaguely explains the speci c patient factors that impact decision making with prescribing medication for this patient. Poor The response inaccurately and vaguely explains the speci c patient factors that impact decision making with prescribing medication for this patient. 18 (18%) – 20 (20%) 16 (16%) – 17 (17%) 14 (14%) – 15 (15%) 0 (0%) – 13 (13%) The response accurately and clearly explains in detail the decision selected. The response accurately explains the decision selected. The response inaccurately or vaguely explains the decision selected. The response inaccurately and vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with speci c clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately and vaguely explains why the decision was selected, with speci c clinically relevant resources that do not support the decision selected, or is missing. The response accurately and clearly explains in detail why the decision was selected, with speci c clinically relevant resources that fully support the decision selected. The response The response explains why the decision was selected, with speci c clinically relevant resources that support the decision selected. The response accurately explains why the other two The response https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16807498_1&rubric_id=_2190621_1 1/7 3/29/2021 provided in the exercise? Be speci c and support your response with clinically relevant and patientspeci c resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be speci c and provide examples. Rubric Detail – Blackboard Learn Excellent Good Fair Point range: 90– 100 Point range: 80– 89 Point range: 70– 79 accurately and clearly explains in detail why the other two responses were not selected, with speci c clinically relevant resources that fully support the response. responses were not selected, with speci c clinically relevant resources that support the response. The response inaccurately or vaguely explains why the other two responses were not selected, with speci c clinically relevant resources that inaccurately or vaguely support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with speci c clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. Decision #2 (1–2 pages) • Which decision did you select? • Why did you select this decision? Be The response accurately explains the outcome the student was hoping to achieve with the selected decision, with speci c clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with speci c clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Poor Point range: 0–69 inaccurately and vaguely explains why the other two responses were not selected, with speci c clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with speci c clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided may support the decisions and responses provided. Examples provided do not support the decisions and responses provided, or is missing. 18 (18%) – 20 (20%) 16 (16%) – 17 (17%) 14 (14%) – 15 (15%) 0 (0%) – 13 (13%) The response accurately and clearly explains in detail the decision selected. The response accurately explains the decision selected. The response inaccurately or vaguely explains the decision selected. The response inaccurately and vaguely explains in detail the decision selected. The response The response The response The response explains why the https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16807498_1&rubric_id=_2190621_1 2/7 3/29/2021 speci c and support your response with clinically relevant and patientspeci c resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be speci c and support your response with clinically relevant and patientspeci c resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be speci c and provide examples. Rubric Detail – Blackboard Learn Excellent Good Fair Point range: 90– 100 Point range: 80– 89 Point range: 70– 79 accurately and clearly explains in detail why the decision was selected, with speci c clinically relevant resources that fully support the decision selected. decision was selected, with speci c clinically relevant resources that support the decision selected. inaccurately or vaguely explains why the decision was selected, with speci c clinically relevant resources that inaccurately or vaguely support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with speci c clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with speci c clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. The response accurately explains why the other two responses were not selected, with speci c clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with speci c clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. The response inaccurately or vaguely explains why the other two responses were not selected, with speci c clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with speci c clinically relevant resources …

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