NURS 6630 Assessing and Treating Patients With Bipolar Disorder
Bipolar disorder is a mental health condition characterized by intense mood swings that can significantly disrupt a person’s behavior and daily life. These mood swings can range from extreme happiness or irritability to deep sadness or depression, and they can last for days or even weeks. These mood changes can make it challenging for individuals to carry out their regular activities and interact with others. Bipolar disorder comes in several forms, including bipolar 1, bipolar 2, and cyclothymic bipolar. Bipolar 1 involves alternating episodes of mania, hypomania, and a normal mood. Bipolar 2 is characterized by major depressive episodes and hypomania. Cyclothymic bipolar is known for frequent mood swings.
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During manic episodes, individuals may experience a decreased need for sleep, rapid and excessive speech, increased physical activity, engage in risky behaviors, have trouble concentrating, and deal with racing thoughts that are difficult to control. In contrast, during hypomanic episodes, individuals may feel intense sadness or hopelessness, lose interest in activities, experience fatigue, have difficulty concentrating, and even have thoughts of death or suicide. Bipolar disorder can have various causes, including genetic factors, a family history of the condition, a stressful environment, and substance abuse.
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NURS 6630 Understanding and Treating Bipolar Disorder
In the presented case study, we encounter a 26-year-old female patient with bipolar disorder. According to the American Psychiatric Association and DSM-5 criteria, she exhibits symptoms such as reduced need for sleep, excessive talking, increased distractibility, a happy mood, rapid or pressured speech, and heightened energy. She scores 22 on the Young Mania Rating Scale.
The treatment for bipolar disorder typically involves the use of antipsychotic medications and psychotherapy. Antipsychotic medications help alleviate the patient’s symptoms, while psychotherapy enables the patient to modify their thoughts and behaviors, ultimately improving cognitive function and overall quality of life.
Decision One
Choice: Initiate treatment with Seroquel XR at a dose of 300mg to be taken orally at bedtime.
Reason for Selection: Seroquel is a second-generation antipsychotic medication that has a strong affinity for dopamine and serotonin receptors. Its mechanism of action involves blocking these receptors and binding to the norepinephrine transporter (Hamed, et al, 2017). This action is beneficial for memory, mood regulation, aggression control, and coordination of muscle movements in the brain. Seroquel is the preferred choice for this patient because it is FDA-approved for the treatment of acute manic episodes in bipolar disorder. Moreover, studies conducted by the American Psychiatric Association have confirmed its effectiveness in treating bipolar disorder.
Reason for Rejecting Other Options: Risperdal, another second-generation antipsychotic, is often used to treat schizophrenia and for maintenance therapy in bipolar disorder. It works by reducing serotonin and dopamine activity in the brain, thus alleviating mood symptoms, agitation, and symptoms of schizophrenia. However, it was not chosen for the patient due to its side effects, including drooling, weight gain, fatigue, and nausea.
Lithium is commonly prescribed for both preventing and treating manic episodes. It acts by regulating neurotransmitters and inhibiting excitatory neurotransmitters like dopamine and glutamate. It has neuroprotective effects on the brain, helping regulate mood. Lithium is FDA-approved for mood disorders and bipolar, but it was not selected for this patient due to her non-compliance with the treatment, likely resulting from its unpleasant side effects.
What was your goal in making this choice?
The aim of starting the patient on Seroquel XR 300mg is to ease the symptoms and lower the Young Mania Rating Scale score. Expected side effects include dry mouth, drowsiness, constipation, and weight gain.
Communication is the sharing of information from the sender to the recipient to understand, interpret, and respond. Communicating with a patient who has bipolar disorder can be challenging because they talk quickly and have racing thoughts. Therefore, the nurse applies the principle of justice when assessing the patient. Justice means providing equal and quality services to all, regardless of their underlying issues. Justice helps the nurse communicate effectively with the patient.
Decision Two
Which choice did you make?
I decided to discontinue Seroquel and start Geodon 40mg.
Why did you choose this option?
Geodon is a second-generation antipsychotic that inhibits the reuptake of norepinephrine and serotonin, blocking alpha and antihistaminic activities. This reduces hallucinations, enhances clear thinking, decreases agitation, and improves daily activities. It has 60% bioavailability and is 99% protein bound. The drug is initiated at a low dose and gradually increased over two weeks to reduce side effects. I selected this drug because it effectively treats bipolar disorder and has no adverse effects on the patient.
Why didn’t you choose the other two options provided in the exercise?
Increasing the Seroquel dose to 400mg to improve the patient’s symptoms is not a good choice because she previously complained of weight gain and constipation. Raising the dose would worsen these side effects. Using dietary measures to control weight gain and obesity is ineffective because the drug’s muscarinic cholinergic antagonism induces gastrointestinal hypomotility, leading to constipation and weight gain. Reducing the dosage would not have positive effects on the patient’s symptoms and would still result in unpleasant side effects.
What did you hope to achieve with this decision?
The expectation of switching the patient’s treatment to Geodon is to improve the symptoms, decrease the Young Mania Rating Scale score, and alleviate constipation and weight gain.
Explain how ethical considerations may impact your treatment plan and communication with patients. Provide specific examples.
In this decision, the nurse considers the principle of autonomy. Autonomy means respecting a person’s decisions and preferences. The patient is uncomfortable with Seroquel due to constipation despite symptom improvement. The nurse changes the treatment to ensure the patient’s satisfaction.
Decision Three
Which choice did you make?
I decided to increase Geodon to 60mg orally twice daily with a 500-calorie meal.
Why did you choose this option?
Geodon was effective during the initial stage of treatment. Increasing the dose from 40mg to 60mg is effective in improving the symptoms. Additionally, the recommended dose is 60mg to 80mg with a gradual increment every two weeks. I selected this choice because it will accelerate the improvement of the symptoms.
Why didn’t you choose the other two options provided in the exercise?
I did not continue with the same drug dosage because the American Psychiatric Association recommends 60mg to 80mg to relieve the symptoms. I did not augment with lithium because it has unpleasant side effects. Additionally, augmentation is recommended in the incidence of depression and hypomania. There is a contraindication for lithium augmentation with antipsychotics like olanzapine, haloperidol, and Geodon.
What were you hoping to achieve with this decision?
The expectation of increasing the dosage is to expedite the improvement of the symptoms.
Explain how ethical considerations may impact your treatment plan and communication with patients. Provide specific examples.
The nurse uses the principles of beneficence and non-maleficence. Beneficence means doing what is right, and non-maleficence is protecting the patient from harm. The nurse carefully analyzes the best treatment for the patient to improve the symptoms and prevent adverse effects.
Conclusion
Bipolar disorder involves extreme mood swings that can last for days to weeks, impacting daily tasks and social interactions. Manic episodes are characterized by reduced need for sleep, rapid speech, increased activity, risky behavior, distractibility, and racing thoughts. Hypomania features intense sadness, loss of interest, fatigue, concentration difficulties, and thoughts of suicide. Seroquel, a second-generation antipsychotic, antagonizes receptors to improve memory, mood, aggression, and muscle movement in the brain. However, it causes weight gain and constipation. Geodon is an effective treatment for bipolar disorder, well-tolerated with minimal side effects. Ethical principles in nursing, including beneficence, autonomy, consent, justice, and non-maleficence, improve assessment and communication techniques.
References
Ashok, A., Marques, T., Jauhar, S. et al. The dopamine hypothesis of bipolar affective disorder: the state of the art and implications for treatment. Mol Psychiatry 22, 666–679 (2017). https://doi.org/10.1038/mp.2017.16
Asl, R. G., Taghinejad, R., Parizad, N., & Jasemi, M. (2022). The relationship between professional autonomy and job stress among intensive care unit nurses: A descriptive correlational study. Iranian Journal of Nursing and Midwifery Research, 27(2), 119. https://doi.org/10.4103%2Fijnmr.ijnmr_375_20
Findling, R. L., Atkinson, S., Bachinsky, M., Raiter, Y., Abreu, P., Ianos, C., & Chappell, P. (2022). Efficacy, Safety, and Tolerability of Flexibly Dosed Ziprasidone in Children and Adolescents with Mania in Bipolar I Disorder: A Randomized Placebo-Controlled Replication Study. Journal of Child and Adolescent Psychopharmacology, 32(3), 143-152. https://doi.org/10.1089/cap.2021.0121
Hamed, R., AlJanabi, R., Sunoqrot, S., & Abbas, A. (2017). The effect of pH, buffer capacity and ionic strength on quetiapine fumarate release from matrix tablets prepared using two different polymeric blends. Drug Development and Industrial Pharmacy, 43(8), 1330-1342. https://doi.org/10.1080/03639045.2017.1318897
Schoretsanitis, G., Spina, E., Hiemke, C., & de Leon, J. (2017). A systematic review and combined analysis of therapeutic drug monitoring studies for long-acting risperidone. Expert review of clinical pharmacology, 10(9), 965-981. https://doi.org/10.1080/17512433.2017.1345623
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