Client of Korean Descent Ancestry with Bipolar Disorder

1 Client of Korean Descent Ancestry with Bipolar Disorder Bipolar Therapy Introduction Bipolar is associated with detrimental health problems to the patient. Hence, it needs proper and prompt treatment to prevent further damages. Bipolar can affect individuals at any age, both children and adults. Patients diagnosed with the disorder have shifted in the mood accompanied by a series of mania and depression (Lake, 2020). The high emotions are called mania, and the low emotions are depressions. Bipolar makes it hard for the patient to perform daily activities and concentrate on critical issues. There are three types of bipolar disorder: Bipolar I disorder Bipolar II disorder, and Cyclothymic disorder, also known as cyclothymia.

There are various medications and lifestyle changes recommended for patients diagnosed with bipolar. The main symptoms of bipolar disorder are alternating episodes of high and low moods (Lake, 2020). It also interferes with sleep, focus, and other features that can significantly affect one's behavior, relationship, works, and other aspects of life.

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2 The presented patient is a 26-year-old Korean woman suffering from Bipolar I disorder.

The patient was diagnosed with bipolar I sometimes disorder back. She has come to the clinic for her first appointment flowing 21 days of hospitalization due to the onset of acute mania (Chen et al., 2015). The psychiatric mental health nurse found the patient in the office playing with things on the table and shifting from one side of her chair to another. The patient is oriented X3 (person, time, and event). She seems so happy and high in the mood. She says she sleeps 5 hours but hates sleep because it is no longer fun (Chen et al., 2015). Therefore, the purpose of this paper is to select three decisions that would improve the patient's condition based on the provided case study.

Decision Point One The selected option was to Begin Seroquel XR 300 mg orally at HS. This decision was selected because it was the best among the three. The patient has shown a bad reaction to lithium. Additionally, Seroquel XR is widely used and approved to treat Bipolar I disorder (Baldessarini et al., 2019). It is an atypical antipsychotic belonging to a chemical class, the dibenzothiazepine derivatives. The medication affects chemicals that allow communication between nerve cells (neurotransmitters). Illnesses that affect the brain may be due to certain chemicals (dopamine and serotonin) in the brain being out of balance (Lake, 2020). Seroquel XR tries to balance these chemicals to improve the patient's condition.

For one or two reasons, the other two decisions were not selected. The patient did not show a positive response with Lithium 300mg orally BID. The patient could not be compliant with the medication for reasons that are yet to be known (Chen et al., 2015). For that reason, it was not appropriate to administer Lithium 300mg orally BID. On the other hand, Risperdal 1mg orally BID was not selected, though it was not a bad option, because the patient was diagnosed

3 with the CYP2D6*10 allele. The patient is likely to have a slower clearance of Risperdal from her system (Chen et al., 2015). Continuous administration of Risperdal 1mg orally BID would lead to accumulation of the drug in the blood, resulting in severe sedation.

The expected results included improvement of the bipolar-related symptoms. The patient's sleep was expected to improve. The depressive and agitation symptoms were expected to resolve (Miklowitz, 2019). No drug side effects were anticipated. The results showed a slight reduction in bipolar symptoms. However, the patient complained of weight gain, constipation, and dryness of the mouth. One important ethical consideration is explaining drug side effects and management (McDermott-Levy et al., 2018). The patient should take part in the decision process.

Decision Point Two The selected decision point two is to discontinue Seroquel and start Geodon 40mg orally BID, administered with a 500 calorie meal. This decision was preferred for several reasons (Baldessarini et al., 2019). For instance, the patient reported several side effects with the previous medication (Seroquel), which needed serious attention. Second, the patient requested another medication because she was uncomfortable with the side effects, especially weight gain (Chen et al., 2015). Third, Geodon is widely used for the treatment of bipolar I disorder.

The other two decisions were not selected because of some reason. Seroquel XR to 400 mg orally at HS could have caused severe side effects. Increasing the dose was not a good option because the patient already had side effects with a lower dose (Miklowitz, 2019). Continuing the same dose was also not a good option because it caused serious side effects such as dryness of the mouth, weight gain, and constipation. Also, the patient had requested another medication.

4 The expected results after four weeks include improved sleep and other bipolar-related symptoms by 50%. The manic and depressive symptoms of the patient are expected to reduce by 50% when measured against the Young Mania Rating Scale (Chen et al., 2015). The medication's side effects such as weight gain, dry mouth, and constipation are expected to resolve. The actual results matched the expected ones. The client returned to the clinic after four weeks and reported a 50% decrease in score on the Young Mania Rating Scale. Also, the patient denied additional side effects. Ethical considerations include patient education, patient autonomy, beneficence, and non-maleficence (McDermott-Levy et al., 2018). The healthcare provider must ensure all these issues are addressed to ensure quality care.

Decision Point Three The selected option three is to continue with the current dose (Geodon 40mg orally BID. Administered with 500 calorie meal) and reassess in 4 weeks. This decision was selected because the current dose presented a positive result (Lake, 2020). There was no reason to change either the dose or medication because the patient reported a 50% symptoms reduction. A 50% reduction in the symptoms is considered a full response, but it should not be confused with full recovery (Baldessarini et al., 2019). The patient should receive counseling about the side effects of medications and how to manage weight gain, constipation, and dry mouth.

The other two decisions were not selected for distinct reasons. For example, Increasing Geodon 40mg to Geodon 60 mg orally BID was not selected because it would cause serious side effects, hence, putting the patient's life in danger (Miklowitz, 2019). Increasing the dose could lead to side effects such as lightheadedness, weakness, nausea, vomiting, runny nose, cough, drowsiness, and dizziness. On the other hand, Augmentation with Lithium may be appropriate if

5 the goal of therapy is to discontinue antipsychotic therapy and treat with Lithium monotherapy (Chen et al., 2015). The patient should be educated regarding the side effects of medications.

The expected results for decision point three will be evaluated in four weeks. The therapist expects the patient to recover fully from the maniac and depressive symptoms. The patient is expected to have normal sleep patterns (Baldessarini et al., 2019). The other symptoms, such as constipation, dry mouth, and weight gain, will have resolved by the fourth week. Specific ethical issues must be put into considerations when treating the patient. For example, the patient needs to be educated about medication compliance and adherence. Beneficence, nonmaleficence, and justice must all be considered. The patient must be allowed to make decisions about her treatment (McDermott-Levy et al., 2018).

Conclusion The presented case study is about a 26-year-old Korean woman suffering from Bipolar I disorder. The patient was diagnosed with bipolar I sometimes disorder back. She has come to the clinic for her first appointment flowing 21 days of hospitalization due to the onset of acute mania. Bipolar is a mental health problem that causes mood, behavior, concentration, and interest shifts. It is associated with high emotions (mania) and low emotions (depression). There are three types of bipolar disorder: Bipolar I disorder, bipolar II disorder, and Cyclothymic disorder, also known as cyclothymia.

The therapist made three crucial decisions to improve the patient's condition. The selected option was to Begin Seroquel XR 300 mg orally at HS. The two chosen decision is to discontinue Seroquel and start Geodon 40mg orally BID. Option three is to continue with the current dose (Geodon 40mg orally BID. Several ethical issues must be put into considerations when treating the patient. For example, the patient needs to be educated about medication

6 compliance and adherence. The patient must be allowed to make decisions about her treatment.

Beneficence, non-maleficence, and justice must all be considered.

7 References Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular Psychiatry, 24(2), 198-217.

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/s00228-015-1855-6 Lake, C. (2020). Bipolsar. Elsevier Academic Press.

Miklowitz, D. J. (2019). The bipolar disorder survival guide: What you and your family need to know. Guilford Press.

McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing Outlook, 66(5), 473-481. https://doi.org/10.1016/j.outlook.2018.06.013