Psychopharmacology

1 Psychopharmacology Psychological health disorders have been recognized as significant health issues and primary contributors to poor quality of life among individuals and families. These disorders disrupt the life of individuals making it impossible to engage in activities of daily living. The common mental health problems include bipolar disorder, depression, anxiety, inattentiveness, and addiction among others (Kumar, 2020). Whereas some of these health problems have shortterm impacts on an individual, others may persist throughout life. The symptoms of various mental health disorders range from mild to severe. These symptoms include abnormal thinking patterns, aggression, sadness, poor cognition, decreased memory, and inattentiveness among others (Anderson & Reid, 2019). Some symptoms are hard to control but others can be controlled using pharmacological agents and psychotherapy.

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The psychiatric mental health nurse practitioner evaluates individuals suspected of mental health problems to ascertain their mental health needs (Ettinger, 2017). The nurse develops an appropriate intervention that incorporates psychotherapy and medications. The plan of care aims to improve their social functionality and self-care (Anderson & Reid, 2019). Further, the plan ensures that the risk of relapse and potential complications are prevented. Since numerous pharmacological agents have been approved for mental illnesses, the nurse should determine the most effective medication for every case (Ettinger, 2017). In some instances, different patients may present with similar psychological symptoms. However, the mental health needs of these patients may differ, thus, making it inappropriate to use similar medications. In this paper, the treatment of a patient with bipolar disorder is highlighted. The medical management needs together with the community support resources available for the client have also been identified.

HPI and Clinical Impression The case addressed in this paper revolves around a 42-year-old female client, who was brought to the facility by her husband. The husband stated that the client has been presenting risky behaviors and severe mood swings. She was abusing alcohol and acted impulsively. The client has a history of hypomania and depressive episodes dating far back to her early 20s. Over the years she has been diagnosed with various forms of depression including borderline personality disorder, bipolar disorder, and major depression. The client states that her family has neglected her and she is being treated like a stranger. Although during the previous clinical visit she was prescribed mood stabilizers Lithium 900 mg her mood has never improved. This was attributed to noncompliance with the medications. While her use of alcohol use during

3 hypomanic states may lead to a provisional borderline diagnosis, the most suitable diagnosis for her current condition is bipolar disorder.

Psychopharmacologic Intervention Latuda 40 mg PO qDay initially is a suitable prescription for this patient. This dose can be adjusted per the client’s response to treatment. This medication was selected since it has minimal side effects. Fewer side effects than lithium can help to improve the client’s compliance (Pikalov et al., 2017). Further, Latuda is effective in combating mental symptoms. This drug can improve behavior, mood, and thinking. Since it increases the brain's neurotransmitter levels, it can combat the client’s lack of interest in social activities (Pikalov et al., 2017).

Psychotherapy The integration of psychotherapeutic interventions in mental health care plan plays an invaluable role in improving the health of the client and preventing relapse of devastating symptoms. Cognitive Behavioral Therapy (CBT) is one of the most suitable therapies to employ in the current case. CBT is a short-term program that takes about eight sessions to complete (Ye et al., 2016). This intervention enables an individual to identify and change potentially destructive behaviors, thoughts and attitudes. Since CBT breaks down overwhelming feelings, thoughts, and behaviors into smaller portions, the client can independently tackle each problem (Ye et al., 2016). Through CBT, the client identifies the interconnectedness of different psychological elements hence developing positive behaviors that can pull her out of the vicious cycle of bipolar symptoms. Ye et al., (2016) made it clear that CBT improves a client’s ability to overcome issues that are hard to manage using medications.

Medical Management Needs

4 Since the client presented in the facility with different symptoms that typify bipolar disorder, her primary care needs would include alleviating the symptoms, improving mental health, and preventing relapse. Importantly, the care provider has to assess the client to make an appropriate diagnosis comprehensively. A comprehensive assessment further assists in the identification of potential comorbidities that would compliance patient care. The presence of bipolar symptoms appears to have overwhelmed the client’s ability to socialize. Therefore, the plan should reduce the severity of the symptoms to improve social functioning. The other medical management need for the client is education. Patient education is essential in mental healthcare as it improves compliance with medications besides helping the client to identify nonmedication interventions to deal with her challenges.

Community support resources Family and community support is essential for individuals presenting with various forms of psychological disorders. This support helps the client to overcome antisocial behaviors besides being engaged in constructive activities. One of the key community support services available for the client with Bipolar disorder is the Depression and Bipolar Support Alliance.

This is a community-based entity that offers peer support services, education, and inspiration to bipolar patients (DBSA, 2020). Another support entity is the International Bipolar Foundation, which offers counseling and other therapeutic services to individuals diagnosed with Bipolar (The Mental Health Innovation Network, 2020).

Follow-up plan A four-week follow-up plan was developed for the client. This plan is justifiable since it would allow the client to take her medications without interruptions. Furthermore, some medications take more than three weeks to achieve their optimal therapeutic effect. Therefore, if

5 a shorted follow-up plan was scheduled the therapeutic effect of some medications would be evaluated wrongly. However, it was emphasized that the client should report to the facility if she develops adverse effects due to the prescribed medications. It was also suggested that the client should visit a psychological counselor for comprehensive mental health assessment and counseling.

Conclusion Pharmacological agents and psychotherapy are the primary treatment interventions for mental health disorders such as bipolar disorder. These interventions help to lower the severity of symptoms in addition to reducing relapse and potential complications. Commencing treatment at an early stage helps combat mental health disorders before they progress to stages requiring complex management and interventions. Once treatment has started, the client should be followed closely to ensure the targeted outcomes are achieved. Follow-up also helps to nurse to make the necessary treatment adjustments to accomplish the ultimate health goals.

Noncompliance is also detected and addressed appropriately in situations where clients are closely monitored.

6 References Anderson, I. M., & Reid, I. C. (2019). Fundamentals of Clinical Psychopharmacology. CRC Press.

Depression and Bipolar Support Alliance (DBSA) (2020). Bipolar Disorder. https://www.dbsalliance.org/education/bipolar-disorder/ Ettinger, R. H. (2017). Psychopharmacology. Psychology Press, Kumar, R., (2020). Essentials of Psychiatry and Mental Health Nursing, First Edition. Elsevier Health Sciences.

Pikalov, A., Tsai, J., Mao, Y., Silva, R., Cucchiaro, J., & Loebel, A. (2017). Long-term use of lurasidone in patients with bipolar disorder: safety and effectiveness over 2 years of treatment. International Journal of Bipolar Disorders, 5(1), 9. https://doi.org/10.1186/s40345-017-0075-7 The Mental Health Innovation Network (2020). International Bipolar Foundation. https://www.mhinnovation.net/organisations/international-bipolar-foundation Ye, B. Y., Jiang, Z. Y., Li, X., Cao, B., Cao, L. P., Lin, Y., Xu, G. & Miao, G. D. (2016).

Effectiveness of cognitive-behavioral therapy in treating bipolar disorder: An updated meta‐analysis with randomized controlled trials. Psychiatry and clinical neurosciences, 70(8), 351-361. https://doi.org/10.1111/pcn.12399