Assignment; Assessing and Treating Patients with Bipolar Disorder

Assignment; Assessing and Treating Patients with Bipolar Disorder

Assignment; Assessing and Treating Patients with Bipolar Disorder

Mental health problems act as a source of considerable disease burden to the global populations. Nurses and other healthcare providers play a crucial role in the adoption of evidence-based interventions that promote recovery from mental health problems. Sources of evidence-based data and clinical guidelines inform the decisions that psychiatric mental health nurse practitioners make in their daily practice. Psychiatric mental health nurse practitioners should be aware of strategies to promote safety and quality in the treatment of mental health problems in special populations. Therefore, the purpose of this paper is to examine bipolar I disorder among the adolescents. The essay examines topics that include its prevalence and neurobiology, differences with another subtype of bipolar, special populations and considerations, treatments, and monitoring patients.

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Prevalence and Neurobiology

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The selected mental health problem for analysis in this paper is bipolar I disorder in adolescents. Bipolar I disorder is a type of bipolar disorder characterized by the shifts in mood, activity levels, and energy, which affects daily functioning. Patients diagnosed with bipolar I disorder must have at least a manic episode with or without a history of major depression episode. The prevalence of bipolar I disorder is at least as bipolar II disorder in the population. The existing evidence shows that 4.4% of adults in the USA experience bipolar disorder at some point in their lives. Statistics show that the prevalence of bipolar I disorder among adults aged 18 years and above was 2.8% in the past year with 9% of the affected suffering from serious impairment while 1% developed moderate impairment. Adolescents have a lifetime prevalence of 2.9% of developing bipolar I disorder with 2.6% of them experiencing severe impairment(Kessing et al., 2021; McIntyre et al., 2020; Psycom.net, 2021). The global lifetime prevalence of bipolar I disorder is 2.4%.

Bipolar I disorder has neurobiological basis. One of them is the influence of genetics. Children born to parents with bipolar disorder have a tenfold risk of being affected by bipolar disorder. The heritability of the disorder has been shown to be 0.7-0.8 in twin studies. Bipolar disorder has also been associated with calcium dysregulation. Patients with bipolar disorder have been found to have increased intracellular signaling. Neurotransmitters have also been implicated in the development of bipolar disorder(Scaini et al., 2020). Accordingly, studies have found that patients with bipolar disorder have increased noradrenergic turnover in the thalamic and cortical areas.

There is also the altered sensitivity of beta and alpha 2 adrenergic receptors, which contribute to bipolar disorder and other mood disorders. Other studies have shown the reduction in 5-HIAA in bipolar disorder and mood disorder patients, which increase their susceptibility to aggression, suicide attempts, and impulsivity. Lastly, HPA axis dysregulation because of persistent exposure to high stress levels have been associated with the development of bipolar disorder(Young &Juruena, 2021). Chronic stress causes atrophy as well as the death of hippocampal neurons, hence, the basis of bipolar disorder.

Differences

A comparison is made between bipolar II disorder and I. Patients diagnosed with bipolar I disorder experience mania episodes. Those diagnosed with bipolar II disorder experience hypomanic episode. This implies that patients with bipolar II disorder have less severe periods of mania as compared to those with bipolar I disorder. Patients with bipolar I disorder can or cannot experience depressive episodes. However, those diagnosed with bipolar II disorder experience episodes of major depression. Patients with bipolar I disorder also experience mania and hypomania alongside depression while those with bipolar II have hypomania episodes alone besides depression. Patients with bipolar I disorder may also experience psychosis symptoms such as hallucinations and delusions, which is not evident in bipolar II disorder(Gandhi, 2022). Bipolar I disorder also high impact on the patient’s quality of life and functioning as compared to bipolar II disorder.

Special Populations and Considerations

Children, adolescents, pregnant and post-partum mothers, elderly and emergency care patients comprise a vulnerable population. Children are vulnerable based on their immature organs and immune systems. Children have immature organs such as live and kidneys, which play the major role in drug elimination and metabolism. The immaturity in organs predispose them harm in the treatment of bipolar I disorder. Most of the drugs used in the treatment of bipolar I disorder have not been approved by the FDA for use in the pediatric population. The prescription is large for off-label purposes(Gandhi, 2022). As a result, it predisposes children to harm in the treatment of bipolar disorder.

Adolescents are also a vulnerable population. Most of the drugs used in the treatment of bipolar disorder in adolescents are off-label. This predisposes them to harm in the treatment process. Healthcare providers should also be cautious when prescribing medications to pregnant and post-partum mothers suffering from bipolar disorder. The risk of teratogenicity is high among pregnant mothers with some drugs being excreted through the breast milk. Healthcare providers must weigh the benefits and risks of the different treatment options for the optimum health and outcomes for the patients and their newborns. The elderly populations have decline in most of the physiological processes(Gandhi, 2022). For example, they experienced reduced renal and hepatic functions. These changes affect drug processes such as metabolism and excretion. Healthcare providers must prescribe medications that pose limited risk of harm due to reduced organ functions.

Healthcare providers consider a range of issues when working with the vulnerable populations. One of them is the promotion of data integrity in the treatment process. Healthcare providers ensure the protection of data privacy and confidentiality. They ensure autonomy my seeking informed consent from the patients before sharing information with other parties. The other consideration is the promotion of safety in their practice. The vulnerable populations are increasingly predispose to harm because of their health status. As a result, psychiatric mental health nurse practitioners and other healthcare providers must make decisions informed by best clinical evidence and guidelines(Gorczynski et al., 2021). The treatment decisions should minimize the risk of harm while optimizing its associated benefits to the vulnerable populations.

The vulnerable populations have unique needs, preferences, and values. Healthcare providers must incorporate these diversities in making decisions related to the treatment for the vulnerable populations affected by bipolar disorder. For example, they should involve the patients in making decisions and developing personalized treatment plans(Gorczynski et al., 2021). They also promote culture competence by developing care plans that align with the cultural values, beliefs, and practices of their patients and their families.

Psychiatric mental health practitioners should also be aware of the differences in access to care for the vulnerable populations. Social determinants of health such as income level, employment status, having an insurance coverage, and disability affect the access to mental health care services by those affected by bipolar disorders. Psychiatric practitioners should be proactively involved in identifying and addressing barriers to care for the vulnerable populations(Ungar& Theron, 2020). Strategies such as advocacy and linking them to the available resources help enhance their access to the mental healthcare they need for their health and wellbeing.

FDA and or Clinical Practice Guidelines Approved Pharmacological Treatments

The Food and Drug Administration (FDA) has approved several drugs for use in the treatment of bipolar I disorder among the adolescents. One of them is lithium. Lithium has been approved for both acute and maintenance treatment of bipolar disorder in this population. The FDA has also approved the use of Lexapro and Prozac in teenagers with bipolar I disorder. Prozac and Lexapro are antidepressants that manage the depressive symptoms that patients with bipolar disorder experience(Hafeman et al., 2020). They are indicated for both acute and maintenance treatment in the disorder. Atypical antipsychotics have also been approved for bipolar disorder in adolescents. They include drugs such as Zyprexa, Abilify, and Risperidone. The drugs effectively manage the mania symptoms in bipolar disorder both in the acute and maintenance phase. The additional antipsychotics include quetiapine, olanzapine, lurasidone, cariprazine, asenapine, aripiprazole, and ziprasidone(Klein et al., 2020).

Clinical guidelines support the use of the above agents in the treatment of bipolar I disorder among the adolescents. For example, Chia et al., (2019) recommend that second generation antipsychotics should be used to treat acute mania in adolescents. The authors also recommend the use of the second-generation antipsychotics to treat and prevent progression of the disorder in its early stages. McIntyre et al., (2020) consider lithium as the standard drug for bipolar disorder in adolescents. This is because of its anti-suicide, antidepressant, and antimanic effects. The authors also recommend the use of carbamazepine and divalproex for acute mania and lamotrigiene to prevent bipolar depression. According to Yee et al., (2019), anticonvulsants, second-generation antipsychotics, and lithium have the efficacy of reducing long-term morbidity in patients diagnosed with juvenile bipolar disorder. Similarly, the drugs may offer protective effect if used in adolescents diagnosed with bipolar I disorder.

Side Effects, FDA Warnings, Monitoring, and Comorbid Issues

The above drugs are associated with considerable side and adverse effects. Antipsychotics used in the treatment of bipolar I disorder have a range of adverse and side effects. They are associated with sedation, orthostasis, weight gain, dyslipidemia, fluid retention, dry mouth, and loss of menstrual period in women. Patients using antipsychotics should be monitored for side effects that include tremors, agitation, and stiffness. They should also be monitored closely for neuroleptic malignant syndrome, which is characterized by fever, delirium, muscle stiffness, and hypertension. Some of the laboratory monitoring for patients using antipsychotics include performing lipid profile to detect hyperlipidemia. It is also important to monitor weight and body mass index, blood pressure and heart rate, comprehensive metabolic panel, fasting glucose, and white blood cell count(Kaar et al., 2020). Some of the comorbidities associated with the use of antipsychotics include weight-related problems, neuroleptic malignant syndrome, and weight gain related problems such as obesity, overweight, and hypertension.

Lithium is the other drug used in bipolar I disorder in adolescents. Lithium is associated with side effects that include diarrhea, fatigue, weight gain, mild tremors, and nausea. Lithium is also associated with adverse effects such as kidney problems, hypothyroidism, and serotonin syndrome. Patients should be monitored for weight gain, renal function tests, thyroid function tests, cardiac tests for QT prolongation, and central nervous system assessment for neurological effects of the drug(Hedya et al., 2023). Some of the comorbidities associated with lithium include renal impairment, delirium, coma, brain death, and hypothyroidism.

Antidepressants used in the treatment of bipolar I disorder also have side effects. They include weight gain, insomnia, and decrease in libido, easy irritability, and dizziness, loss of appetite, constipation, and headaches. Patients should be monitored closely for adverse effects. They include suicidal thoughts, plans, or attempts, and serotonin syndrome. Patients should be monitored for weight gain, blood pressure, heart rate, and lipid profile. Patients should also be monitored for cues of suicidal behaviors such as increased energy levels, social withdrawal, irritability and increased agitation(Baldelli et al., 2021). Patients prescribed anticonvulsants should be monitored for side effects such as dizziness, irritability, fatigue, nausea, and mood changes. Some of the adverse effects that should be monitored include the development of skin rash, ataxia, changes in vision, and seizures(Selim et al., 2023).

Examples of Prescriptions

The following are three examples of the drug prescriptions for an adolescent patient who has been diagnosed with bipolar I disorder.

Example 1

Patient’s name: A.Y

Age: 15 years

Diagnosis: Bipolar I disorder

Treatment: Lithium 300 mg TDS orally 1/12

Medication refill: None

Prescriber’s name:

Example 2

Patient’s name: T.T.

Age: 16 years

Diagnosis: Bipolar I disorder

Treatment: Ziprasidone 80 mg orally BD 1/12

Medication refill: None

Prescriber’s name:

Example 3

Patient’s name: V.G.

Age: 15 years

Diagnosis: Bipolar I disorder

Treatment: Risperidone 1 mg once a day orally 1/12

Medication refill: None

Prescriber’s name:

Conclusion

Bipolar I disorder is a type of a bipolar disorder that affects the adolescents. Bipolar I disorder has low prevalence rate among adolescents and the population in general. Bipolar I disorder differs from bipolar II disorder. Its neurobiology is attributed to factors such as genetics and changes in the brain components such as neurotransmitters and functioning of HPA axis. The FDA has approved several drugs for us in adolescents with bipolar I disorder. Patients should be monitored closely for side effects, adverse effects, and laboratory investigations done to rule out any potential commodities that are associated with the drugs.

References

Baldelli, S., Cheli, S., Montrasio, C., Cattaneo, D., &Clementi, E. (2021). Therapeutic drug monitoring and pharmacogenetics of antipsychotics and antidepressants in real life settings: A 5-year single centre experience. The World Journal of Biological Psychiatry, 22(1), 34–45. https://doi.org/10.1080/15622975.2020.1747112

Chia, M. F., Cotton, S., Filia, K., Phelan, M., Conus, P., Jauhar, S., Marwaha, S., McGorry, P. D., Davey, C., Berk, M., &Ratheesh, A. (2019). Early intervention for bipolar disorder – Do current treatment guidelines provide recommendations for the early stages of the disorder? Journal of Affective Disorders, 257, 669–677. https://doi.org/10.1016/j.jad.2019.07.062

Gandhi, S. (2022). Textbook of Mental Health and Psychiatric Nursing: Principles and Practice. Elsevier Health Sciences.

Gorczynski, P., Currie, A., Gibson, K., Gouttebarge, V., Hainline, B., Castaldelli-Maia, J. M., Mountjoy, M., Purcell, R., Reardon, C. L., Rice, S., & Swartz, L. (2021).Developing mental health literacy and cultural competence in elite sport.Journal of Applied Sport Psychology, 33(4), 387–401. https://doi.org/10.1080/10413200.2020.1720045

Hafeman, D. M., Rooks, B., Merranko, J., Liao, F., Gill, M. K., Goldstein, T. R., Diler, R., Ryan, N., Goldstein, B. I., Axelson, D. A., Strober, M., Keller, M., Hunt, J., Hower, H., Weinstock, L. M., Yen, S., &Birmaher, B. (2020). Lithium Versus Other Mood-Stabilizing Medications in a Longitudinal Study of Youth Diagnosed With Bipolar Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1146–1155. https://doi.org/10.1016/j.jaac.2019.06.013

Hedya, S. A., Avula, A., &Swoboda, H. D. (2023).Lithium Toxicity.In StatPearls.StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK499992/

Kaar, S. J., Natesan, S., McCutcheon, R., &Howes, O. D. (2020). Antipsychotics: Mechanisms underlying clinical response and side-effects and novel treatment approaches based on pathophysiology. Neuropharmacology, 172, 107704. https://doi.org/10.1016/j.neuropharm.2019.107704

Kessing, L. V., González-Pinto, A., Fagiolini, A., Bechdolf, A., Reif, A., Yildiz, A., Etain, B., Henry, C., Severus, E., Reininghaus, E. Z., Morken, G., Goodwin, G. M., Scott, J., Geddes, J. R., Rietschel, M., Landén, M., Manchia, M., Bauer, M., Martinez-Cengotitabengoa, M., … Vieta, E. (2021). DSM-5 and ICD-11 criteria for bipolar disorder: Implications for the prevalence of bipolar disorder and validity of the diagnosis – A narrative review from the ECNP bipolar disorders network. European Neuropsychopharmacology, 47, 54–61. https://doi.org/10.1016/j.euroneuro.2021.01.097

Klein, C. C., Topalian, A. G., Starr, B., Welge, J., Blom, T., Starr, C., Deetz, I., Turner, H., Sage, J., Utecht, J., Fornari, V., Patino Duran, L., Higdon, C., Hutton, J. J., Sorter, M. T., Correll, C. U., &DelBello, M. P. (2020). The Importance of Second-Generation Antipsychotic-Related Weight Gain and Adherence Barriers in Youth with Bipolar Disorders: Patient, Parent, and Provider Perspectives. Journal of Child and Adolescent Psychopharmacology, 30(6), 376–380. https://doi.org/10.1089/cap.2019.0184

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders.The Lancet, 396(10265), 1841–1856. https://doi.org/10.1016/S0140-6736(20)31544-0

Psycom.net. (2021, July 14). Prevalence of Bipolar 1 Disorder. https://pro.psycom.net/assessment-diagnosis-adherence/bipolar-disorder/bipolar-disorder-prevalence-and-risks

Scaini, G., Valvassori, S. S., Diaz, A. P., Lima, C. N., Benevenuto, D., Fries, G. R., &Quevedo, J. (2020). Neurobiology of bipolar disorders: A review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings. Brazilian Journal of Psychiatry, 42, 536–551. https://doi.org/10.1590/1516-4446-2019-0732

Selim, M., Anilkumar, A. C., &Cichowski, E. (2023).Antiepileptic Drug Monitoring.In StatPearls.StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK482298/

Ungar, M., & Theron, L. (2020). Resilience and mental health: How multisystemic processes contribute to positive outcomes. The Lancet Psychiatry, 7(5), 441–448. https://doi.org/10.1016/S2215-0366(19)30434-1

Yee, C. S., Hawken, E. R., Baldessarini, R. J., &Vázquez, G. H. (2019). Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses. International Journal of Neuropsychopharmacology, 22(8), 531–540. https://doi.org/10.1093/ijnp/pyz034

Young, A. H., &Juruena, M. F. (2021).The Neurobiology of Bipolar Disorder. In A. H. Young & M. F. Juruena (Eds.), Bipolar Disorder: From Neuroscience to Treatment (pp. 1–20). Springer International Publishing. https://doi.org/10.1007/7854_2020_179

BUY A CUSTOM PAPER HERE ON; Assignment; Assessing and Treating Patients with Bipolar Disorder

For this assignment, you will write a 5–6-page paper on the topic of bipolar and bipolar and related disorders. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your paper, you will choose one of the following diagnoses: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, Bipolar and Related Disorder Due to Another Medical Condition. Your paper will include discussion for your chosen diagnosis of bipolar and related disorder on the following:

Prevalence and Neurobiology of your chosen disorder
Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria
Discuss special populations and considerations (children, adolescents, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder; demonstrating critical thinking beyond basics of HIPPA and informed consent with discussion of at least one for EACH category: legal considerations, ethical considerations, cultural considerations, social determinants of health
Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder
Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings. What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.
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.

Resources: 

  • Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
    • Chapter 7, “Treatments for Mood Disorders: So-Called “Antidepressants” and “Mood Stabilizers” (pp. 338-358)
  • 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/bipolar-watch.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/s40263-013-0060-3
  • U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:

  • amitriptyline
  • bupropion
  • citalopram
  • clomipramine
  • desipramine
  • desvenlafaxine
  • doxepin
  • duloxetine
  • escitalopram
  • fluoxetine
  • fluvoxamine
  • imipramine
  • ketamine
  • mirtazapine
  • nortriptyline
  • paroxetine
  • selegiline
  • sertraline
  • trazodone
  • venlafaxine
  • vilazodone
  • vortioxetine

 

BUY A CUSTOM PAPER HERE ON; Assignment; Assessing and Treating Patients with Bipolar Disorder

Rubric:

  • • Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria.
  • • Discuss special populations and considerations (children, adolescent, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder-be specific, not general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health.
  • • Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder • Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings. What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring.
  • Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.
  • Written Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
  • Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources; Paper is 5-6 pages not counting title page and reference page.

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