Assignment: NURS 6630 Assessing and Treating Patients With Bipolar Disorder
Assignment: NURS 6630 Assessing and Treating Patients With Bipolar Disorder
Assignment: NURS 6630 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.
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Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
Learning Resources
Required Readings
- 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
- Links to an external site. (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
- Links to an external site., 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
- Links to an external site. (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
- Links to an external site., 27(5), 331–333. https://doi.org/10.1007/s40263-013-0060-3
Medication Resources
- U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs
- Links to an external site.. 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:
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Required Media
- Doc Snipes. (2022, February 14). Bipolar disorder assessment and diagnosis
- Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=onKHtQWkNaU
Note: The approximate length of this media piece is 1 hour and 5 minutes
Optional Resources
- 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
- Links to an external site., 52(10), 734–739. http://acta.tums.ac.ir/index.php/acta
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
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.
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
Links to an external site. 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
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Rubric
NURS 6630_Week5_Assignment_Rubric
Criteria | Ratings | Pts | ||||
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This criterion is linked to a Learning Outcome Write a 5–6-page paper on the topic of bipolar and bipolar related disorders: • Prevalence • Neurobiology |
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20 pts | ||||
This criterion is linked to a Learning Outcome • 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. |
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20 pts | ||||
This criterion is linked to a Learning Outcome • 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. |
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20 pts | ||||
This criterion is linked to a Learning Outcome • 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. |
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15 pts | ||||
This criterion is linked to a Learning Outcome 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. |
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15 pts | ||||
This criterion is linked to a Learning Outcome 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. |
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5 pts | ||||
This criterion is linked to a Learning Outcome 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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5 pts | ||||
Total Points: 100 |
Assignment: NURS 6630 Assessing and Treating Patients With Bipolar Disorder Sample
Bipolar disorder is a debilitating condition that is characterized by episodes of hypomania or mania, as well as periods of low mood. This condition has the potential to be chronic and long-lasting. Individuals diagnosed with bipolar disorder experience challenges in various domains, including academic and occupational pursuits, social interactions, psychosocial functioning, marital relationships, and recurrent suicidal ideation and behavior. The current classification system for bipolar and related disorders, as recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), comprises five distinct categories. These include bipolar 1, cyclothymic disorder, bipolar 2, unspecified bipolar and related disorders, and other specified bipolar and related disorders (Miller & Black, 2020). This paper aims to expound upon the comprehensive evaluation and treatment of bipolar I disorder and elucidates the differences between bipolar I disorder and bipolar II disorder.
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Prevalence and Neurobiology
The onset of bipolar 1 disorder symptoms typically occurs at an average age of 18 years, and there is often a considerable duration between symptom onset and the initiation of treatment by mental health practitioners. Research indicates that a proportion ranging from 1% to 2.4% of the global populace will encounter bipolar 1 disorder during their lifespan, with equivalent prevalence rates for both genders (Gordovez & McMahon, 2020). Sex, as well as associated genetic and environmental risks, is another factor in the lifetime chance of developing bipolar disorder. Empirical data suggests that there exists a correlation between hypothalamic-pituitary-adrenal (HPA) axis malfunction in bipolar disorder and neuro-progression, resulting in persistent modifications in the HPA axis that lead to depression and more resistant bipolar episodes in later stages of life.
The exact cause of bipolar disorder is still not fully understood. However, it is known that the disorder may be caused by the interaction of genetic factors that make a person more likely to get the disorder and environmental factors that can cause, worsen, or keep the disorder going, such as stress or traumatic events(Lyall et al., 2019). The pathophysiological model of the illness suggests that mitochondrial malfunction, oxidative stress, and intracellular metabolic cascades interfere with the mechanisms involved in neural plasticity. According to post-mortem and neuroimaging studies, this eventually leads to cellular damage and a subsequent loss of brain tissue. Bipolar illnesses are related to alterations in peripheral biomarkers connected to hormones, oxidative stress, inflammation, and neurotrophins, especially during acute mood episodes, according to Jain and Mitra’s (2022) study. These changes have all been associated with the disease’s systemic toxicity and the damage that results from recurring episodes. The recurrence of episodes of bipolar disorder may lead to systemic toxins, which can affect the physical changes in the brain caused by stress and neurogenesis, as well as the reaction to treatment.
Differences in Bipolar I and Bipolar II Disorder
The manic episodes associated with type 1 bipolar disorder are considered to be more severe than those associated with type 2 bipolar illness. According to the DSM-V, the primary difference between bipolar 1 and bipolar 2 disorders is that the former condition requires a minimum of one manic episode, while the latter condition requires a minimum of one hypomanic episode and a minimum of one instance of severe depressive illness (Jain & Mitra, 2022). This fundamental difference is what distinguishes the two conditions from one another. Depression is not a required condition for the categorization of type I bipolar disorder, even though people who have been diagnosed with bipolar 1 disorder often have significant bouts of the mood disorder. The diagnosis of bipolar 1 disorder is contingent on several characteristics, such as the nature and severity of the most recent episode, the existence of psychotic symptoms, and the patient’s current state of remission.
Special Population and Considerations
The diagnosis of bipolar 1 disorder in children is a challenging task and has been a topic of significant controversy. The primary factor contributing to this conflict is the diagnosis of bipolar disorder (BD) in children presenting with severe mood dysregulation and/or persistent irritability in multiple centers across the United States(Gordovez & McMahon, 2020). This trend has increased the reported prevalence of BD. The identification of BD poses a challenge as a significant proportion of adolescents exhibiting its symptoms also meet the diagnostic criteria for ADHD and ODD.
It is imperative to acknowledge the probability of depression in geriatric patients, who commonly exhibit persistent ailments or recent loss. It is advisable to exercise caution when taking drugs as mood-related symptoms may resemble medical indications owing to delayed medication metabolism associated with aging. Clinicians may encounter legal and ethical challenges when providing treatment to patients diagnosed with bipolar disorder. Individuals who are undergoing manic or mixed-mood episodes may lack the capacity to provide informed consent or exhibit sound decision-making skills regarding their treatment due to their impulsivity, cognitive impairment, and impaired judgment.
Pharmacological Treatment
FDA-approved initial therapies for bipolar 1 disorder are commonly known as mood stabilizers, encompassing antidepressants, anticonvulsants, antipsychotics, and antimanic agents. According to Fountoulakis et al. (2019), the initial course of treatment for severe manic episodes or mixed episodes, as per the recommended practices of the American Psychiatric Association, involves the administration of lithium in combination with an antipsychotic or valproic acid in conjunction with an antipsychotic. Initially, it is imperative to optimize the ongoing medication for patients who encounter episodes of manic or hypomanic symptoms. The optimization of medication efficacy can be facilitated through the monitoring of blood levels of drugs such as lithium or valproic acid.
According to Miller and Black (2020), depending on the nature and intensity of the occurrence, antipsychotic medications and benzodiazepines may be prescribed and given to the patient as needed. In situations in which the primary medication, even when given in the optimal dosages, does not produce significant therapeutic outcomes, alternative strategies may include exchanging lithium for valproic acid or vice versa, incorporating oxcarbazepine or carbamazepine as a replacement for additional primary medication, or introducing antipsychotic drugs if they have not been used in the past. In all of these cases, the goal is to achieve the same effect as the primary medication (Volkmann et al., 2020). Clozapine has shown promise as a therapeutic option for the treatment of disorders that are resistant to many therapies.
Contemporary studies have provided evidence in favor of employing quetiapine single-agent therapy and olanzapine in conjunction with fluoxetine for the management of bipolar depression. According to Fountoulakis et al. (2019), patients may remain highly susceptible to recurrence for a duration of six months following the resolution of an acute episode. The aforementioned period is considered to be a constituent of the maintenance stage. The primary objective of maintenance therapy for Bipolar 1 is to prevent the recurrence of manic or depressive episodes, alleviate residual symptoms, mitigate the risk of suicide, and enhance the patient’s general well-being. According to the American Psychiatric Association, lithium, valproate, and lamotrigine are highly recommended for their significant contribution to the management of bipolar disorder(Post et al., 2019).
Proper Prescriptions
Conclusion
Given that bipolar disorder is a chronic condition, therapy must be sustained for a long time. The administration of medication to patients with bipolar disorder is a widely accepted practice. Nevertheless, there exists a range of evidence-based strategies and options to manage the various manifestations of manic depression like CBT. Determining the optimal medication for a patient necessitates a longitudinal assessment of treatment efficacy. As per the data presented in this scholarly paper, individuals afflicted with bipolar disorder may be prescribed a range of pharmacological interventions, including those aimed at addressing symptoms such as restlessness, anxiousness, insomnia, or despondency.
References
Fountoulakis, K. N., Yatham, L. N., Grunze, H., Vieta, E., Young, A. H., Blier, P., Tohen, M., Kasper, S., & Moeller, H. J. (2019). The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder. International Journal of Neuropsychopharmacology, 23(4), 230–256. https://doi.org/10.1093/ijnp/pyz064
Gordovez, F. J. A., & McMahon, F. J. (2020). The genetics of bipolar disorder. Molecular Psychiatry, 25(3). https://doi.org/10.1038/s41380-019-0634-7
Jain, A., & Mitra, P. (2022). Bipolar Affective Disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558998/
Lyall, L. M., Penades, N., & Smith, D. J. (2019). Changes in prescribing for bipolar disorder between 2009 and 2016: national-level data linkage study in Scotland. The British Journal of Psychiatry: The Journal of Mental Science, 215(1), 415–421. https://doi.org/10.1192/bjp.2019.16
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
Miller, J. N., & Black, D. W. (2020). Bipolar Disorder and Suicide: a Review. Current Psychiatry Reports, 22(2). https://doi.org/10.1007/s11920-020-1130-0
Post, R. M., Yatham, L. N., Vieta, E., Berk, M., & Nierenberg, A. A. (2019). Beyond the evidence‐based treatment of bipolar disorder: Rational pragmatic approaches to management. Bipolar Disorders, 21(7), 650–659. https://doi.org/10.1111/bdi.12813
Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium Treatment Over the Lifespan in Bipolar Disorders. Frontiers in Psychiatry, 11(377). https://doi.org/10.3389/fpsyt.2020.00377