NURS 6630 ASSIGNMENT: ASSESSING AND TREATING PATIENTS WITH BIPOLAR DISORDER
NURS 6630 ASSIGNMENT: ASSESSING AND TREATING PATIENTS WITH BIPOLAR DISORDER
Assessing and Treating Patients with Bipolar Disorder
Mental health disorders are a crucial public health concern because of its rising rates and impacts on the health of the population. Mental health problems such a bipolar disorder affect the patient’s quality of life and productivity. Mental health nurse practitioners explore effective, evidence-based interventions that will promote recovery and prevent relapse among the affected populations. Often, pharmacological and non-pharmacological interventions are effective in facilitating bipolar disorder management and prevention of symptom relapse. Therefore, the purpose of this paper is to explore bipolar I disorder. It examines topics that include prevalence and neurobiology of bipolar I disorder, differences with bipolar II disorder, treatment in a special population and consideration, and monitoring drug use in the population.
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Prevalence and Neurobiology
The selected type of bipolar disorder for analysis in the project is bipolar I disorder. Bipolar I disorder is a mental disorder characterized by patients experiencing episodes of irritable or highly elevated mood. The mood is referred to as mania. The expansive mood may be accompanied by other symptoms such as grandiosity, decreased need for sleep, racing thoughts, talkativeness, and engaging in risk-taking behaviors. The mood swings may shift between irritability, depression, anger and mania, resulting in mixed features in the bipolar disorder (Jones et al., 2022). Bipolar I disorder affects the health, wellbeing, and functioning of the patients, hence, the need for responsive strategies to optimize outcomes.
Bipolar I disorder has a lifetime prevalence of 0.6%. The prevalence is distributed equally between males and females. However, males tend to experience more manic episodes with the disorder while female experience more of depressive cycling episodes. The rates of bipolar I disorder is high in the developed countries (1.4%) as compared to the low-income countries (0.7%). Separated, widowed, or divorced individuals have the highest rate of bipolar I disorder. The cumulative prevalence of the three types of bipolar disorders is 1.8%. The onset of bipolar I disorder in the USA is at the age of 20 years while it is 29 years in the European countries (Psychdb.com, 2022). The prevalence rate among adults aged 18 years and above is 2.8%, with 4.4% of this population expected to develop it at some point in their lives. Adolescents have a lifetime prevalence of 2.9% of developing bipolar I disorder, with 2.6% of them suffering from severe impairment (Psychom.net, 2021). The risk factors for developing bipolar I disorder include genetics and environment risks such as traumatic experiences, substance abuse, and maternal vital infections during the prenatal period.
Bipolar I disorder has neurobiological basis. First, most studies have shown that individuals with bipolar disorder, including bipolar I experience death of neurons and glial cells. Persistent exposure to stress or traumatic events affects the functioning of glial cells and neurons, precipitating the onset of symptoms. There is also the role of neurotransmitters in the development of bipolar disorder. Accordingly, patients with bipolar disorder demonstrate changes in the regulation of dopamine, serotonin, and acetylcholine neurotransmitters (Young & Juruena, 2021). Alterations in the balance as well as their receptor systems affect functions such as behavior, endocrine regulation, and sleep-wakefulness.
Patients with bipolar I disorder also have problems with intracellular signaling in their brains. Studies have found the existence of macroscopic changes in brain regions and circuits, which are accompanied by chemical and histopathological brain changes. Stressors promote oxidative processes, which destroy brain cells, neurons, and cause imbalance in chemicals causing symptoms of bipolar I disorder (Scaini et al., 2020). For instance, there is an increase in the activity of chemical superoxide dismutase, which can depression and manic episodes in the affected patients.
Differences
A comparison is made between bipolar I and bipolar II disorder. The both types of bipolar have periods of depressive symptoms and elevated mood. The disorders also share similar symptoms during manic episode such as euphoria, insomnia, excessive talking, racing thoughts, and inflated self-esteem. They also have the same symptoms of depression such as low energy, sadness, decreased appetite, feelings of guilt, and isolation (Jones et al., 2022). However, they have some differences. The first one is that patients experience full manic episodes in bipolar I disorder. They experience extreme shifts in energy and mood. The symptoms are severe to affect the functioning of the patients in the social and occupational roles. The symptoms of mania and depression are less severe in bipolar II disorder. For example, hypomanic symptoms in this disorder such as elevated mood are not intense to affect the individual’s functioning. The depressive symptoms in bipolar I disorder lasts at least two weeks while in bipolar II they last at least two weeks but longer than bipolar I. Patients experiencing bipolar I disorder also have at least an episode of mania while there is no mania in bipolar II disorder (Coda, 2022). There is also the experiences of delusions and hallucinations in bipolar I disorder, which are not evident in bipolar II disorder.
Special Population and Considerations
Treatment of bipolar I disorder in special populations present unique challenges to mental health practitioners. The special populations include children, adolescents, pregnant mothers, post-operative adults, and the elderly. Each of this populations have unique needs that influence the selection of treatment in bipolar disorders. Children and adolescents have immature organs such as the liver and kidneys. These vital organs are involved in the metabolism and excretion of the different drugs used in treating bipolar disorders. Psychiatric mental health nurse practitioners must weigh the benefits and risks of the different options for treatment before prescribing them. Most of the treatments utilized for children and adolescents are also off-label. This places them at an increased risk of harm due to the use of drugs with unknown safety and efficacy index. The elderly patients also experience considerable functional declines that affect the options of treatment for bipolar disorders (Healthcare, 2023; Skidmore-Roth, 2022). For example, the decline in renal and hepatic functions affect the dosing of different medications for use in treating bipolar I disorder. Psychiatric mental health nurse practitioners must also assess the efficacy of the different drugs to prenatal mothers to eliminate risks of teratogenicity.
One of the legal consideration when treating bipolar I disorder is the psychiatric mental health nurse practitioner providing care within her scope. This includes ensuring the prescription of drugs for bipolar I disorder within her prescriptive authority. Practicing within the scope eliminates potential issues that may arise due to harm from the provided care. PMHNP should also make decisions based on ethical considerations. This includes seeking informed consent, and promoting privacy and confidentiality of the patients’ data. The nurse must also ensure safety in the care process. The prescribed treatments should not predispose the special populations to any harm. The decisions made should also aim at safeguarding the rights and needs of the patients, hence, non-maleficence and benevolence. PMHNP should also adopt patient-centered interventions in bipolar I disorder management. This includes utilizing interventions that align with the values, beliefs, practices, and expectations of the patients and their families (Healthcare, 2023; Williams, 2021). The consideration of patient factors in the treatment process promotes outcomes such as enhanced adherence to the prescribed interventions.
FDA and or Clinical Practice Guidelines
The Food and Drug Administration (FDA) is mandated with the responsibility of recommending drugs for use in treating conditions in different populations. The FDA has approved olanzapine-fluoxetine combination for treatment of bipolar disorder with depressive symptoms. The other approved drugs for acute treatment of bipolar depression include quetiapine and lurasidone. The FDA has also approved Risperdal, quetiapine, and aripiprazole for use in children and adolescents experiencing any stage of bipolar disorder. Lithium is approved for use in adolescents aged 12 and above years (Skidmore-Roth, 2022). Olanzapine recommendations is used for adolescents aged 13 years and above. The FDA also recommends lithium and aripiprazole use in children and adolescents to prevent symptom relapse. The FDA has also approved caplyta for treating bipolar disorder in the elderly population. The FDA approved treatment for mixed bipolar disorder entails the use of quetiapine and combination of fluoxetine and olanzapine (Citrome, 2020; Wang & Osser, 2020). Healthcare providers may also consider antipsychotics such as aripiprazole, asenapine, risperidone, and ziprasidone for maintenance treatment, as they are FDA approved.
Side Effects, FDA Warnings and Monitoring
Safety and quality should be upheld when treating patients with bipolar disorder. As a result, patients should be monitored closely for side effects and adverse reactions to the above treatments. The healthcare providers should monitor patients prescribed Risperdal, quetiapine, and aripiprazole for side effects that include weight gain, dizziness, akathisia, tiredness, nausea, night tremors, and decreased libido. They should also assess for increased appetite, drowsiness, and heartburn. Rare side effects that must be reported include seizures, parkinsonian side effects such as tremors and muscle stiffness, changes in ECG, and neuroleptic malignant syndrome (Healthcare, 2023; Williams, 2021). The signs to monitor related to neuroleptic malignant syndrome include fainting spells, racing heart rate, fever, and muscle stiffness.
Patients prescribed lithium should be monitored for side effects that include drowsiness, bradycardia, fainting, confusion, and weight gain. The additional side effects include diarrhea, seizures, blurred vision, tinnitus, and vomiting. Patients prescribed fluoxetine should be monitored for side effects such as weight gain, decreased libido, and insomnia. The use of antidepressants such as fluoxetine carriers the risk of suicidal thoughts, attempts, or plans. Patients and family members should be educated about the importance of monitoring mood and sudden surge in the patient’s energy. Such observations are clues to potential intent of self-harm by the patient. Weight gain in already obese or overweight patients should also be considered an issue of concern (Skidmore-Roth, 2022). Patients should be referred to a nutritionist for dietary recommendations and be educated about the importance of healthy lifestyles and behaviors such as engaging in active physical activity.
Proper Prescription
Name: Mr. V
Age: 35
Diagnosis: Bipolar I disorder
Treatment: po risperidone 2 mg od 1/12
Refills: none
Signature:
Name: AA
Age: 15
Diagnosis: Bipolar I disorder
Treatment: po Lithium 300mg od 1/12
Refills: none
Signature:
Name: Mrs. W
Age: 25
Diagnosis: Bipolar I disorder
Treatment: po risperidone 3mg od 1/12
Refills: none
Signature:
Conclusion
In summary, bipolar I disorder is a type of a mental health disorder associated with severe mania and hypomania. It affects negatively patient’s health, wellbeing, and functioning. Bipolar I disorder is severe than bipolar II. The FDA has approved several drugs for use in bipolar disorder. Psychiatric mental health nurse practitioners should monitor patients for side and adverse reactions to the prescribed treatments.
References
Citrome, L. (2020). Food and Drug Administration–Approved Treatments for Acute Bipolar Depression: What We Have and What We Need. Journal of Clinical Psychopharmacology, 40(4), 334. https://doi.org/10.1097/JCP.0000000000001227
Coda, F. (2022). 2023 Foundations of Psychiatric-Mental Health Nursing. Amazon Digital Services LLC – Kdp.
Healthcare, S. (2023). Pharmacology, Nutrition, Paediatric Nursing—2023. Svastham Healthcare.
Jones, D. J. S., Jones, J. S., & Beauvais, D. A. M. (2022). Psychiatric Mental Health Nursing: An Interpersonal Approach. Jones & Bartlett Learning.
Psychdb.com. (2022, January 16). Bipolar I Disorder. PsychDB. https://www.psychdb.com/bipolar/bipolar-i
Psychom.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
Skidmore-Roth, L. (2022). Mosby’s 2023 Nursing Drug Reference—E-Book. Elsevier Health Sciences.
Wang, D., & Osser, D. N. (2020). The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An update on bipolar depression. Bipolar Disorders, 22(5), 472–489. https://doi.org/10.1111/bdi.12860
Williams, L. (2021). Nursing 2022: Drug Handbook. Independently Published.
Young, A. H., & Juruena, M. F. (2021). The Neurobiology of Bipolar Disorder. Current Topics in Behavioral Neurosciences, 48, 1–20. https://doi.org/10.1007/7854_2020_179
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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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
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LEARNING RESOURCES
Required Readings
- Ostacher, M. J., & Hsin, H. (2016). The use of antiepileptic drugs in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 93–98). Elsevier.
- Perlis, R. H., & Ostacher, M. J. (2016a). Bipolar disorder. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 48–60). Elsevier.
- Perlis, R. H., & Ostacher, M. J. (2016b). Lithium and its role in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 86–92). Elsevier.
- Traeger, L., Brennan, M. M., & Herman, J. B. (2016). Treatment adherence. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 20–26). Elsevier.
- American Psychiatric Association. (2010b). Practice guideline for the treatment of patients with bipolar disorderLinks 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 PharmacologyLinks 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 disorderLinks 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 DrugsLinks 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 drugsLinks 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 diagnosisLinks 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 IranicaLinks 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 CenterLinks 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.
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Rubric
NURS_6630_Week5_Assignment_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning OutcomeWrite a 5–6-page paper on the topic of bipolar and bipolar related disorders: • Prevalence • Neurobiology |
|
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. |
|
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. |
|
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. |
|
15 pts | ||||
| This criterion is linked to a Learning OutcomeProvides 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. |
|
15 pts | ||||
| This criterion is linked to a Learning OutcomeWritten 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. |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten 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. |
|
5 pts | ||||
| Total Points: 100 | ||||||
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