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Psychological Disorder, Presented and the Decision Steps
The psychological disorder chosen for this week’s discussion was Bipolar Disorder 1. The client is of Korean descent, a 26-year-old woman. She returned to her first appointment following a 21-day hospitalization for the onset of acute mania. She is dressed quite strangely, wearing what appears to be a sleeping gown to her appointment. Speech is rapid, pressured, tangential. The self-reported mood is euthymic. Upon arrival in the office, she is quite restless playing with things on your desk and changing from side to side in her chair. The patient reports a fantastic mood. She notes that she sleeps about five hours a night, to which she said that I hate sleep, it is no fun.” She says that she denies she has bipolar. She likes to talk and dance, sing, and cook. She tells being prescribed Lithium while she was hospitalized but confessed that she stopped taking this medication after she was discharged.
The beginning assessment activities describe those as a bipolar, manic, or euphoric state. Mania is a type of mental illness when a person shows a significantly elevated mood and mental instability. Their mood changes very frequently, and they bear the lack of concentration. The thought is inconstant. The mood shifts very often, with excessive unnatural excitement and not reliable and dependable—lesser need to sleep (Rosenthal & Burchum, 2018). The Bipolar mood or affective disorder is characterlike by recurrent episodes of mania and depression in the same patient at different times. These patients often have episodes of severe manaia and severe depression. Bipolar people may have normal moods in period manic or depressive episodes, making treatment observation even more complicated.
Recommended May Impact the Patient’s Pathophysiology.
The first treatment plan requires patient compliance for taking antimanic drugs such as lithium 300 mg PO twice a day for bipolar disorder is much higher than for other mental health disorder medications. According to medical records, lithium is the most prescribed drug. While it is still not clear what causes bipolar disorder, Research reports that it is the imbalance of brain chemicals that play a massive role in people with this condition. Specifically, serotonin and norepinephrine are the common chemicals in people with the condition that trigger manic episodes. The condition is more entrenched in the nervous system making it possible to successfully treat it with medication that stabilizes the moods of a patient and psychotherapy used to help patients manage complications in life emerging from the disorder’s episodes (Rosenthal & Burchum, 2018). The brains of people with bipolar disorders differ significantly from people who do not have bipolar or any mental illness. It is more likely that genetics plays a role in developing bipolar disorder in that patient whose parents had this disorder have a higher chance of developing the disease themselves (Cerimele, Chwastiak, Chan, Harrison, & Unützer, 2015). Patients can go through periods of normal moods in between manic or depressive episodes, making treatment difficult.
The client came back to the clinic by presenting manic behavior. During the episodes, a patient may look disturbed, but they become stable and sane once the events end. The patient may feel that her behavior does not require medications every day. The patient refutes she has problems. Lithium is for controlling acute manic episodes in patients with Bipolar disorder (BPD) and for long-term prophylaxis against the recurrence of mania or depression. In manic patients, lithium reduces euphoria, hyperactivity, and other symptoms but does not cause sedation. Antimanic effects begin 5 to 7 days after treatment onset, but full benefits may not develop for 2 to 3 weeks. Lithium noncompliance, the perceived loss can be a factor in relapses associated with bipolar (Gooding & Wolford, 2019).
The second treatment plan was to find what she was stable on at the hospital by reviewing records. To discuss the reason for non-compliance to cause justification for non-compliance and educate client drug benefits and pharmacology. The patient likely will not be compliant with any medications. Her family should see about discussing things to come up with a plan to compliant mediations. Throughout patients teaching is required proscribing all medications. It is essential to re-assess the patient’s level of understanding of each follow-up appointment if non-compliance happens, which lacks a sense of the importance of compliance with medications. To review the lithium level labs and reorder labs if needed.
The third plan if clinician is unable to access records, as well as start the risperidone at 2 mg at bedtime. The provider would want to see her in a week and make sure someone is helping take her medications. To make sure to do lab monitoring for lithium if this event has not been done at the hospital Clinician must have been controlled on a medication regiment before discharge. It is crucial that she comply with the medication regiment. Health care professionals should inform of the Lithium-related side effects possible trigger or exacerbate each other (Demirtas 2015). The side effects caused by lithium are GI distress, polyuria, cardiac irregularities, hypotension thyroid problems, tremors, etc. Observe this close condition and monitor. A therapeutic blood level of lithium is 0.6 and 1.2 milliequivalents per liter. Lithium toxicity can happen when the level reaches 1.5 mEq/L or higher. Severe lithium toxicity occurs at a level of 2.0 mEq/L and above, which can be life-threatening in a rare case.
To avoid toxicity, close follow-up and clinical supervision is essential. Monitor lithium level and abnormal electroencephalography (EEG) changes. The elevated serum lithium level will decrease before EEG normalization (Omi, 2018).
Treatment plans
For a treatment plan to develop successfully, the patient and treatment members must work together to develop achievable goals. Suppose a patient is non-compliant with medications or worries about side effects. In this case, the patient must be provided with medical education. For example, explaining how the side effects can subside in time, and to provide a course of action if the side effects do not subside after completing an adequate trial of the sustained-release preparation. There is also the opinion the change to the mood-stabilizing medications. It is vital to support and to supply honest medication education to help reach improved patient outcomes.
It is critical to educate the patient of the medication’s potential to increase their functioning role in society, as well as their general wellbeing. It is possible to successfully treat it with medication that stabilizes a patient’s moods and psychotherapy to help the patient manage complications in life emerging from the disorder episodes.
Lithium treatment may be associated with less progression in carotid intima-media thickness, and the reduced risk for atherosclerosis in adults with bipolar disorder, including those with high cardiovascular disease risk. In addition to age and body mass index, antipsychotics may increase carotid intima-media thickness even in low cardiovascular disease-risk patients (Tsai et al., 2020).
Although it is not yet clear what causes bipolar disorders, brain chemicals’ imbalance plays a massive role in people with this disorder. Specifically, a surplus or deficient amount of serotonin and norepinephrine are the common issues in people with the condition, which trigger manic episodes. Lithium therapy can help with bipolar disorder, and information is helpful to further patient education. Patients should be aware of the possible side effects and positive impact of complying with medication on their everyday life.
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