NURS 6630N Psychopharmacologic Approaches To Treatment Of Psychology Assignment

The Assignment NURS 6630N Psychopharmacologic Approaches

Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:

Decision #1

• Which decision did you select?
• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources
• Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? NURS 6630N Psychopharmacologic Approaches To Treatment Of Psychology Assignment.

Decision #2

• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? NURS 6630N Psychopharmacologic Approaches To Treatment Of Psychology Assignment.

Decision #3

• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
• Also, include how ethical considerations might impact your treatment plan and communication with clients. NURS 6630N Psychopharmacologic Approaches To Treatment Of Psychology Assignment.

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Sample Solution

An Asian American Woman with Bipolar Disorder

            The case study at hand is about an Asian American woman with bipolar disorder. Essentially, bipolar disorder connotes a hyper-depressive mental condition that leads to typical changes in the mood, energy, levels of activity, and capacity to perform activities of daily living among the patients (Ludwig & Dwivedi, 2016). The condition triggers mood episodes in patients which are commonly characterized by abnormal behaviors, unusually extreme emotions, and interruption in levels of activity and sleep patterns. However, health care providers often face considerable challenges in diagnosing bipolar disorder given that its symptoms are mostly the same as other mental disorders, thus, leading to frequent misdiagnosis. As such, it is imperative for mental health care providers to gain insight into the pathophysiology of bipolar disorder to enable them to create the best care plan (Ludwig & Dwivedi, 2016). It is against this backdrop that this paper seeks to delve assess and develop a treatment plan for the patient in the case study. The appropriate pharmacokinetics and pharmacodynamics medications for the patient will be determined by her genetic makeup.

Decision One

Selected Decision

Initiate treatment with Risperdal 1 mg PO twice everyday

Rationale for Selection

            Reportedly, studies have indicated the existence of cytochrome P450 (CYP) 2D6*10 allele in the Asian American population and its association with Risperdal or plasma 9‐OH‐RIS active moiety levels (Vanwong et al., 2017). Therefore, the administration of Risperdal I mg PO twice every day is deemed appropriate since the medication is metabolized by CYP450 2D6. Risperdal is a usual antipsychotic agent that is recommended by the Food and Drug Administration (FDA) and World Health Organization (WHO) in the treatment of mental health disorders such as bipolar disorder. Although the manner of action of Risperdal is yet to be established, many scientists have associated Risperdal’s mode of operation with its capability to obstruct 5-HT2A and D2 receptors (Masi, Milone, Stawinoga, Veltri & Pisano, 2015). The frequency of dosage was deemed effective because the half-life of Risperdal approximately ranges between 20 to 24 hours. On the other hand, the side effects associated with Risperdal in the treatment of symptoms of bipolar disorder manifest within a period of one week. However, Risperdal can still remain effective with minimum side effects even after prolonged use. Besides, the side effects are not serious even when the drug is used and administered as a monotherapy. Moreover, Risperdal is among the safest psychotropic agents. 

            The patient can also be managed by other medications. For instance, Seroquel XR can be used; however, the drug is associated with numerous side effects such as weight gain. Also, Lithium can be suitable for the patient. But, since the patient is an Asian and has GIVEN the potential side effects of the drug, this option is also dispelled. As a result, the only best medication left t help in managing bipolar disorder in the patient is Risperdal. 

Expected Outcomes

            As noted above, it takes about one week for Risperdal to begin action in the body. As such, the patient is expected to visit the hospital after four weeks after fully recovering from the symptoms of bipolar disorder. Besides, it is projected that the patient will record maximum improvements in areas such as depressive and maniac symptoms, sleeping patterns, and interest in routine activities in this period of four weeks. 

Difference between Expected Outcomes and Actual Results

            The patient visited the facility after four weeks looking tired and sedated. There was an insignificant reduction in the symptoms of depression, which was different from the expectation since the side effects of the drug were not observable. Fundamentally, the original expectation is that the patient was able to manage her mood and also think appropriately but, this expectation did not actually materialize. Essentially, the side effects presented such as lethargy and sedation could be attributed to the higher Risperdal concentration in the blood of the patient.

Decision Two

Selected Decision

Dropping the dose to 1mg Risperdal HS

Rationale for Selection

            Although the patient came back to the facility with an insignificant reduction in symptoms, it does not imply that the medication failed to work on the patient. The only challenge reported was the manifestation of the side effects of Risperdal such as sedation and lethargy, which were attributed to higher concentrations of the drug in the blood of the Asian patient. Consequently, Stahl (2013) argues that it is imperative to reduce the routine dosage of Risperdal to half strength so as to lessen the concentration of plasma. However, opting for other options at this stage such as recommending the use of lithium to the patient is not recommended because of potential side effects and even interrupting the initial response to the Risperdal drugs. Moreover, changing the medication might impact the patient negatively by getting her confused and giving up on the effectiveness of the medication if any time she visits the clinic, a different drug is prescribed. Therefore, it is only prudent to intervene by reducing the dosage of the drug. 

Expected Outcomes

            Risperdal drugs tend to work by inhibiting the dopamine and serotonin receptors. Therefore, a reduction of the Risperdal dose may mitigate this effect. Nonetheless, the expectation is that side effects of sedation and lethargy are likely to withdraw between two to three weeks. Given that the symptoms of bipolar disorder in the patient-reported improvement, it is expected that the Risperdal drug will still reduce the symptoms of the condition regardless of the reduced dosage (Stahl & Stahl, 2013). The patient is expected to visit the facility again after four weeks feeling energetic, increased interest in routine daily activities, better sleeping pattern, and controlled mood.

Difference between Expected Outcomes and Actual Outcomes

            The patient visited the hospital four weeks after the last visit and confirmed that the symptoms of the side effects of sedation and lethargy improved. Besides, the patient’s symptoms of depression and maniac also reduced by half from the last visit. Nonetheless, the patient still complained about minimal interruption in the sleeping patterns and less interest in routine activities. Essentially, these patient outcomes regarding the side effects were expected. Nevertheless, the overall outcomes for bipolar disorder, the results were unexpected because the drug did not entirely eradicate the bipolar disorder inpatient after weeks on the drug as was expected.   

Decision Three

Selected Decision

Maintain administration of 1mg Risperdal HS

Rationale for Selection

            Since the patient reported a positive response to 1mg Risperdal HS with no indicated side effects, maintaining the Risperdal dose is recommended to further manage the symptoms of the bipolar disorder for the period of four weeks. However, any attempt to increase the dosage may lead to negative side effects. Reportedly, many studies have shown the benefits of prolonged use of Risperdal as monotherapy in managing bipolar disorder (Jeong et al., 2015). Consequently, owing to the effectiveness of the Risperdal drug for this patient, it is needless to introduce other psychotropic agents to avoid further complications on the patient. Taken together, the most appropriate intervention for the patient is to maintain the same doses of Risperdal drugs until the patient is fully recovered from the bipolar disorder.

Expected Outcomes

            Since it has been established that the Risperdal drug is most suitable in managing the patient’s symptoms without any presenting side effects, it is anticipated that maintaining the use of the drug will address the symptoms of depression and maniac inpatient within a period of two to three weeks (Stahl, 2013). Eventually, the patient is expected to have proper sleeping patterns, normal behaviors, regain interest in routine activities, have proper thoughts, and enhanced mood. No side effect is expected in the patient.

Difference between Expected Outcomes and Actual Outcomes

            The patient visited the facility after four weeks after the previous visit. She appeared energetic, normal, and in a cheerful mood. She confirmed not having any sleeping disturbances. Moreover, the patient claimed that she had recommenced her routine activities and there are no longer complaints about her behaviors. Ideally, this was the exact expectation after the third intervention. Consequently, it can be concluded that 1mg of Risperdal HS is a suitable medication for managing bipolar disorder without any undesirable side effects and should, therefore, be highly regarded as the best intervention in managing a similar case of bipolar disorder in the future.

Ethical Considerations

            The management and treatment of patients with bipolar disorder or any other mental health issues should be based on ethical principles and practices. In the present case, the psychiatric nurse practitioner (PMHNP) should strive to provide culturally-oriented patient care by incorporating the patient cultural beliefs and practices into the treatment plan. Besides, it is imperative for nurses to focus on patient-centered care by making every effort to involve the patient or her family in their care. Patient-centered care can be upheld by ensuring that the patient or her family is made aware of the diagnosis and treatment option and letting them choose the one they deem fit (Taylor, Lynn, & Bartlett, 2018). Besides, if any intervention is chosen, it is an ethical duty of the PMHNP to inform the patient or her family of the rationale for opting for the intervention or changing the treatment medication. The patient should also be informed of the possible side effects of using any given medication. Moreover, mental health patients often need intense family support for better outcomes. As such, the PMHNP should find the best ways of involving the patient’s family members in the best ways of managing symptoms for better outcomes.

Conclusion

            It has been established that many medications used in the management and treatment of mental health disorders tend to be influenced by the genetic composition of the various patients from various ethnic origins. For instance, in the case at hand, the choice of medication to manage and treat the condition was considerably influenced the ethnic background of Asian American origin. Nevertheless, even after the selection of the most appropriate drug that fits one’s ethnic origin, it is important to note that patients tend to respond differently to various medications. Therefore, the PMHNP should consider the essence of conducting follow-ups to find out any issues that may arise in the medication process to enable necessary interventions to fully manage the symptoms. The key consideration for the PMHNP should be ensuring that the treatment plan opted for does not harm the patient but offers optimum health benefits.

References

Jeong, J. H., Lee, J. G., Kim, M. D., Sohn, I., Shim, S. H., Wang, H. R., … & Min, K. J. (2015). Korean Medication Algorithm for Bipolar Disorder 2014: comparisons with other treatment guidelines. Neuropsychiatric disease and treatment, 11, 1561.

Ludwig, B., & Dwivedi, Y. (2016). Dissecting bipolar disorder complexity through epigenomic approach. Molecular psychiatry, 21(11), 1490-1498.

Masi, G., Milone, A., Stawinoga, A., Veltri, S., & Pisano, S. (2015). Efficacy and safety of risperidone and quetiapine in adolescents with bipolar II disorder comorbid with conduct disorder. Journal of clinical psychopharmacology, 35(5), 587-590.

Stahl, S. M., & Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.

Taylor, C., Lynn, P., & Bartlett, J. (2018). Fundamentals of Nursing: The Art and Science of Person-Centered Care. Lippincott Williams & Wilkins.

Vanwong, N., Ngamsamut, N., Medhasi, S., Puangpetch, A., Chamnanphon, M., Tan-Kam, T., … & Sukasem, C. (2017). Impact of CYP2D6 polymorphism on steady-state plasma levels of risperidone and 9-hydroxyrisperidone in thai children and adolescents with autism spectrum disorder. Journal of child and adolescent psychopharmacology, 27(2), 185-191.

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NURS 6630N Psychopharmacologic Approaches To Treatment Of Psychology