Therapy for Patients with Bipolar Disorders Nursing

NURSING

Nursing: Therapy for Patients with Bipolar Disorders

Bipolar disorder is one chronic illness that has gained emphasis over the past few decades. Depressive symptoms are included in this condition, which could be observed during adolescence or young adulthood and carried on in the late years of the patients’ lives (McCormick et al., 2015). Recurrent episodes of mood pathology could be witnessed for bipolar patients as there is a relative minimum to a high level of manic period, indicating high depressive episodes. This paper explores the symptoms and condition of a patient with bipolar disorder, the suggested therapy and medication represented by three decisions, the reason for selecting those decisions, and the ethical implications for carrying out each one.

Introduction to the Case

A Korean descent woman aging 26 years showed signs of acute mania after staying hospitalized for three weeks. Her diagnosis was found to be that of bipolar disorder. When she first visited the practitioner’s office, she was restless but still showed a cheerful mood. However, the signs included constantly moving in her chair and playing with things on the office table.

Her sleep was only five hours a day as she believed that sleep is unnecessary and hinders a person from having fun in life. The hospital physician found her overall health fine, with her weight being 100 pounds and a height of 5’5”. The medications were not working on her as she tested positive for the CYP2D6*10 allele condition, and she self-reported she does not consume Lithium as was first prescribed to her.

Her mental status seems satisfactory, as she said she has no homicidal or suicidal intentions. Her judgment skills appeared normal and outwardly not delusional or paranoid. The patient seemed alert; the dressing was inappropriate for a hospital visit. Her speech was tangential, and her mood was euthymic.

Decision 1

The first decision would be to reinforce the patient to take Lithium as advised earlier by the physician. Lithium is clinically proven and approved by FDA for positive outcomes for bipolar patients, especially patients hosing high signs of euthymia, significant depression, and (hypo-) mania (Volkmann et al., 2020).

The reason for not choosing the other two options in the exercise is that the patient is not taking Lithium initially, and option two talks about increasing the dose. She should be encouraged to adhere to the first medication plan so that if effective results are not observed even after following the prescribed dose, a revised higher dosage could be recommended. She needs first to understand the importance of medication adherence and its results on her condition on a long-term basis that could deteriorate functioning with a greater ‘efficacy-effectiveness’ gap and low improvements in the condition (Guadiano et al., 2008).

After selecting this option, it was hoped that the patient would show positive adherence patterns with education about medication adherence and its effects along with the actual prescribed dosage (Taibanguay et al., 2019). Also, since she has a CYP2D6*10 allele condition, her metabolism and body response to the medicine might not be accurate for a higher dose. Evidence suggests that bipolar patients with this condition could exhibit revolving door condition that is not acknowledged due to high economic costs for re-hospitalization (Seripa et al., 2018).

The ethical consideration of cultural competency for communication with Asian (Korean) patients is one of the chief factors for creating entrustment with the physicians. With entrusted professional activities (EPA), the assessment and implementation of pharmacological treatment would be more effective as communication would guarantee patient-centered care and understanding (Younas et al., 2021). Cultural sensitivity, empathy, and knowledge would be considered for ethical clinical practice so that speaking truth and confidentiality of the patient help guide the practitioner for an effective therapeutic role (Hoop et al., 2008).

Decision 2

The second decision could be to assess the rationale for non-compliance to medication adherence to know the reason and educate her to stop this behavior with the diffusion of knowledge about drug effects and pharmacology. Research has cited that patients’ belief plays an important role in medication adherence, and for bipolar pharmacological treatment to be successful, poor mortality or morbidity rates could prove detrimental (Tan, 2020). Beliefs might be associated with sociodemographic factors, pre-held opinions, and preferences. In the case of Korean descent, she is currently displaying primary non-adherence, which means she has stopped the medication on her own (Tan, 2020).

The other two options were not selected since increasing the Lithium dose and shifting the patient to Risperdal would have some adverse effects on her health. One of the medications might increase her sleep hours but would not be recommended for her weight. The other medication would make her too lethargic that she might come with her mother’s support next time, appearing too lazy compared to her first cheerful meeting.

It is expected that patients would adhere to medicine with enhanced motivation as self-efficacy would mediate. A strong connection has been confirmed amid education adherence and high levels of information. In contrast, self-efficacy was seen to promote the motivation for the patient’s well-being (Nafaradi et al., 2017). The same is hoped for the Korean descent woman.

The ethical consideration could involve the ‘ethical nudge’ influencing a patient’s decision by organizing their environment for better self-care and better opportunities of adopting health behaviors that are beneficial for chronic diseases like bipolar disorder (Reach, 2016). While some criticism about patient education might arise concern that it might include manipulation of patient’s beliefs into doing something, patient education is only about information and interpretive dissemination of knowledge to an autonomous person who has free will to accept or reject it (Reach, 2016).

Decision 3

The third decision is the least desirable one but still could be opted for due to better results on the Young Mania Rating Scale and a greater number of sleeping hours. Reduced sleep is associated with bipolar disorders and aggravation in its symptoms like mood swings and (hypo-) manic attitude (Hensch et al., 2019). Seroquel XR 300 mg does bring obesity symptoms, but it could be due to increased hours of sleep, as it causes constipation, one of the leading factors for obesity (Silveira et al., 2021).

The other options were not selected for the reasons mentioned earlier: extreme lethargy and finding support to come to the practitioners’ office. Discontinuation of Seroquel and starting other medication might have adverse effects due to the patient’s CYP2D6*10 allele condition. Also, administrating a 500-calorie meal might infuse weakness within the patient, which would not be favorable for psychological functioning. Counseling the client for constipation could be, however, a good option still, medication adherence for constipation also would be questionable under the client’s previous record for not taking prescribed medicines.

It is hoped while making this decision that a better Young Mania Rating Scale would help improve the symptoms of bipolar disorder and episodic maniac periods since the client was initially hospitalized for the onset of acute mania. With the set dosage of 300mg per day, it is expected that serious adverse effects would not be observed (Muneer, 2015). With a low dosage, the treatment could be assumed beneficial for treating episodic mania in the beginning.

The ethical consideration for the client here would also be cultural knowledge, empathy, confidentiality, and manipulation while executing patient education about the dosage of the selected medicine, the number of times it should be consumed, any side effects, and ways to prevent constipation. Although it was mentioned earlier that constipation prevention might involve concern about medication adherence, the patient should still be informed about the effects the drugs would have on her.

Conclusion

The three selected decisions are recommended based on the client’s condition regarding bipolar disorder. The client’s current health condition seems fine, but some issues still need to be fixed, and the prevention of acute mania episodes needs to be avoided. The first decision is about continuing Lithium, as suggested by the former physician at the hospital since Lithium has shown positive health outcomes for bipolar patients, as verified by evidence. The second decision is about assessing the rationale for non-compliance with medication adherence. At the moment, it is considered a primary reason for some of the recurring signs of the disorder since medicines that research has certified bring positivity to a bipolar patient’s health are not being followed as per prescription. Primary non-adherence is detected as the actual reason for the Korean descent woman. The third decision is least desirable since it has created more problems for the patient, yet, it has opted for a better Young Mania Rating Scale score and improved hours of sleep.

Similar hopeful results were expected in all three decisions as the main goal is improving health outcomes for Asian women. Regarding ethical implications, cultural competency is a mandatory clinical practice for the nurse practitioner as communication needs to build trust and create motivation for the patient to self-adhere and enhance self-efficacy. Confidentiality, patient education without manipulation, truthfulness, transparency, and honesty for fully informed patients are some of the ethical obligations of the practitioner in the given case.

References

Gaudiano, B. A., Weinstock, L. M., & Miller, I. W. (2008). Improving treatment adherence in bipolar disorder: a review of current psychosocial treatment efficacy and recommendations for future treatment development. Behavior Modification, 32(3), 267–301. https://doi.org/10.1177/0145445507309023