Mood Disorder Case Study Psychopharmacology Analysis
Psychiatric disorders, such as bipolar disorder, present multiple clinical symptoms that should all be addressed. These symptoms are addressed through pharmacologic and non-pharmacologic interventions with varying degrees of success.
In addition, underlying conditions such as obesity and diabetes can affect care interventions hence the need for their consideration. Periodic evaluation of treatment regimens is also integral to determine if they are achieving their targets for vital clinical decision-making. This essay evaluates the treatment regimen of a patient with bipolar disorder.
The physiologic treatments are aripiprazole, sertraline, and lamotrigine. Aripiprazole was introduced to the treatment regimen after the insurer stopped paying for cariprazine. Cariprazine was used to replace quetiapine in managing bipolar mania after quetiapine, and valproic acid led to a marked increase in body weight. The therapeutic effect is to control weight gain, a side effect of using quetiapine and valproic acid together.
Sertraline was removed from the therapy but reintroduced after the patient developed depressive symptoms. Sertraline is a selective serotonin reuptake inhibitor that will help suppress the depressive symptom, which was the original desire during the first visit featured in the case study. Lamotrigine is used to manage bipolar depression, while aripiprazole addresses bipolar manic episodes. As seen in the case study, these drugs have been used to address different problems.
These three drugs, aripiprazole, sertraline, and lamotrigine, address different symptoms contributing to the patient’s diagnosis. They target various clinical signs of bipolar disorder. Aripiprazole targets bipolar mania, while lamotrigine targets bipolar depression, aiming to address the symptoms from all angles. The reintroduction of sertraline targets the depressive mood reoccurring after weaning her off sertraline. Thus, the physiologic targets of aripiprazole, sertraline, and lamotrigine are different.
Combining the three drugs is necessary, and the removal of one drug could negatively affect the patient’s recovery. While sertraline is an FDA-approved antidepressant drug, it cannot be used alone in treating bipolar disorders. The use of antipsychotic medications increases the efficiency of drugs.
In this case study, the treatments perform different functions, as seen earlier, and removing one drug could heighten some symptoms. Bhaji et al. (2021) tested the efficacy of these three drugs in achieving their therapeutic targets and showed them to be effective.
Sertraline and lamotrigine combined therapy is reported to cause suicidal ideations in females and dehydration in males. Sertraline and lamotrigine have superimposed effects and lead to rapid resolution of depressive impacts, leading to the development of manic and pre-manic symptoms such as suicidal ideations and suicidal attempts (Gatti et al., 2021).
Tremors among females and drug ineffectiveness are typical when sertraline and aripiprazole are used together. The effects could be expected due to the mechanism of action and the therapeutic targets. Sertraline elevates the mood, while aripiprazole tries to calm the elated mood. This antagonizing may thus lead to drug effectiveness. However, the bipolar symptoms all seem to react to the different therapies, and removing one drug could lead to undesirable effects.
Sertraline and aripiprazole have a superimposing effect hence dizziness and cardiac arrhythmias (potentially life-threatening) (Gatti et al., 2021). These drugs can be used together, and there is no contraindication. However, they have the potential for drug interactions, although rare, that are life-threatening. Reviewing the patient every month will help determine their effectiveness and help determine the need for therapy changes depending on side effects and patient response.
References
Bahji, A., Ermacora, D., Stephenson, C., Hawken, E. R., & Vazquez, G. (2020). Comparative efficacy and tolerability of pharmacological treatments for the treatment of acute bipolar depression: a systematic review and network meta-analysis. Journal of Affective Disorders, 269, 154-184. https://doi.org/10.1016/j.jad.2020.03.030
Gatti, M., De Ponti, F., & Pea, F. (2021). Clinically significant drug interactions between psychotropic agents and repurposed COVID-19 therapies. CNS Drugs, 35(4), 345-384. https://doi.org/10.1007/s40263-021-00811-2
Week 3: Assessing and Diagnosing Patients with Mood Disorders |
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:
- Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
- Objective: What observations did you make during the psychiatric assessment? 
- Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
- Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).