Therapy for Patients with Bipolar Disorder NURS 6630 Week 5 Assignment

Prevalence and Neuroscience of Bipolar I Disorder

Bipolar I disorder, often known as manic-depressive disorder, is a mental condition characterized by periods of extreme mood elevation and high energy, followed by episodes of depression. The alternating pattern of mania and depression is a hallmark of bipolar disorder. Between mania and depressive periods, people with bipolar I illness may lead regular lives.

Therapy for Patients with Bipolar Disorder NURS 6630 Week 5 Assignment

According to the National Institute of Mental Health (2022), Bipolar I disorder affects approximately 2.5% (6 million individuals) of the population in the United States. The symptoms of bipolar 1 disorder first occur in adolescence or early adulthood, generally before the age of 50. The exact etiology of the disease is unknown; however, neurochemical, genetic, and environmental factors have been implicated to have a role.

Researchers have discovered that brain circuits in various parts of the brain govern emotions and mood by producing serotonin, norepinephrine, and dopamine (Young & Juruena, 2021; Scaini et al., 2020). The imbalance of neurotransmitters and faulty brain circuit functioning play an important part in the development of bipolar I disorder.

Furthermore, a combination of genetics and environmental factors is implicated in developing this disease; hence, the probability of having bipolar I in persons with certain specific genes and close family members with bipolar I is increased. Environmental variables such as chronic severe stress or trauma, feeling overwhelmed, and drug addiction may all contribute to the development of bipolar I disorder.

Bipolar 1 Presentation, and its DSM-5 Diagnostic Differences from the other Types of Bipolar Related Disorder (Bipolar II)

Symptoms

Manic episodes are characterized by euphoria, irritability, and disruptive and aberrant behaviors such as a quick shift of mind from one concept to the next, fast, uninterruptible, and pressured speech, high energy, high activity, grandiosity, drug misuse, egoism, and hypersexuality (APA, 2013). Following a manic episode, depression may occur quickly or later.

The majority of people have extended periods without bouts of mania and depression-cycling symptoms, and there are uncommon examples of fast cycling in those with Bipolar I. Another potential for people with bipolar disorder is that their mania and depression moods occur on the same day, which is known as a mixed characteristic.

The depressive mood of persons with Bipolar I is similar to that of typical clinical depression, with decreased energy, reduced appetite, suicidal thoughts, low self-esteem, and anhedonia (inability to enjoy pleasure) that lasts for weeks or months but seldom more than a year.

DSM-5 Diagnostic Differences Between Bipolar I and Bipolar II

Bipolar II disorder is the second bipolar-related illness type to which bipolar I will be compared. The manic phase in bipolar 1 is defined by an excessively high, expansive, or irritated mood that lasts at least one week and occurs virtually every day (criteria A), as well as at least three of the following symptoms: increased self-esteem, decreased need for sleep, excessive talkativeness, flight of ideas, easy distractibility, increase in goal-directed activities, and increased involvement in highly pleasurable but dangerous activities such as sex and overspending (criteria B), the symptoms cause marked dysfunction in social, occupational, and other vital areas of functioning (Criteria C), and the symptoms are not attributed to the physiological effects of a substance abuse (criteria D) (APA, 2013).

Bipolar 1 may also have a hypomanic phase, in which the symptoms are identical to the manic phase, but the time of excessively high, expansive, or irritated mood lasts at least four consecutive days rather than one full week (APA, 2013). Bipolar 1 may also have a depressive episode, which presents as a low mood with loss of interest, weight loss, insomnia, psychomotor agitation, fatigue, worthlessness, the difficulty of focus, and recurring thoughts of death (APA, 2013).

While complete manic and depressive episodes characterize bipolar I condition, bipolar II is distinguished by one hypomanic and one full depressive episode, as defined by the DSM-5 diagnostic criteria. The two illnesses may appear in clinically similar ways, necessitating a mental healthcare clinician who is familiar with the DSM-5 diagnostic criteria to identify and establish an accurate diagnosis.

Special Populations and Consideration

Treatment of mental disorders in children and adolescents may be challenging. The first obstacle arises from the difficulty in diagnosing mood disorders since it may be difficult to distinguish, for example, bipolar 1 illness from age-appropriate mood changes (Brickman & Fristad, 2022). The difficulties may result in a decline in the diagnosis of mood disorders in children and adolescents, resulting in inadequate treatment of the illnesses.

The second difficulty is that children and adolescents have not reached the legal age of consent and must rely on their parents and guardians’ choices to seek care and treatment, which may result in underdiagnosis and undertreatment of mood disorders. Pregnancy and postpartum changes are key phases to consider when treating bipolar individuals.

Pregnancy and postpartum states have been proven to increase the likelihood of relapse in people with bipolar illnesses, owing to hormonal changes during these times (Sharma et al., 2020). Women with bipolar illnesses who are hoping to conceive should engage closely with their mental healthcare specialists to develop methods for properly managing their condition. Because of the increased risk of suicide in the senior population, mood problems may be catastrophic.

The elderly population has limited social support and affection, which may be related to the loss of loved ones, insufficient financial support due to retirement, and may have difficulty accessing care due to physical immobility or multiple comorbidities, all of which increase their risk of suicidal ideation.

To reduce suicidality, elderly people need careful attention and care from mental health professionals as well as accessible family members. In terms of emergency care, bipolar 1 disorder might appear similar to any other mental illness or organic disease, prompting care providers to have a high clinical acumen to avoid missing the diagnosis.

FDA and/or Clinical Guidelines Approved Pharmacological Treatment Options

Bipolar I disorder is treated with mood stabilizers, antipsychotics, and sedative-hypnotics such as benzodiazepines. Lithium, for example, is the widely used mood stabilizer used to regulate largely classical euphoria or manic episodes rather than a depression-mania combination mood at the same time (Hafeman et al., 2020).

Before administering lithium, care providers must assess renal and thyroid function and avoid the drug if the baseline organ functions are abnormal. Further, Lithium has a narrow therapeutic window, necessitating cautious prescription and frequent monitoring of the patients on the drug. Valproate (antiseizure medicine) may be utilized for quick-acting mood balancing during acute bouts of mania.

Valproate (Depakote) is often administered using a loading dosage strategy, which begins with a high dose and results in mood stabilization after a few days of treatment. Other anti-seizer drugs used to treat mania and depression include carbamazepine and lamotrigine. Some antipsychotic drugs, such as Haldol and Thorazine, are used to treat manic and manic-depressive mixed moods.

Benzodiazepines, such as Xanax and diazepam, are used for the short-term treatment of acute manic symptoms such as anxiety and sleeplessness; however, benzodiazepines do not address the core symptoms of bipolar I and should only be considered as an adjunct treatment. In general, since benzodiazepine medications may be abused and misused by certain patients, doctors must exercise extreme care while administering them.

Common antidepressants such as Prozac, Zoloft, and Paxil are ineffective in treating depressive mood in people with bipolar I illness since they may increase manic episodes. The FDA-approved drugs for bipolar I depression include Symbyax (olanzapine-fluoxetine), Lurasidone, Caplyta, Seroquel, and Vraylar. In addition, electroconvulsive therapy (ECT) may be an effective treatment for manic and depressive moods in people with bipolar I.

Bipolar 1 disorder prevention may be difficult due to the unclear nature of its etiology; nonetheless, there are several approaches to reduce the risks associated with bipolar I development. Stress reduction, medications, sleep hygiene management, reducing/stopping alcohol or drug usage, and developing strong friends/family/society support are among the strategies.

Examples of Prescription

  1. Lithium

Indication: Bipolar disorder

Initial dosage: 1800 mg PO per day divided 8 hourly. Increase the dose as tolerated to target serum lithium concentrations of 0.8-1.2 mEq/L (acute goal) or 0.8-1.0 mEq/L (maintenance goal)

  1. Fluoxetine

Indication: Depression associated with bipolar 1 disorder, Major depressive disorder

Initial dosage: Fluoxetine 20 mg plus 5 mg Olanzapine PO every night at bedtime. Make dosage adjustments, if indicated, according to efficacy and tolerability within dose ranges of fluoxetine 20-50 mg and olanzapine 5-12.5 mg

  1. Lurasidone

Indication: Bipolar depression

Initial dosage: Lurasidone 20 mg PO per day initially, may increase the dose if needed, not to exceed 120 mg/day

Conclusion

Mood disorders are among the most common mental diseases that have existed since antiquity. Bipolar and depressive diseases are common mood disorders that gradually debilitate patients. Bipolar disorder is categorized into distinct categories according to the DSM-5 diagnostic criteria, with a narrow line of demarcation.

A mental healthcare provider with DSM-5 understanding and good clinical acumen is essential to make correct diagnoses and progress patients’ treatment. Several psychopharmacologic medications show promising results in illness therapy. However, the use of pharmacologic agents may be limited by side effects, patient comorbidities, and patient preferences. Thus, a clinician’s duty in the therapy of mood disorders is to prescribe and justify drugs according to the patient’s requirements.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
  • Brickman, H. M., & Fristad, M. A. (2022). Psychosocial treatments for bipolar disorder in children and adolescents. Annual Review of Clinical Psychology, 18(1), 291–327. https://doi.org/10.1146/annurev-clinpsy-072220-021237
  • Hafeman, D. M., Rooks, B., Merranko, J., Liao, F., Gill, M. K., Goldstein, T. R., Diler, R., Ryan, N., Goldstein, B. I., Axelson, D. A., Strober, M., Keller, M., Hunt, J., Hower, H., Weinstock, L. M., Yen, S., & Birmaher, B. (2020). Lithium versus other mood-stabilizing medications in a longitudinal study of youth diagnosed with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 59(10), 1146–1155. https://doi.org/10.1016/j.jaac.2019.06.013
  • National Institute of Mental Health. (2022). Bipolar disorder. National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/bipolar-disorder
  • 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. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil: 1999), 42(5), 536–551. https://doi.org/10.1590/1516-4446-2019-0732
  • Sharma, V., Sharma, P., & Sharma, S. (2020). Managing bipolar disorder during pregnancy and the postpartum period: a critical review of current practice. Expert Review of Neurotherapeutics, 20(4), 373–383. https://doi.org/10.1080/14737175.2020.1743684
  • 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

Therapy for Patients with Bipolar Disorder Instructions

For this assignment, you will write a  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.

Bipolar I

Bipolar I disorder also known as manic-depressive disorder is a mental illness with period of abnormal mood elevation and high energy associated with abnormal disruptive behaviors followed by episode of depression. Mania and depression cycling pattern is a sign of bipolar. People with bipolar I disorder may experience normal lives between mania and depression episodes. About 2.5% of the United States populations (6 million people) have bipolar I disorder.

Teenagerhood or early 20 years are the ages that bipolar disorder symptoms first appear. The sign and symptoms of bipolar I disorder may appear before age of 50-year-old. However, neurobiology of bipolar I mental disorder is not completely understood, researchers have found that emotions and mood are managed by the brain circuits in different part of brain by producing serotonin, norepinephrine, and dopamine. These neurotransmitters imbalance and abnormal brain circuits functionality play a significant role in development of bipolar I disorder.

The imbalance of neurotransmitters produced and released by the circuits cause the hallmark of bipolar I disorder which is manic and depressive episodes. Also, mix o genetic and environment factors are involved in development of this illness; therefore, the risk of developing bipolar I in individuals who have some certain genes and immediate family members with bipolar I is higher. The environmental factors such as experiencing consistent severe stress or trauma, being overwhelmed, substance abuse can be potential contribution to bipolar I disorder development.

Euphoria or irritability are the manifestations of manic episodes. The disruptive and abnormal behaviors of manic episodes are including rapid change of mind from one idea to the other, fast, uninterruptible, and load speech, high energy, high activity, grandiose, substance abuse, egoism, and hypersexuality. The mania episode can last few days to couple months if it is untreated. The following depression can happen shortly or longer after mania episode.

Majority of individuals experience long period without episodes of mania and depression-cycling symptoms, and there are rare cases of rapid cycling happening in individuals with Bipolar I. Another possibility for individuals with bipolar I that the mania and depression mood happening simultaneously at the same day which is called mixed feature. Depressive mood of people with Bipolar I is like regular clinical depression including low energy, reduced appetite, suicidal ideation, low self-esteem, anhedonia (inability to feel pleasure which happen for weeks or months but hardly ever longer than a year.

The treatments used for bipolar I disorder are including mood stabilizers, antipsychotics, and sedative-hypnotics such as benzodiazepines. Examples of mood stabilizers are lithium to control mostly classical euphoria or mania rather than depression-mania mixture mood at the same time. It is more than sixty years that lithium is used to treat bipolar I, and it can take weeks to see the effective results. Providers need to assess the kidney and thyroid functionality and lithium level before prescribing lithium.

For acute episodes of mania, the Valproate (antiseizure medication) can be used for fast acting-mood balancing. Usually, a loading dose method which starting with a high dose is used for Valproate (Depakote) and stabilizing of mood caused by this medication is seen after couple days of using.  Carbamazepine and lamotrigine are other anti-seizer medications that are used to treat mania and depression mood.

Some antipsychotic medications such as Haldol and Thorazine are used as preventive treatment and to treat manic and manic-depression mixed mood. Some benzodiazepines such as Xanax and diazepam are used for short-term management of acute mania symptoms including anxiety and insomnia, however the fundamental symptoms of bipolar I symptoms such depression or abnormal excitement are not treated by benzodiazepines.

In general, providers need to be extra caution when prescribing benzodiazepine medications since they can be addictive and abused by some patients. common antidepressants including Prozac, Zoloft, and Paxil are not found to be useful in treating depression mood of individuals with bipolar I disorder since it can worsen the manic episodes. Symbyax (olanzepine-fluoxetine), Lurasidone , Caplyta, Seroquel, and Vraylar are the FDA approved medications to treat bipolar I depression. Also, electroconvulsive therapy (ECT) can be used as an efficient treatment for manic and dperession mood of individuals with bipolar I. ECT can be used as a fast recovery and relief of severe bipolar I symptoms.

Bipolar I development can’t be prevented completely because the causes of this illness is not well understood, but there are some ways to lower the risks associated with bipolar I development such as adhering stress, medication, sleep hygiene management, reduce/stop alcohol or drug use, and creation of strong friends/family/society supports.

How Is Bipolar I Different From Other Types of Bipolar Disorder?

Reference

Young, A. H., & Juruena, M. F. (2020). The neurobiology of bipolar disorder. In Bipolar Disorder: From Neuroscience to Treatment (pp. 1-20). Springer, Cham.

Therapy for Patients with Bipolar Disorders Example two

Mood disorders are common psychiatric conditions that have existed since antiquity.  In psychiatric pedagogy, mood is defined as a persistent and pervasive feeling or emotional reaction that influences one’s whole psychic life (Sekhon & Gupta, 2022). Thus, mood disorders are characterized by significant disturbances in emotions, either low or high. For example, the two most widely researched mood disorders are bipolar and depression, which is distinguished by elevated emotions and severe lows, respectively (Sekhon & Gupta, 2022).

While the exact cause of mood disorders is unknown, genetics, biological, neuroendocrine, physiological, and psychological variables have all been proposed to have a role. The objective of this paper is to explore the prevalence, neurobiology, DSM5 diagnostic criteria, special populations, and considerations and describe the FDA-approved pharmacologic treatment options, side effects, and methods of monitoring with reference to a chosen bipolar disorder (bipolar 1) and one other related disorder (depression).

Prevalence and Neurobiology

Estimates of the prevalence of mood disorders are heavily reliant on research conducted within particular groups of people and in certain countries. According to the American Psychiatric Association [APA] (2013), the 12-month prevalence estimate of bipolar 1, as defined by the DSM5, in the United States is 0.6%, while the same condition’s 12-month prevalence varied from 0.0% to 0.6% across 11 countries. Bipolar 1 disorder has a modest gender bias, with a lifetime male-female prevalence ratio of approximately 1.1:1. (APA, 2013).

The 12-month prevalence of major depressive illness in the United States is approximately 7%. (APA, 2013). However, there is a significant disparity in prevalence by age, with persons aged 18 to 29 having a twofold greater prevalence than those aged 60 and above (APA, 2013). Sekhon and Gupta (2022) underpin the above findings by stating that the prevalence rate of depression among adults in the United States is 7.1%, with women being twice as afflicted as males. However, the explanation for the gender variations in mood disorders is unclear and needs further investigation.

The neurobiology of a disease aids in the explanation of the exact or proposed mechanisms that are attributed to the disease’s causation. Both bipolar 1 and depression, as mood disorders, share a neurobiology hypothesis; however, there are minor differences. The biochemical theory, which attributes mood disorders primarily to monoamines (norepinephrine, dopamine, and serotonin), is widely accepted.

In bipolar 1, there is a functional increase of amines at the synaptic cleft, which is responsible for the expansive mood that prevails; however, in depression, there is a functional decrease in amine levels, which causes the predominant mood to be sad/depressed (Kaltenboeck & Harmer, 2018; Scaini et al., 2020). Furthermore, the effects of antidepressants and mood stabilizers add to the biochemical theory of mood disorders. A decrease in serotonergic function in depressive patients, as evidenced by low urinary and plasma serotonin levels, provides additional evidence.

The Differences in the DSM5 Diagnostic Criteria between Bipolar 1 and Major Depressive Disorder

The DSM5 diagnostic tool is a clinical guideline that contains the most up-to-date criteria for diagnosing mental illnesses. The DSM5 diagnostic criteria for bipolar 1 and major depressive disorder vary grossly. To diagnose bipolar 1, a manic episode is defined as a distinct period of abnormally elevated, expansive, or irritable mood that lasts one week and is present most of the time (criteria A), with three or more of the following symptoms: grandiosity/inflated self-esteem, decreased need for sleep, flight of ideas, over talkativeness, easy distractibility, increase in goal-oriented activities and increased engagement in pleasurable activities such as sex (criteria B), impairment in social, occupational, or other areas of functioning (C), and the episode cannot be linked to the physiological consequences of drug addiction or another medical condition (D) (APA, 2013).

Bipolar 1 disorder may also have a hypomanic phase, which is virtually identical to the manic phase except that the distinct time of excessively elevated, expansive, or irritated mood lasts at least four days rather than one week as in the manic phase (APA, 2013). In addition, during the depressed phase of bipolar 1, a person may experience extreme sadness, loss of interest, and fatigue, as well as trouble concentrating, changes in appetite, and suicidal thoughts.

The DSM5 criteria for diagnosing major depressive disease include five elements. Within two weeks, five or more of the following occur: depressed mood, loss of interest, loss of energy, weight loss, sleep disturbances, feelings of worthlessness, recurring thoughts of death or suicidal ideation, difficulty concentrating, and psychomotor agitation or retardation (criteria A); impairment in social, occupational, and other important areas of functioning (criteria B); symptoms are not attributed to physiological effects of substance abuse or another medical condition (criteria C); symptoms are not better explained by another psychiatric disorder (criteria D); and in criteria E, there has never been a manic or hypomanic episode (APA, 2013). The DSM5 diagnostic criteria clearly show how the presentations of the two illnesses vary, allowing a clinician to differentiate between the two.

Special Populations and Considerations

The treatment of mental health diseases in children and adolescents is challenging. This is because certain mental health disorders, such as attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), are only diagnosed in childhood, and hence may mislead physicians for other ailments such as bipolar 1 and depressive illnesses. Confusion may lead to a misdiagnosis of bipolar 1, resulting in suboptimal and improper therapy. Pregnancy and postpartum states increase the likelihood of relapse in bipolar 1 or depressed individuals (Sharma et al., 2020).

The impact of hormonal changes during pregnancy and the post-partum states are thought to increase the chance of relapse (Sharma et al., 2020). Women who are hoping to conceive should thus collaborate closely with their mental health care providers to design a treatment plan and relapse prevention techniques. Suicide is more likely in older persons with bipolar 1 or a depressive disorder.

The increased suicide risk is ascribed to loneliness caused by the death of loved ones, a lack of appropriate financial support due to retirement, and anxiety caused by the uncertainty of many comorbidities associated with aging (Morgan et al., 2018). Older persons need constant attention from caregivers and accessible family members to lessen the risk of suicidality. Because the acute presentation of bipolar 1 and other acute mental disorders are so similar, an emergency treatment for bipolar 1 patients may be challenging; consequently, caregivers must have a high clinical index of suspicion.

FDA and/or Clinical Guidelines Approved Pharmacological Treatment Options

The first-line pharmacologic treatments for bipolar 1 disorder include mood stabilizers and antipsychotics. Lithium is the most effective mood stabilizer used in the treatment of bipolar disorder; nonetheless, it has a narrow therapeutic window, necessitating cautious prescription and regular monitoring (Chokhawala et al., 2022).

Lithium side effects include leukocytosis, polyuria, teratogenicity, dry mouth, hand tremors, confusion, reduced memory, muscular weakness, and gastrointestinal disturbance such as nausea, vomiting, and diarrhea in more than 10% of patients (Chokhawala et al., 2022). Quetiapine, olanzapine, and risperidone are the most often used antipsychotics to treat bipolar 1 disorder. They have the advantage of not being teratogenic like lithium. However, the use of atypical antipsychotic medicines is restricted due to adverse effects such as weight gain, diabetes, and hypercholesterolemia (Willner et al., 2022).

In the treatment of major depression, selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline, as well as serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine, are used. The effectiveness of antidepressants is largely equal across classes; therefore, side effects, comorbidities, and patient characteristics may influence a doctor’s decision to prescribe one class over another. Antidepressant side effects vary per medication and include sedation or activation, weight gain, headaches, tremors, high blood pressure, sexual dysfunction, and gastrointestinal upset (Sheffler & Abdijadid, 2022). Because all of the treatments listed are FDA-approved, it is up to a doctor to evaluate which would best fit a certain patient’s requirements.

While on Lithium drug, doing a complete blood count at least twice a week helps in the detection of leukocytosis, a side effect of the drug. Also, frequent thyroid function tests must be obtained when on Lithium, due to the drug’s tendency to induce goiter and hypothyroidism (Chokhawala et al., 2022). While the patient is on the atypical antipsychotics, monitoring weight, blood pressure, lipid levels, and random blood sugar levels help detect metabolic syndrome, which may set in as a side effect of the medications (Sheffler & Abdijadid, 2022). Further, since Venlafaxine, an SNRI, causes raised blood pressure, constant measuring of blood pressure is essential.

Writing Proper Prescriptions

  1. Lithium

Indication: Bipolar disorder

Initial dose: Immediate release 1800 mg/day PO divided 8 hourly a day

  1. Quetiapine

Indication: Adjunct therapy for bipolar disorder

Initial dose:

Immediate release

Day 1: 100 mg/day PO divided q12hr

Day 2: 200 mg/day PO divided q12hr

Day 3: 300 mg/day PO divided q12hr

Day 4: 400 mg/day PO divided q12hr

Further dosage adjustments, up to 800 mg/day by day 6, should be in increments ≤200 mg/day

Dosage range: 400-800 mg/day; not to exceed 800 mg/day

  1. Fluoxetine

Indication: Depressive illness

Initial dose: 20 mg PO per day. May consider gradually increasing the dose after several weeks by 20 mg/day; not to exceed 80 mg per day.

Conclusion

Mood disorders are among the most frequent and long-standing mental diseases. Bipolar and depressive illnesses are frequent mood disorders that continue to debilitate people over time. Various psychopharmacologic drugs show prospective improvements in disease treatment. However, pharmacologic agents’ use may be restricted by side effects, patient comorbidities, and patient preferences. Consequently, a clinician must be aware of the drug’s pharmacology and prescribe accordingly.

References

  • Chokhawala, K., Lee, S., & Saadabadi, A. (2022). Lithium. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519062/
  • Kaltenboeck, A., & Harmer, C. (2018). The neuroscience of depressive disorders: A brief review of the past and some considerations about the future. Brain and Neuroscience Advances, 2, 2398212818799269. https://doi.org/10.1177/2398212818799269
  • Morgan, C., Webb, R. T., Carr, M. J., Kontopantelis, E., Chew-Graham, C. A., Kapur, N., & Ashcroft, D. M. (2018). Self-harm in a primary care cohort of older people: incidence, clinical management, and risk of suicide and other causes of death. The Lancet. Psychiatry, 5(11), 905–912. https://doi.org/10.1016/S2215-0366(18)30348-1
  • 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. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil: 1999), 42(5), 536–551. https://doi.org/10.1590/1516-4446-2019-0732
  • Sekhon, S., & Gupta, V. (2022). Mood Disorder. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558911/
  • Sharma, V., Sharma, P., & Sharma, S. (2020). Managing bipolar disorder during pregnancy and the postpartum period: a critical review of current practice. Expert Review of Neurotherapeutics, 20(4), 373–383. https://doi.org/10.1080/14737175.2020.1743684
  • Sheffler, Z. M., & Abdijadid, S. (2022). Antidepressants. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538182/
  • Willner, K., Vasan, S., & Abdijadid, S. (2022). Atypical Antipsychotic Agents. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448156/

Name: NURS_6630_Week 5_Assignment_Rubric

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List View
Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point range: 0–69
Write a 5–6-page paper on the topic of bipolar and bipolar related disorders:

• Prevalence
• Neurobiology
18 (18%) – 20 (20%)
Discussion includes Prevalence and Neurobiology of chosen bipolar and related disorder.
16 (16%) – 17 (17%)
Discussion is vague regarding Prevalence and Neurobiology of chosen bipolar and related disorder.
14 (14%) – 15 (15%)
Discussion is missing one section for Prevalence and Neurobiology of chosen bipolar and related disorder.
0 (0%) – 13 (13%)
Discussion is inaccurate or missing more than one section for Prevalence and Neurobiology of chosen bipolar and related 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.
18 (18%) – 20 (20%)
Discussion includes the differences between 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.
16 (16%) – 17 (17%)
Discussion includes the differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM version older than DSM 5 TR criteria.
14 (14%) – 15 (15%)
Discussion is vague in differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria and/or missing discussion presentation of symptoms according to DSM 5 TR criteria or older version of DSM.
0 (0%) – 13 (13%)
Discussion is inaccurate or does not include the differences between 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 or older version of DSM.
• 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.
18 (18%) – 20 (20%)
Special Populations and Considerations are discussed and 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.
16 (16%) – 17 (17%)
Special Populations and Considerations are discussed not specific, but 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.
14 (14%) – 15 (15%)
Special Populations Considerations are discussed not specific, but general and missing 1-2 of EACH category and does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health.
0 (0%) – 13 (13%)
Special Populations Considerations are vaguley or not discussed, not specific, is inaccurate and/or general and missing 3+ or more of or none of EACH category, inaccurate discussion and/or does not demonstrate critical thinking beyond basics of HIPPA and informed consent: 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.
14 (14%) – 15 (15%)
Discussion includes FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is discussion regarding side effects, FDA approvals and warnings. Paper includes what is important to monitor in terms of labs, comorbid medical issues with why important formonitoring.
12 (12%) – 13 (13%)
Discussion includes vague FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is vague discussion regarding side effects, FDA approvals and warnings. Paper includes vague discussion what is important to monitor in terms of labs, comorbid medical issues with why important for monitoring.
10 (10%) – 11 (11%)
Discussion includes pharmacological treatment options but not aligned with FDA approved and/or clinical practice guidelines in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is missing elements for discussion regarding side effects, FDA approvals and warnings. Paper includes what is important to monitor in terms of labs, comorbid medical issues but does not discuss why important for monitoring.

0 (0%) – 9 (9%)
Discussion inaccurate and/or missing pharmacological treatment options but not aligned with FDA approved and/or clinical practice guidelines in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is inaccurate or no elements for discussion regarding side effects, FDA approvals and warnings. Paper does not include what is important to monitor in terms of labs, comorbid medical issues but does not discuss why important for monitoring.

Provides 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.
14 (14%) – 15 (15%)
Provides 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.
12 (12%) – 13 (13%)
Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 1-2 elements of the following; date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.
10 (10%) – 11 (11%)
Provides two examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 3 of the following: date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.
0 (0%) – 9 (9%)
Provides one example of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 4+ or is inaccurately written for date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.

Written 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 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written 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 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors; 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.
4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors; includes the following: title page and reference page. Only contains 2 scholarly supporting resources outside of course provided resources. Paper is 4 pages not counting title page and reference page.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (three or four) grammar, spelling, and punctuation errors; missing one of the following; title page or reference page; only contains 1 scholaraly supporting resources outside of course provided. Paper is 3 pages or exceeds to page 7 not counting title page and reference page.
0 (0%) – 3 (3%)
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding; missing the following; title page and reference page; contains no scholarly supporting resources outside of course provided resources. Paper is 2 pages or exceeds 8 pages not counting title page …

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