Assessing and Treating Bipolar Disorder
Introduction
Bipolar disorder is one of the psychological conditions affecting people of various age brackets both male and female. Clinicians should select the best treatment options depending on the patient factors. For example, Lithium is one of the best medications prescribed to treat bipolar disorders. Clinicians should also educate the patients about the side effects of Lithium (Malhi et al., 2017). The drug affects the kidney and thyroid systems are affected by long-term use of Lithium. Clinicians should also consider various ethical issues to prevent lawsuits. Treatment of bipolar disorder requires selecting the best medication and assessing the patient as they continue taking the medication.
Decision #1
The first decision is to compare the number of medications to decide the best option. The options available include Lithium 300mg orally BID, Risperdal 1 mg orally BID or Seroquel XR 100 mg orally HS. The best decision among the three medications to treat bipolar disorder with manic episodes is Lithium 300mg orally BID. Lithium is one of the widely used medication to treat bipolar disorders (Malhi et al., 2017). It is effective in reducing the severity and frequency of mania or bipolar depression. Clinicians also recommend the medication to patients to prevent future manic attacks (Stahl, 2013). Another reason for selecting the 300mg dosage of Lithium is that it is effective in female patients. Clinicians begin treatment with a low dosage to monitor patients and reduce the severity of side effects related to pharmacokinetics and pharmacodynamics (Ketter et al., 2016). An assessment of the kidney and thyroid system is required before prescribing the drug to avoid adverse effects.
The expectation upon prescribing the medication is that the patient will reduce the frequency and severity of manic attacks. Another expectation is that Lithium will suppress the symptoms including irritated mood, poor quality of sleep, unusual frequency of talking, organized thoughts, and reduce distractions (Malhi et al., 2017). The expectations are that the patient should have a lower Young Mania Rating Scale. Currently, the Young Mania Rating Scale is 22 according to a clinical assessment. For example, the patient should record a low mood change frequency and low irritability. Lithium also helps patients to improve interaction with peers and family members after four weeks of taking the medication (Stahl, 2013). She should also freely engage in daily activities such as going to work, eating, sleeping, cooking and doing house chores.
The patient returns to the clinic after four weeks. She indicates that little improvement has occurred after taking the medication. However, she confesses that she has not taken the medication consistently. According to the Young Mania Rating Scale, the patient still has 22 points. Therefore, she has not made any progress. One of the reasons for the lack of progress is due to the inconsistent administration of the drug. Another reason could be due to the low dosage of the drug.
Decision #2
The second decision involves increasing the dosage to 450mg orally BID. Randomized control trials indicate that increasing the dosage is effective since it boosts the therapeutic ability of the drug (Findling et al., 2019). The second decision also involves educating the patient on the purpose of taking Lithium medication consistently. While educating the patient, it is essential to determine why the patient is not taking the medication consistently (Stahl, 2013). Another decision is that the patient should take the medication and report back to the clinic after four weeks. Researchers indicate that four weeks is ample time for the Lithium drug to suppress the bipolar disorder symptoms.
The expectation after administering a higher dosage of the drug is that the patient demonstrated improved symptoms after four weeks. Currently, the patient is still demonstrating symptoms such as bipolar depression, hyperactivity, mood changes, and aggression (Findling et al., 2019). Other symptoms include poor quality of sleep, poor interaction with peers and low appetite. Lithium drug is an effective medication in the management of the bipolar disorder and helps patients to improve daily interactions and participation in basic tasks (Findling et al., 2019). Therefore, it is expected that after four weeks the symptoms will have improved significantly. Majorly, the expectation is to help the patient to participate in daily activities and improve the quality of life.
The patient returned to the clinic after four weeks. The presentation of the patient was an indication that the expectations had been met significantly. One of the outcomes is that the patient confessed she had taken the medication consistently after the awareness. The patient appreciated that she received the education and the medication had suppressed the symptoms. One of the improvements in the patient was the reduction of bipolar disorder, an improvement in the quality of sleep, appetite, reduction in hyperactivity and the ability to participate in daily activities. Additionally, the patient recorded a reduction in the Young Mania Rating Scale. According to the scale, the patient had 11 points, which is a 50 percent improvement in the symptoms. The patient also reported an increase in weight, which was expected. Weight gain is a common adverse effect of using Lithium for bipolar disorder.
One of the differences between the outcome the expectations is that the patient only had a 50 percent improvement. The difference could be due to the time and that if the patient takes the drug for another four weeks, she can improve 100 percent.
Decision #3
Decision #3 is to continue with the medication, Lithium 450mg orally BUD, since it has positive results on the patient. Research also shows that Lithium takes several weeks to create a significant change in an individual. The only side effect is an increase in weight which is a common side effect (Ketter et al., 2016). Changing the drug may not be healthy for the patient since it could lead to loss of weight. Losing weight is not healthy for the patient since it can affect their body functionality. Therefore, it is important to continue with the drug and change it to manage the weight after treating bipolar disorder. Lithium 450mg is an effective drug since it prevents future manic and depressive episodes (Stahl, 2013). It is also prescribed for long-term treatment as maintenance therapy. The drug is effective since it works on the brain and the central nervous system to control the mood.
During the drug prescription for another four weeks, it is important to notify the patient about other side effects during the long-term administration of the drug. Patients should take 8-12 glasses of water to avoid lithium from affecting the thyroid or kidney function (Ketter et al., 2016). The patient should also avoid taking salt above normal levels. During the prescription, it was also important to check the level of lithium concentration in the patient. The reason is that Lithium is metabolized differently in female patients compared to male patients (Stahl, 2013). Therefore, the dosage can be reduced once the patient improves significantly to avoid adverse effects.
The expectation is that the patient will manifest a 100 percent improvement in various symptoms after four weeks. For example, I expected the patient to report better quality of sleeping, improved interaction with other people and a reduction in mood changes. Research shows that the administration of Lithium for several weeks is effective in the treatment of the bipolar disorder (Ketter et al., 2016). It is also recommended for patients with symptoms such as delusions, hallucinations, hyperactivity, lack of sleep, and racing thoughts.
The outcome of the treatment is that the patient recorded a 100 percent improvement in symptoms. When the patient returned to the clinic, the expressed their joy that they had experienced better quality of sleep with no hallucinations. The patient also participated in daily activities without hyperactivity, mood changes, and racing thoughts. The expectations of the treatment had been met. However, a lower dosage of the drug can be prescribed or a different drug for therapeutic maintenance purposes to prevent the reoccurrence of the symptoms.
Ethical Considerations and Treatment
Ethical considerations are important during treatment to enhance the quality of treatment and prevent lawsuits. One of the ethical considerations during the treatment is to educate the patient about the effects of Lithium drugs (Stahl, 2013). For example, the adverse effects of Lithium is adding weight. The explanation is essential to discard therapeutic misconception. A patient is also entitled to information about changes in medication or dosage and reasons for the changes. Another consideration is to get the informed consent of the patient regarding treatment (Muir et al., 2019). The patient should agree to receive treatment and comply with the treatment goals. Treatment of mental conditions also requires confidentiality. All the information about the patient should be kept confidential. Clinicians risk legal implications if they do not comply with the privacy and confidentiality requirements in the treatment of mental conditions.
Clinicians should observe the human rights of a patient. Despite the medical condition of the patient, it is essential to avoid any violation of human rights or dignity. Healthcare providers should also provide care while observing justice and fairness (Muir et al., 2019). Fairness means caring for all patients without any bias. Consequently, clinicians are advised to avoid any conflict of interest such as providing care to patients with whom they have other relations (Stahl, 2013). For example, a PMHNP would be unethical for caring for a family member. Additionally, PMHNP should be ready to provide care to patients during emergencies. If a clinician fails to provide care, he would be deemed unethical (Muir et al., 2019). Therefore, the various ethical considerations are essential to improve the quality of treatment of mental health patients.
Conclusion
Treatment of bipolar requires a series of decisions. A series of decisions helps in monitoring the improvements in a patient. Lithium is one of the best medications used to treat bipolar disorders. During the prescription, it is important to educate a patient about the need to take the medication consistently. Patients should also adhere to the treatment to ensure better results. PMHNP should consider various ethical issues that affect the treatment of mental conditions such as bipolar disorder. Treatment of the bipolar disorder is effective when PMHNP choose the best medication among the available choices and assess the outcomes for appropriate changes.

References
Findling, R. L., McNamara, N. K., Pavuluri, M., Frazier, J. A., Rynn, M., Scheffer, R., … & Rowles, B. M. (2019). Lithium for the maintenance treatment of bipolar I disorders: a double-blind, placebo-controlled discontinuation study. Journal of the American Academy of Child & Adolescent Psychiatry, 58(2), 287-296.
Ketter, T. A., Miller, S., Dell’Osso, B., & Wang, P. W. (2016). Treatment of bipolar disorder: Review of evidence regarding quetiapine and lithium. Journal of Affective Disorders, 191, 256-273.
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: recommendations from clinical practice guidelines. Journal of Affective Disorders, 217, 266-280.
Muir, H. J., Coyne, A. E., Morrison, N. R., Boswell, J. F., & Constantino, M. J. (2019). Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems. Psychotherapy, 56(4), 459.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

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