The client is a 26-year-old woman of Korean descent who presents to her first appointment

Case study:

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder. 

Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?” 

She weights 110 lbs. and is 5’5” 

SUBJECTIVE 

Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.” 

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work. 

Genetic testing reveals that she is positive for CYP2D6*10 allele. 

Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago. 

MENTAL STATUS EXAM 

The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation. 

The Young Mania Rating Scale (YMRS) score is 22.

Results of the interactive exercise:

Decision point One: 

I chose to start Lithium 300 mg orally BID over Risperdal 1mg orally BID or Seroquel XR 100 mg orally at HS.  

Results of the decision point one:   

• Client returns to clinic in four weeks. 

• Client informs you that she has been taking her drug “off and on” only when she “feels like she needs it.” 

• Today’s presentation is similar to the first day you met her.

Decision point two: 

I chose to assess the rationale for non-compliance to elicit reason for non-compliance and educate client Re: Drug effects, and pharmacology over increasing Lithium to 450 mg orally BID or switching to Depakote ER 500 mg orally at HS.

Results of the decision point two

• Client returns to clinic in four weeks.

• Client states that the drug makes her nauseated and gives her diarrhea.

• Client states that she stops taking it until these symptoms abate, at which point she re-starts only to experience the symptoms again.

Decision point three: 

I chose to change Lithium to Sustained Released preparation at same dose and frequency over changing to Depakote ER 500 mg orally at HS or changing to Trileptal 300 mg orally BID.

Guidance to Student of decision point three

In this case, the client is having nausea and diarrhea, classic side effects of lithium therapy. Changing the client to an extended-release formulation can often prevent these symptoms while at the same time affording the client the benefit of lithium’s mood stabilizing properties. Also, lithium is a good choice for control of mania and has also been shown to decrease risk of suicide, which adds to its overall benefits. Depakote may be an option if changing to sustained release lithium does not alleviate the side effects. Oxcarbazepine (Trileptal) is an option but is a second line therapy and is not appropriate at this stage as the client has not had an adequate trial of first line agents.

Instructions: 

The Assignment: 5 pages

Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

1- Which decision did you select?

2- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

3- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

4- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

5- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

1- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

2- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

3- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

4- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

1- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

2- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

3- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

4- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Please make sure all questions are answered entirely, use APA 7 and please provide plagiarism free paper.

Thank you.