Bipolar disorder refers to a mental condition that causes episodes of either great moods and high spirits or hopelessness and acute discouragement in the affected patients. This state of mind is called hypomania and is based on the seriousness of the patient’s condition who may either be too cheerful, irritable or lively during these moments (Fountoulakis, 2015). Patients who are experiencing bipolar disorder often tend to settle on choices that may not suit them without caring about the consequences after that. Research done on bipolar patients has shown that they are prone to suicidal thoughts with those suffering for more than 20 years having 6% of cases of suicides. It is estimated that 30-40% of bipolar disorder patients take options of self-destruction and may harm themselves while other seek in substance abuse (Fountoulakis, 2015). Bipolar disorder can either be attributed to hereditary or ecological factors such long-stress and mishandling of adolescence. Bipolar disorder can be classified either as Bipolar 1 where the patient has had more than one hyper case even if depression was involved or not, or Bipolar 2 which is characterized by the occurrence of more than one hypomanic case with a massive episode of depression.
The case study refers to a 26-year-old Korean woman who gets an appointment at the clinic after being hospitalized for 21 days for acute mania. This woman was diagnosed with Bipolar 1 disorder, and her behavior at the clinic confirmed this possibility which she expressed by having episodes of wonderful moods. The patient’s hospital records and laboratory results showed that she was in good health and her body conditions were normal, but her genetic testing confirmed that she was positive for the CYP2D6*10 allele which was responsible for her disorder (Laureate Education, 2016). According to the young mania rating scale, she scored 22 on assessment.
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Decision One: Risperdal Medication Commencement at 1mg Orally BID
Risperdal medication was chosen because administrating the drug to the patient; specifically, 1mg of the drug taken orally BID, is always the best selection to patients who are in the same category as one in the case study. Risperdal is referred to as an atypical antipsychotic, which is a second-generation drug that is used in the treatment of the bipolar condition. CYP2D6 metabolizes the drug by involving the cytochrome P450 (CYP) 2D6 mitochondrial system (Weiss & Connery, 2014). The drug is effective by enabling consideration and inclination in the conduct of the patient by providing serotonin and dopamine balance.
The patient was projected to have improvements in her sleeping, mood, and speech after a period of four weeks under this medication. Risperdal administration was considered to help adjust the mental action to the capability and capacity of establishing sound mindedness. After four weeks, the patient was readmitted this time accompanied by her mother, and she appeared to be in a sedated and lethargic states which had been the case for the last week as her mother stated. It was discovered that the Risperdal did not work as expected because the decision resulted in the patient to consuming large quantities of the drug which caused sedation. It was concluded that the build-up caused the patient to be in the lethargic and sedated state, so she was unable to prevent Risperdal from quickly building up in her body.
Decision Two: Decrease of Risperdal Medication to an Administration of 1mg at HS
This decision was chosen because the first was not as effective as it was expected. The first decision led to sedation due to the cumulation of Risperdal in the patient’s body; therefore, the second decision was to reduce the dosage. This is because the CYP2D6 seemed to correlate with poor levels of metabolizing medication consumed (Weiss & Connery, 2014). The results expected from this decision was that was that the medication would improve the general well-being of the patient as well as minimizing the side effects experienced from medication consumption. The patient was at the hospital a month later after the second decision for assessment where her ratings on the young mania rating scale had reduced from 22 to 26, and also her lethargic and sedated state had decreased. The bipolar disorder reduction rate exhibitions of the symptoms war rated at an average of 25% and the mark of success were about 50%.
Decision 3: Continuation of Risperdal Medication at the same Dosage
Due to the success of the second decision, the patient was prescribed to continue with the same dosage of 1mg at HS. The consistent use of Risperdal medication by this patient was expected to improve and reduce her bipolar symptoms and side effects with an estimated 50% decline after the fourth week. The patient was expected to experience moments of great sleep, a better frame of her mind, and express herself in an ordinary manner (Weiss & Connery, 2014). It was projected that should the patient continue appropriately on her medication, and she could ultimately fully recover. These outcomes are expected because there is a consistency in pharmacokinetics and pharmacodynamics.
In conclusion, bipolar is a complex condition which permits clinicians to analyze the patient critically. This is because bipolar disorder side effects are numerous and have the same characteristics as those of other diverse mental conditions. During treatment, the medication taken by the patient should strictly be considered because many drugs have side effects which may result in harm to the patient and others.
References
Fountoulakis, K. N. (2015). Bipolar disorder: An evidence-based guide to manic depression .
Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author.
Sajatovic, M., Subramoniam, M. & Fuller, M. A. (2006). Risperidone in the treatment of bipolar mania. Retrieved from: https://wwww.ncbi.nim.nih.gov/pmc/articles/pmc2671778
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27 (5), 331-333. doi:10.1007/s40263-013-0060-3
Weiss, R. D., & Connery, H. S. (2014). Integrated group therapy for bipolar disorder and substance abuse . New York: The Guilford Press.
