On conducting a mental status exam to the 26-year-old patient, I found several symptoms that reflected the previous diagnosis of bipolar I disorder. The client had increased activities, observed upon arrival in my office. In addition, during the mental status exam, she had an exaggerated sense of self-confidence and well-being (Perry et. al, 2011). The client also had unusual talkativeness, also observed while she visited my office. Also, the client had an abnormal jumpy character shifting from one side of the chair to the other in my office. As a consequence, I had to review her hospital records and found that she had been treated by a physician reporting that she was in good health. Also, the patient had been prescribed lithium from the hospital where she had been hospitalized for 21 days. In consideration of different medical reports and the hospital, records are given, I had to make an informed decision on the best treatment approach for bipolar I disorder since she had been diagnosed with bipolar I disorder.
Decision #1
The first decision after diagnosis of bipolar I disorder involved prescribing Seroquel XR 100 mg that was to be administered orally at HS. This medicine was the best among the options presented in the case. Also, in the patient’s medical report, she had been prescribed lithium, which she could not complete the dosage. The Seroquel XR 100 mg dose was effective for better sleep, improved concentration, good moods, calm thoughts and limited distractibility (Dion et. al, 2008) . After the prescriptions, the client returned to the clinic in four weeks. After proper administration of the dose, the client reported that she could sleep a bit more at bedtime. Nevertheless, she was not comfortable that she had gained around 3 pounds. Also, she reported that she suffered constipation since starting the prescribed medication. Her young mania rating scale had decreased from 22 to 18. She complained about dry mouth and said she was not comfortable about it. In return, she requested a different medication that would prevent weight gain.
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Decision #2
Considering the side effects emanating from the first prescription, I decided to discontinue Seroquel and start Geodon 40 mg, which was to be administered orally together with a 500 calorie meal. I selected this prescription since it was necessary for preventing weight gain and reducing the young mania rating scale (Geddes, 2013) . As a consequence, I expected the prescription to arrest weight gain and reduce the impact of other side effects emanating from the prescribed medicine. The client returned to the clinic in four weeks. Her young Mania rating scale had decreased from 22 to 11 recording a 50% decrease in score. Successfully, the client denied any additional weight gain and denied other side effects that could have resulted from the prescription.
Decision #3
Following the client’s condition, I decided that she continues with the same dose and conduct a reassess in four weeks. I selected this decision since it had previously demonstrated positive results including decreased young mania rating scale score. Changing to Geodon was substantial since it arrested weight gain in the client and eliminated other symptoms (Ghaemi & Katzow, 2009) . After reassessing, the client a good mood and demonstrated no symptoms of bipolar I disorder. I also decided to increase the dose to 60 mg orally BID in order to hasten her symptom improvement. I was sure that this prescription would be associated with some side effects. In return, I decided to educate her regarding the side effects and the need to maintain compliance with the clinic in case of any side effects that would make her uncomfortable. My decisions had a significant impact reflecting on previous prescriptions and the client’s condition.
References
Dion, G. L., Tohen, M., Anthony, W. A., & Waternaux, C. S. (2008). Symptoms and functioning of patients with bipolar disorder six months after hospitalization. Psychiatric Services , 39 (6), 652-657.
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet , 381 (9878), 1672-1682.
Ghaemi, S. N., & Katzow, J. J. (2009). The use of quetiapine for treatment-resistant bipolar disorder: a case series. Annals of Clinical Psychiatry , 11 (3), 137-140.
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Perry, A., Tarrier, N., Morriss, R., McCarthy, E., & Limb, K. (2011). Randomised controlled trial of the efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ , 318 (7177), 149-153.
