Bipolar affective disorder is a grave mental health problem that begins in early adolescence. It is marked by depressive episodes, mania, hypomania and mixed episodes, with intermittent recovery periods. Patients with the mental health condition display residual signs of bipolar disorder during the intermittent recovery phase (Shah et al., 2017). If not addressed promptly using appropriate pharmacological interventions, it negatively impacts on patients’ ability to function due to aggravated social psychological marital and interpersonal problems. Several patients exhibit suicidal symptoms and susceptibility to eating disorders and physiological comorbidity. Shah et al. (2017) observe that 30% to 50% of patients treated with different medication combinations are more likely to develop therapeutic failures. Low drug tolerations metabolic difficulties and pyramidal effects, and adverse drug interactions further serve to inhibit treatment efficacies.
Underlying genetic variances necessitate the utilization of drug combinations that promote treatment efficacy and lead to patients’ normal function and improved quality of life. CYP2D6 gene allele significantly contributes to positive medication therapy responses or triggers treatment failures (Seripa et al., 2018) . It is essential to utilize drug combinations according to patients’ genetic characteristics in order to optimize therapeutic efficacy reduce drug related complications and lower costs associated with recurrent hospital admissions. The 26 year old female Korean client mental health examination reveals a normal and affect and mood. The patient has no evident physical comorbidities as shown by the lab test results. However, owing to the patient’s abnormally high BMI, the patient has an eating disorder, indicating comfort feeding and lack of the ability to self-regulate personal habits (Shah et al., 2017). The Young Mania Rating Scale score of 22 specifies that the patient is suffering from mild mania. However, the severity may increase due to non-adherence to the lithium mono-therapy which can cause exacerbated symptoms and predispose the patient to depressive episodes.
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They key to treating the patient lies in optimizing drug combinations that are congruent with the CYP2D6*10 genetic characteristic in order to maximize drug metabolism and tolerances. Maximizing on the lithium dose to 600 mg three times a day in order to offer extended release, prevent the likelihood of self-harm, and eliminate suicide ideation or attempt, which are prevalent among patients suffering from Bipolar disorders ( Fountoulakis et al., 2017) . However, it will be vital to test for lithium blood levels every 6 to 12 months. Patients with the Cyp2D6*10 poorly tolerate benzodiapines such as diazepam, it is critical to prescribe a selective serotonin reuptake inhibitor to balance serotonin chemical substances in the brain such as fluvoxamine (Fortinguerra, Sorrenti, Giusti, Zusso & Buriani, 2020) . This will help to patient’s increased urge to perform repeated actions, as well as decrease the obsessive compulsive. In addition, sodium valproate may adversely affect women of child bearing age who are likely to become pregnant and is not well tolerate by patients of Asian descent. Additionally, evidence shows that people with the CYP2D6*10 exhibit severe intolerances to risperidone. Hence, prescribing second generation antipsychotic medications such as olanzapine, particularly zyprexa, 2.5mg per day will enable the patient to achieve balance mood balances, prevent depressive episodes, increase normal everyday function and promote positive thoughts and reduce agitation.
The patient needs health education to promote adherence to drug treatment regimen. Lack of compliance with prescribed medication regimes may further predispose the patient to treatment failures. Treatment failure leads to exacerbation of mental health issues and the need t increased hospitalizations, resulting in high healthcare costs (Lequimener-de et al., 2019) . To begin with the patient needs awareness about the illnesses and the importance of prescribed drug therapies in enabling the patient to function normally. Strategies such as psychotherapy involving the patient, family members and people in her social support circles will effectively promote adherence to treatment and also decrease recurrence of maniac episodes.
References
Fortinguerra, S., Sorrenti, V., Giusti, P., Zusso, M., & Buriani, A. (2020). Pharmacogenomic characterization in bipolar spectrum disorders. Pharmaceutics , 12 (1), 13.
Fountoulakis, K. N., Young, A., Yatham, L., Grunze, H., Vieta, E., Blier, P., ... & Kasper, S. (2017). The International College of Neuropsychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BD-2017), part 1: background and methods of the development of guidelines. International Journal of Neuropsychopharmacology , 20 (2), 98-120.
Lequimener-de, V. L., Chirio-Espitalier, M., & Grall-Bronnec, M. (2019). Influence of a therapeutic patient education (TPE) program on quality of life in bipolar disorder: Preliminary results. L'Encephale , 45 (2), 127-132.
Seripa, D., Lozupone, M., Miscio, G., Stella, E., La Montagna, M., Gravina, C., Urbano, M., di Mauro, L., Daniele, A., Greco, A., Logroscino, G., Panza, F., & Bellomo, A. (2018). CYP2D6 genotypes in revolving door patients with bipolar disorders: A case series. Medicine , 97 (37), 1-8. https://doi.org/10.1097/MD.0000000000011998
Shah, N., Grover, S., & Rao, G. P. (2017). Clinical practice guidelines for management of bipolar disorder. Indian Journal of Psychiatry , 59 (1), 51–66. https://doi.org/10.4103/0019-5545.196974
