Diagnosing and Treating a Bipolar Client: A Case Study

Introduction

Bipolar is one of the hardest conditions to diagnose as it results in both depression and mania in clients. The disorder is characterized by extreme mood swings; these are the emotional highs referred to as mania and lows known as depression. Concerning the condition, the paper analyzes a case study of a bipolar client to assess and treat the client presenting the bipolar disorder.

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Client Factors and History

The presented client has a Korean ancestry. She is a 26-year-old Asian woman presenting to her first appointment after being hospitalized for 21 days following acute mania. The diagnosis of her condition revealed she had bipolar I disorder. She acts weird sometimes because she gets busy playing with things on people's desks and shifts from side to side in her chair. She has mysterious behaviors as she keeps on insisting she is not bipolar, as the physicians say. From the hospital review, her physician reports her to be in overall good health. Besides, lab studies support the same because the results were in normal limits. Genetic testing is conducted on her and reveals she is positive for the CYP2D6*10 allele. She admits having stopped taking her lithium as prescribed by the doctor.

Factors that Influence Pharmacokinetic and Pharmacodynamic Processes in Clients Requiring Bipolar Therapy

According to Wu et al. (2015), pharmacokinetics is the study of how organisms affect drugs, while pharmacodynamic studies how drugs affect organisms. Pharmacokinetic and pharmacodynamic concepts are critically used for stabilizing mood in bipolar disorder treatment. In treating bipolar disorder, mood stabilizers are highly recommended. Therefore, mood disorders highly influence these processes for the clients in need of bipolar therapy. Individuals diagnosed to have bipolar disorder usually have emotional states characterized by either depressive or manic episodes. Bipolar I patients experience manic lasting for at least one week. Pharmacokinetic and pharmacodynamic processes are critical when it comes to mood stabilization, especially among females. Research shows that women have lower hepatic metabolism when compared to men. The rate of metabolism may be affected by reproductive hormones hence suggesting fluctuations in the drug concentration of plasma. Among the factors influencing pharmacokinetic tests are molecular weight, water solubility, dissociation degree, and fat-soluble. Water is the mode of transport for drugs within the body. Drugs within the sites of absorption need to have some degree of water solubility to be absorbed. Therefore, a drug requires certain water solubility. Polarity, crystal form, solubility melting point affects the absorption rate of drugs.

Evaluate the Efficacy of Treatment Plans

Since bipolar I is characterized by intense manic experience, it requires treatment with drugs like mood stabilizers.

Mood Stabilizers

Lithium- it is used to reduce the recurrence of the manic episode; however, it is indicated for depressive episodes. Despite lithium being used as a bipolar disorder treatment for a very long time, there has not been a full clarification of its action mechanism. Some molecular steps have had implications along the signal transduction cascade, which receives activation from neurotransmitter receptors like G proteins (Vitiello, 2013). The growth factors of gene expression have associated itself with lithium activity through signal transduction components such as protein kinase C. Based on this and other lithium molecular associations, different studies have been conducted to identify the predictors of genetic lithium response.

Antiepileptics as Mood Stabilizers

Since recurrent manic episodes result in even further manic episodes, there has been a recommendation of logical parallelism whereby the appearance of repeated episodes exposes the victim to further seizures. This has called for a prescription of different antiepileptics in an attempt to treat bipolar disorder. Some have proven to be more effective than others. One of the antiepileptics is valproic acid; it is recommended for long-term treatment to prevent the recurrence of mania among bipolar patients (Vitiello, 2013). In addition, it is applicable in the acute mania phase; however, its activity of prevention is not fully clarified in this context. Just as lithium, its administration is once a day alongside other mood stabilizer is corresponding to the therapeutic lower limit range. Carbamazepine is another antiepileptic that proven to be effective in mania treatment; however, it did not receive the approval of the FDA formally. Lastly, lamotrigine is used to prevent both mania and depression, although the drug has not received FDA approval in treating bipolar depression.

Benzodiazepines

According to Fortinguerra (2020), despite there being no full approval of such drugs for purposes of a mood stabilizer, benzodiazepine is a representation of considerable value treatment, most notably in emergencies. The prompt drug administration can result in a quick sedative effect and offer precious time different from the mood stabilizers having slower action onset. They are mostly recommended to patients expressing the symptoms of agitation episodes and insomnia.

Associations

Patients with bipolar disorder require treatment from different drugs. Effective combination entails the association of valproate or lithium with antipsychotics. From clinical practices, it is evident that more associations need to be utilized for effective treatment.

Ethical and Legal Implications Related to Prescribing Bipolar Therapy to Clients across the Lifespan

Mental conditions may affect everyone despite their gender, age, sex, religion, and race. Neuropsychiatric disorders are currently the second leading disability cause in the world. For people diagnosed with bipolar conditions, they require bipolar therapy. However, this treatment has drawn in different legal and ethical implications. Prescribing bipolar therapy is beneficial because millions of lives have been saved through the same. However, the overreliance on these drugs has aroused ethical and societal concerns. For instance, some concerns related to children pointing out that children relying on antidepressants may have an increased suicidal risk. In addition, there is a consequent metabolic effect that relates to such kind of treatment.

There is a new concern in regards to the use of psychotropics drugs such as stimulants to improve an individual's cognitive performance. In addition, in relation to bipolar condition, numerous cases have pointed out towards misdiagnosis. According to Stahl (2013), before a patient receives psychotropic medication, there is a thorough need for a careful examination and review of the person's history. This is inclusive of their symptoms and treatment response. A conclusion should be reached after proper examinations to prevent patient's misdiagnosis because of such cases prone to more harm to the patient. Therefore, the goal should focus on prescribing psychotropic medications only when there is a clear indication, and when there is a piece of strong evidence regarding the diagnosis.

In most cases, the interventions of biological and psychosocial are in place to offer the best therapeutic benefit. In cases of misdiagnosis, the law does not hold doctors legally accountable for all errors of diagnosis. However, patients wishing to proceed legally in such cases need to prove somethings for them to prevail in the medical malpractice lawsuit based on the misdiagnosis.

References

Fortinguerra, S., Sorrenti, V., Giusti, P., Zusso, M., & Buriani, A. (2020). Pharmacogenomic Characterization in Bipolar Spectrum Disorders. Pharmaceutics, 12(1), 13.

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

Wu, H., Infante, J. R., Keedy, V. L., Jones, S. F., Chan, E., Bendell, J. C., ... & Kodaira, H. (2015). Factors affecting the pharmacokinetics and pharmacodynamics of PEGylated liposomal irinotecan (IHL-305) in patients with advanced solid tumors. International journal of nanomedicine, 10, 1201.q