Discussion Main Post: Bipolar Disorder
The more research that is completed the better providers can care for their patients. Bipolar disorder is very under-studied in the elderly population but is usually diagnosed in adolescents (Ljubic, 2021). When reviewing a journal article it talked about how many elderly can go undiagnosed due to many other ailments that can cause psychological disorders or distress (Ljubic, 2021). Many things can cause confusion and mental-like illnesses as we age. As a provider, its so important to know the patient’s mental status before a severe illness happens no matter their age. This way there is a known baseline and you will be able to tell if there is an episode, or something else going on.
Pharmacokinetics & Pharmacodynamics & Genetics
Bipolar Disorder (BD) is a chronic illness that is severely debilitating to those diagnosed and their caregivers (McCormick et al, 2015). Most people become diagnosed with BD as an adolescent but there are some cases where it can be late on-set and be diagnosed in our elderly population (McCormick et al, 2015). Having this disorder affects the patient’s mental and physical well-being, education and occupational functioning, and interpersonal relationships (McCormick et al, 2015). Not only caring for themselves with this disease is very difficult but being the one caring for them too. It can be very hard on both parties. When it comes to this disease there isn’t really an age, gender, or ethnicity that it claims to be, but 4% of the people in the United States are diagnosed with BD (McCormick et al, 2015). Something that is big when it comes to the possibility of having it or not is genetics. People who have a known first-degree relative with BD are classified as 8-10 time greater of developing it (Stahl & Schwartz, 2016). Family history can determine if you will develop this disorder.
Treatment Options
As an Advanced Practice Nurse, its important to recognize the specific needs and care for these patients. Its important to follow up and check in to see how not only the patient is doing but also their caregivers too. Patients diagnosed with bipolar disorder have a mood disorder causing major depression episodes along with manic highs (McCormick et al, 2015). These patients need to be on medications to help stabilize their moods. There are many more medications used now than there used to be for BD. The pharmacotherapies are all dependent on the patient and their symptoms (McCormick et al, 2015). The main goal for patients is to reduce symptoms and regain full remission (McCormick et al, 2015). These patients are on mood stabilizers which can be these medications; Lithium, Valproate, Lamotrigine, and Carbamazepine, atypical antipsychotics, which are these medications; Aripiprazole, Asenapine, Lurasidone, Olanzapine, Quetiapine IR, XR, Risperidone, Ziprasidone, and conventional antidepressants (McCormick et al, 2015). Every patient is different some need a mood stabilizer, others need a mood stabilizer and an antipsychotic or some kind of combination of each (McCormick et al, 2015).
Plan of Care and Medications of Use
If we dive deep into the medication Lithium, which is one of the most known mood stabilizers for BD patients, there are some concerns about its use. The medication does have a delayed onset of action, taking longer to calm manic episodes (McCormick et al, 2015). It can be limited in the efficacy of depressive episodes, which usually then the patient has to rely on a conventional antidepressant to counteract those episodes (McCormick et al, 2015). The medication also has a very small therapeutic window, which can cause the patient to either not be therapeutic, or hit toxicity of the drug (McCormick et al, 2015). This drug helps greatly with manic episodes once it has reached its therapeutic window and its important to educate the patients on this so they remember to take their medications at the same time every day and not forget (McCormick et al, 2015). As a BD patient, these medications are life-long and some of them have effects on our body after extensive use. For Lithium, this medication needs to be monitored very frequently to make sure it is within the therapeutic window. Along with that, it is also important to verify other blood levels like renal and thyroid levels as this medication is toxic to these organs (McCormick et al, 2015). It is said that after known long-term use of these drugs, its important to have blood work done every six months to verify that everything is working well (McCormick et al, 2015). When taking the medication Lithium does come with some side effects, the side effects are, tremors, gastrointestinal issues such as nausea, vomiting, and diarrhea (McCormick et al, 2015). The benefits of these outweigh the risks of this medication. As the provider, I would recommend the use of Lithium as it is the number one medication used for BD. This medication will help with the manic episodes for my patients after reaching therapeutic levels of 06-1.2mmol/L, this is also dependent on the patients tolerance as well (McCormick et al, 2015). Along with starting this medication, I would want to administer a conventional antidepressant, either an SSRI or an SNRI, and increase the dose every 4 weeks as needed to reach remission.
Conclusion
When it comes to BD patients its important to get medications started right away as it may take some time to reach therapeutic levels and to reach remission. During these times of waiting to reach therapeutic levels and remission, as the provider, you need to educate the patient on the importance of continuing to take medications. The patient may have a difficult time wanting to continue as they may not see a change in their psyche for up to 4 weeks. In addition to medication, a good recommendation would have the patient see therapy or to go to a support group to help them get through these difficult times.
Last Completed Projects
| topic title | academic level | Writer | delivered |
|---|