Casey Hoffman 

Initial Post

Bipolar Disorder

Bipolar Disorder is a psychiatric condition that is characterized by key changes in mood, energy and activity level (Bipolar Disorder, 2016). Those suffering from Bipolar Disorder can have extremely “up” moods, full of elation, which are known as a manic episode, and extremely low episodes known as depressive episodes. Bipolar Disorders can be genetic in nature (Sanchez-Igleesias, S. Garcia, V. Garcia, 2016). Patients can also have manic episodes that are less severe in nature, which care known as hypomanic episodes. There are 4 types of Bipolar Disorders that are classified within the DSM IV, they include Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and other unspecified Bipolar and related disorders. (Bipolar Disorder, 2016). Patients can also experience mixed episodes which can include symptomologies of both manic and depressive episodes. During manic episodes, patients will exhibit specific behaviors including increased levels of activity, increased energy, indulge in risk behaviors (sexual activity or excessive spending), a flight of ideas, and having trouble sleeping. During depressive episodes, patients may experience feelings of hopelessness, have decreased activity levels, increased need for sleep, and feeling worried. 

Decision Steps

My first decision step was to restart the patient on Lithium 300mg BID. After this initial treatment intervention, the patient returned to the office in 4 weeks’ time, exhibiting many of the same symptomologies that she displayed on her initial visit. She attests to taking her Lithium intermittently and only when she feels like she needs it. Decision point two involved assessing why the patient was non-compliant in her lithium therapy and was then educated on the effects of Lithium and the pharmacological actions involved. The client then returned to the clinic in 4 weeks’ time complaining that the medication makes her nauseated and gives her diarrhea. The patient attests to stopping her lithium therapy until these symptoms dissipate and then will start taking her medication again only to have the symptoms start again. The third decision point involved keeping the patient’s lithium at the same dose and frequency, except making the medication sustained-release instead of immediate release. The patient’s lithium was changed to extended-release because this formulation can prevent the symptomologies of nausea and diarrhea. 

Chosen Pharmacotherapies 

Lithium is an effective medication for treating acute manic and depressive episodes, as well as in reducing the recurrance of mood episodes and minimizing the risk of suicidal behaviors (Merchado-Vieira, Manji, & Zarate, 2009). Lithium is classified as a mood-stabilizing agent. Its mechanism of action involves inducing multiple biochemical and molecular effects on neurotransmitter signaling, signal transduction cascades, hormonal and circadian regulation, ion transport, and gene expression (Merchado-Vieira, Manji, & Zarate, 2009). These effects have been widely associated with the activation of neurotrophic pathways involved in the pathophysiology of Bipolar Disorder (Merchado-Vieira, Manji, & Zarate, 2009). When neurotrophic pathways are enhanced, it creates a therapeutic strategy that is intended to slow or stop the progression of neuronal loss, thus producing favorable long term benefits. Specifically, Lithium will decrease the incidence of manic episodes that a patient may experience, along with making the depressive symptoms less severe. The impact that Lithium has on the pathophysiology of Bipolar Disorder is positive in nature and will effectively treat the frequent manic episodes that the patient is experiencing. 

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