Week 6 ion channel —2 Peer Response 600w. due 10-12-23
Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:
· Compare and contrast your initial posting with those of your peers.
· How are they similar or how are they different?
· What information can you add that would help support the responses of your peers?
· Ask your peers a question for clarification about their post.
· What most interests you about their responses?
Please be sure to validate your opinions and ideas with citations and references in APA format.
IA
This is a very interesting case since Sam is only 19 years old and has a history of major depressive disorder (MDD) and also generalized anxiety disorder (GAD). At a glance, I noticed that his behavior has highs and lows since he has gone from being violent by throwing a chair at a store window to having a “resounding moment” where everything makes sense. Among many other clues, this leads me to believe Sam can be newly diagnosed with bipolar disorder with manic episodes.
After consulting our DSM-5-TR book on page 140, I also realized Sam presents multiple symptoms that represent the diagnosis of bipolar disorder. To start Sam preceded a “psychotic breakdown” along with a history of MDD. He has also presented physiologic changes like diminished sleep, and other signs, and symptoms of a manic episode (Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR 2022). It also appears he is more talkative than usual by engaging his colleagues for long hours in conversation. Adding on to his symptoms it also appears he has engaged in high-risk behaviors such as drinking and sexual relations which was not his norm before. He has thought of himself as being better than the professors which match the ideas of grandiosity.
At first, I wasn’t sure which medication to prescribe, but it seems he would benefit from lithium since lithium is an antimanic medication primarily used to treat bipolar disorder(Lithium, 2022). Sources such as MedlinePlus indicate lithium is a mood stabilizer and works by releasing dopamine and serotonin in the brain (Lithium: MedlinePlus Drug Information 2023). Just like this case, I have seen many but now I see things differently since I know more in-depth the signs and symptoms as well as researching the proper medication.
References:
Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th ed.). (2022). . American Psychiatric Association Publishing.
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: The Prescriber’s Guide (7th ed.). Cambridge University Press.
Townsend., K. I. M., Mary C. (2020). Essentials of Psychiatric Mental Health Nursing, 8th edition. F.A. Davis.
MAM
Week 6, Medication for Bipolar Disorders
What diagnosis do you believe may apply to this individual?
The patient is a young boy presenting with a 'psychotic break,' characterized by reckless behaviors, sudden and unconventional decision-making (such as changing his major in university), distractibility, reduced need for sleep, a heightened sense of knowledge and grandiosity (believing he can teach courses in the university), and unusual beliefs regarding the nature of reality and his newfound appreciation for life. He is also engaging in high-risk behaviors, including excessive drinking, sexual activity, violence, increased spending, and initiating numerous projects without completing any. These symptoms are indicative of a manic episode (if they present more than a week).
Considering the patient's history of Major Depressive Disorder (MDD) and anxiety disorder, the diagnosis of Bipolar I Disorder (BPD) has been established. It is crucial to first rule out any medical problems, brain trauma, substance abuse, and other mental disorders that may be included in the differential diagnosis of BPD. The primary distinction between bipolar I and II lies in the nature of the manic or hypomanic episodes. In bipolar I disorder, individuals experience full manic episodes that typically last for at least one week. On the other hand, bipolar II disorder is characterized by hypomanic episodes, which are milder in intensity and shorter in duration, lasting no more than four days (Stahl, 2021).
Beyond this key difference, there are also variations in the clinical course and family history associated with these two subtypes. Individuals with bipolar II disorder tend to receive their diagnosis later in life, and their first experience of hypomania occurs at an older age compared to those with bipolar I disorder. These distinctions in age of onset and diagnostic patterns contribute to the differentiation between bipolar I and II disorders (Brancati et al., 2023).
Manic often presents with the feeling of being extremely important and having a very high opinion of oneself, sometimes to the point of having false beliefs about one's capabilities (Howse et al., 2023). In this case, the patient believes he is capable of teaching at the university. An experienced Psychiatric Mental Health Nurse Practitioner (PMHNP) can conduct a thorough history assessment to determine whether the psychosis is linked to brain traumas, substance use, schizoaffective disorders, or BPD.
What classifications of medications can be used to treat this disorder? Which medication do you recommend and why?
When the patient is diagnosed with Bipolar disorder, it indicates the need for mood stabilizers. Various mood stabilizers are available, including Lithium, Lamotrigine, Valproic Acid, and Carbamazepine. According to Stahl (2021), Lithium is considered the foundational and standard treatment for bipolar disorder and acute mania. However, this medication comes with several potential side effects, such as tremors, nephrotoxicity (Diabetes Insipidus), hypothyroidism, dyspepsia, nausea, vomiting, diarrhea, weight gain, hair loss, acne, sedation, decreased cognition, and incoordination. It can also lead to EB Stain anomalies in the fetus if taken during pregnancy.
Lithium additionally has a very low therapeutic index, signifying that the lethal dose of this medication is very close to the therapeutic level in the blood. Therefore, monitoring of blood levels of this medication is crucial throughout the treatment process. Regular assessments of kidney function, thyroid hormone levels, and electrolytes are also necessary. Lithium effectively stabilizes mood and reduces the severity of manic episodes (Stahl, 2021). Alongside medication, psychotherapy, such as cognitive-behavioral therapy or family-focused therapy, plays an essential role in treatment. It is equally important to educate the patient's family members about the disease and the treatment process.
References
Brancati, G. E., Nunes, A., Scott, K., O’Donovan, C., Cervantes, P., Grof, P., & Alda, M. (2023). Differential characteristics of bipolar I and II disorders: a retrospective, cross-sectional evaluation of clinical features, illness course, and response to treatment. International Journal of Bipolar Disorders, 11(1), 25. https://doi.org/10.1186/s40345-023-00304-9
Howse, J., Kanter, J., Muhammad, Q. C., & Wojcik, K. D. (2023). Mood disorders with psychotic features: Diagnostic considerations and treatment challenges. Psychiatric Annals, 53(4), 160-165. https://doi.org/10.3928/00485713-20230313-01Links to an external site.
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).