Bipolar Disorders Essay

1. What clinical signs and symptoms can better inform the NP about the diagnosis and why? (10pts) Answer:
Bipolar disorders are chronic and recurrent mental illnesses. Patients with bipolar disorders often report interpersonal and/or occupational difficulties during the episodes (Blairy et al., 2004). People who are suffering from bipolar disorders often report that they have attempted suicide during their lifetime. Bipolar disorders are one of the leading causes of disability for people aged 15 to 44 years (McCarron, Xiong, & Bourgeois, 2009).
The objective data provided in case scenario suggested that Ms. IC might have a history of bipolar disorders. The signs and symptoms are as follows: her current medications (Trileptal, Abilify and

Second, during the manic episode, patients also show three or more of following symptoms: inflated self-esteem or grandiosity, more talkative than usual or pressure to keep talking, distractibility, excessive involvement in pleasurable activities that have a high potential for painful consequences, decreased need for help, flight of ideas or subjective experience that thoughts are racing and increase in goal-directed activity or psychomotor agitation. (McCarron, Xiong, & Bourgeois,

IC is currently taking Trileptal 300mg, BID, and Abilify 10mg, daily for mood stabilization and Trazodone 300mg at bedtime for sleep. Her medication could be changed during the acute manic phase, however, some important concerns have to be considered before prescribing. First, Lithium is used to treat acute manic condition, however, clinicians should exercise extreme caution in use it for patients who have reduced renal function. Lithium is potentially lethal due to its narrow therapeutic window (0.6 to 1.2 mEq/ml). Second, it is recommended to use Olanzapine and/or Quetiapine to treat insomnia and acute agitation related to bipolar disorder. Third, SGAs have the potential to cause metabolic abnormalities and weight gain. So it is important to measure patient’s weight and metabolic profiles before medication treatments and closely monitoring the same during the treatment. Fourth, the drug to drug interaction is a big issue for prescribing medication to bipolar patients. For example, Antiepileptic drugs (Tegretol and Trileptal) would interact with oral contraceptive pills and lead to contraceptive failure. Fifth, a pregnancy test should be performed for female bipolar patients because mood stabilizers cause teratogen. Sixth, almost all mood stabilizers and SGAs have a black-box warning so it is very important that clinicians educate patients very well about the medication side effects, adverse effects and interventions (McCarron, Xiong, & Bourgeois,