Assessing and Treating Clients with Bipolar I Disorder Walden University NURS 6030-5, Psychopharmacologic Approaches to Treatment of Psychopathology

 
The client return to the office in four weeks and
reported that she was not lethargic by the end of first week of therapy, has a slight decrease in
Young Mania Rating Scale(YMRC) from 22 to 19, but a decrease in sleep with an overall
‘feeling happy”. This is pointing in the right direction. There is some evidence that the therapy is
working much better than the first therapy though there is still the need for 50 % improvement in
symptoms which will take us to the next decision tree.
Decision point # 3
This client responded well to the discontinuation of Risperdal and the initiation of
Lithium sustained-release 300 mg orally BID . About a week later, the patient was no longer
feeling lethargic/sedated. However, in the following 3 weeks, she had experienced a slight
improvement in YMSR score although she feeled decreased sleep but felt she is happy overall.
With the client expressing that she is happy at this point , I would like to maintain the “status
quo” and will not make any changes at this point. I will allow the lithium to remain at its current
dose for an additional 4 weeks and then reassess the patient. Aiken(2021) noted that sedation is
sometimes desirable and sometimes not. It is desirable when treating insomnia, as long as the
sedative effects do not linger into the morning.
The other option to increase the lithium to 450 mg orally BID to see if it may hasten
mood stabilization and then reassess in four weeks seems perfect but it may be uncalled for
since this can reintroduce adverse effects that the patient did not like that made her non-
compliant in the first place. Risperdal 0.5 mg orally BID may be appropriate if the clients’ has
experience worsening, symptoms but this client symptom has shown some improvement , hence
no need to reintroduce Risperdal to a Korean descent patient that has positive CYP2D6