Treatment Decision for Bipolar 1 Illness
The decision in this case was to treat the patient for bipolar 1 illness. The treatment for bipolar 1 illness is mostly determined by the patient's symptoms. Bipolar 1 is characterized with one or more manic or mixed mania episodes, according to the American Psychiatric Association (2002). We may deduce from the case study that the patient had acute mania and was hospitalized for 21 days. There is an episode of hypomania at the time of the visit, which is typically associated with bipolar 2 illnesses. A decision about the actual sort of condition cannot be made just on a perception of the symptoms in their whole. Some of the reasons behind this conclusion are that the patient indeed had an episode of acute mania, despite that the patient does not show symptoms of depression which are associated with bipolar 1. Furthermore, the hypomanic experience is mostly associated with bipolar 2 disorders (Keck Jr et al., 2003). In such a scenario, there are no symptoms that would point the treatment towards the direction of a particular condition. The decision, therefore, would be to treat the symptoms and observe the outcomes in the patient ensuring that the real condition is identified and the patient is treated accordingly.
Assuming Bipolar 1 Disorder
I, therefore, assume that the patient is indeed suffering from bipolar 1 disorder as indicated by the first doctor. Furthermore, while the features of bipolar are not much in the patient there are chances that the patient might have undergone a depressive episode. The best approach to treatment of the patient would, therefore, to deal with the conditions that were affecting her normal countenance at the time. Diagnosis of mania is one of the primary methods of keeping the patient calm to enable further treatment (American Psychiatric Association, 2002). The reason behind diagnose of mania is to increase the chances of dealing with the bipolar disorder even without identifying the actual condition. I, therefore, handle the mania and the hypomanic reactions on the client. The diagnosis for the manic episode is confined to the outcomes from the previous hospital. Some of the indications that the diagnosis is accurate include the inability of the client to conduct routine activities and the necessity for hospitalization to avoid harm to the patient or to other individuals (American Psychiatric Association, 2002). A peculiar observation is that mania is usually associated with psychotic experiences. However, the patient reports not to have any psychotic experiences, and with the mania reduced, the patient's elation is only a symptom of bipolar-related hypomania (McElroy et al., 2001). Furthermore, the patient claims and tests derive that the patient mood and countenance is within the normal range in that the patient is neither depressive nor hyper beyond the normal levels.
Hypomania during the First Visit
With the presence of hypomania during the first visit, the expectations involved the presence of psychotic experiences. Furthermore, the patient denied neither any suicidal ideation nor other depressive symptoms. Therefore, the patient's hypomania was the only case that would derive clinical interventions from the office. Some of the primary considerations to make included the genetic factors that would affect the medication provided. According to American Psychiatric Association (2002), the atypical antipsychotic drugs have an effective impact on controlling the mood relapse of the client, especially those with manic reactions. Some of the atypical antipsychotics include Risperidone which is known to be effective, especially for the manic episodes and not for the depressive symptoms. Indeed, the patient did not face any depressive episodes which leave mania and hypomania as the primary symptom affecting the client. Genetics comes in due to the fact that the CYP2D6*10 allele is responsible for the metabolism of the Risperidone compounds. According to Roh et al. (2001), a large portion of Koreans tend to express homozygous for the CYP2D6*10 allele. The implication is that Koreans have a higher chance with antipsychotic medications, such as the Risperidone, the patient may take relatively a longer time to get the drug out of their system (Sajatovic, Madhusoodanan, & Fuller, 2006). It, therefore, explains the somnolence of the client even a week after ending her medication. After letting the medication wear out for weeks the client had a reduced level of mania and the lethargy also reduced due to the Risperidone. After drug cessation the client was expected to be less lethargic and that the symptoms will have reduced (Bowden et al., 2003). However, the outcome was that the patient faced an increase in the symptoms over the next 3 weeks which required an administration of lithium for mood stabilization.
Decision to Use Increased Dosages of Lithium
The expected decision was the use of a different medication other than lithium owing to the fact that the patient had showed no change in the symptoms after the introduction of lithium in the previous medical center. The psychiatrist would, therefore, use an alternative, such as carbamazepine (American Psychiatric Association, 2002). However, in Decision #1 the psychiatrist introduces the patient to increased dosages of lithium which may indeed stabilize the mood. However, the outcome of the medication may not be as expected due to the fact that the patient did not show control symptoms after the introduction of the first line of lithium dosages (Harvey et al, 2005).
References
American Psychiatric Association.(2002). Practice guideline for the treatment of patients with bipolar disorder (revision).American Psychiatric Pub.
Bowden, C. L., Calabrese, J. R., Sachs, G., Yatham, L. N., Asghar, S. A., Hompland, M., ... & DeVeaugh-Geiss, J. (2003). A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Archives of general psychiatry, 60(4), 392-400.
Harvey, A. G., Schmidt, D. A., Scarnà, A., Semler, C. N., & Goodwin, G. M. (2005). Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. American Journal of Psychiatry, 162(1), 50-57.
Keck Jr, P. E., McElroy, S. L., Strakowski, S. M., West, S. A., Sax, K. W., Hawkins, J. M., ... & Haggard, P. (2003). 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. Focus, 1(1), 44-52.
McElroy, S. L., Altshuler, L. L., Suppes, T., Keck Jr, P. E., Frye, M. A., Denicoff, K. D., ... & Rush, A. J. (2001). Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. American Journal of Psychiatry, 158(3), 420-426.
Rohm, H. K., Kim, C. E., Chung, W. G., Park, C. S., Svensson, J. O., &Bertilsson, L. (2001). Risperidone metabolism in relation to CYP2D6* 10 allele in Korean schizophrenic patients.European journal of clinical pharmacology, 57(9), 671-675.
Sajatovic, M., Madhusoodanan, S., & Fuller, M. A. (2006).Risperidone in the treatment of bipolar mania. Neuropsychiatric disease and treatment, 2(2), 127.
