Bipolar Disorder

When treating bipolar disorder to the patient described in the case study, I would also begin with the Risperdal 1 mg PO BID, an oral treatment plan. Risperdal is an effective drug either as mono or as adjunctive therapy used to treat bipolar mania, which is what the patient is diagnosed with. It will work by affecting the neurotransmitter chemicals naturally occurring in a person’s brain, as the patient has an imbalanced of these chemicals. Thus, prescribing this drug aims at improving the imbalance (Jauhar & Young, 2019). Initially, the treatment plan will start as a monotherapy to the patient with an initial dose of 2mg/d in the first two days and after that increase to 3mg/d with a next checkup in the next four weeks. However, upon the arrival of the patient, her mother accompanies and helps her get into the office as she looks sedated and lethargic. She further explains that the patient has been displaying these symptoms since the first week. This is expected, as some of the adverse and common side effects include Parkinsonism, which includes moving troubles, dystonia, tremors, and dyskinesia. She cannot control the movements of her body and somnolence (Varcarolis, 2017).

With this information, I will explain and advise both the mother and the patient the source of these symptoms and decide to decrease Risperdal from the 3mg/d to 1mg/d at HS. At HS, the patient will not experience somnolence and movement problems, as she will be asleep hence limiting adverse effects and impediments during the day. Through this prescription, in the next four weeks checkup the client is less sedated, lethargic, shows improvement, and her YMRS decreased from 22 to 16, which is a show of effectiveness of the treatment plan. Next, since the patient has the CYP2D6*10 allele, a P450 enzyme, she is likely to have a slowed metabolism of drugs and a slower clearance of Risperdal from her system. This situation thus increases the levels of Risperdal in the bloodstream, which utterly causes high levels of sedation (Dodsworth, 2018). Therefore, I will allow her to remain at the same 1mg/d at HS dose and reassess her performance and reaction in the next four weeks. Increasing the dose will take us back to the onset situation of adverse side effects. Latuda is expensive and is approved for bipolar depression 1, yet we are treating bipolar mania.

References

Dodsworth, T. ,. (2018). A systematic review of the effects of CYP2D6 phenotypes on risperidone treatment in children and adolescents. Child and Adolescent Psychiatry and Mental Health, Vol (12), 37.

Jauhar, S., & Young, A. H. (2019). Controversies in bipolar disorder; role of second-generation antipsychotic for maintenance therapy. International Journal of Bipolar Disorders, Vol 7(10). Retrieved from https://www.rxlist.com/risperdal-drug.htm#description

Varcarolis, E. R.-B. (2017). Essentials of Psychiatric Mental Health Nursing – E-Book: A Communication Approach to Evidence-Based Care. Toronto: Elseiver.