Answer

An Asian American Woman with Bipolar Disorder

            The present case study is interesting since the ethnic background of the client plays a critical role in the way she receives treatment from healthcare practitioners. Reportedly, ethnicity can influence how medications work and if there are no detrimental effects that would not be applicable to other lineages. The client, a woman with Korean origin is diagnosed with bipolar disorder. She is presented as manic, euphoric, hyper verbal and diagnosed in thought process having being discharged from an acute healthcare facility (Laureate Education, 2016). The stated client has declared that she is does not comply with the prescribed Lithium after she was discharged. Therefore, this paper seeks to offer appropriate treatment option for a bipolar client by explaining each of the available options at each decision point while considering the ethical background of the client.

Decision #1

            The client has admitted that she no longer use Lithium, a drug she was prescribed to while being discharged from an acute inpatient stay. She appears to be in the initial stages of a manic episode with no homicidal or suicidal ideations. The recent genetic testing has revealed that she has CYP2D6 allele (Molden, Waade, Hoff, & Haslemo, 2016). As such, the available options for starting medication treatment entail Risperdal, Lithium, or Seroquel. Given that the client has tested positive for CYP2D6, giving her Risperdal 1mg twice a day would be a better option. However, it will be difficult to monitor her over sedation because of the slower clearance rate. Stahl (2013) posited that the metabolite of Risperdal is paliperdone that refers to an active metabolite within the system and that the impacts of Risperdal can last for a prolonged period than a client who has tests negative for CYP2D6.  Normally, the manic symptoms should start lessening within a week. However, the process can take up to eight weeks to become fully active.

            Settling on Lithium may be inappropriate option for the client under the study because it can many weeks to become fully effective, demands dietary control, and frequent lab work is required to monitor therapeutic levels. Evidently, from the case scenario, the client has already manifested patterns of non-compliance that unfortunately could result in Lithium toxicity when she fails to adhere to regular labs. Essentially, this option can be reconsidered later in the treatment plan in case augmentation is required with the Risperdal, especially when the client is more stable and compliant.

            Seroquel as contended by Sthal (2013) can cause considerable weight gain, constipation, as well as, severe dry mouth that consequently causes tooth decay. These negative effects can make the patient to immediately stop the medication without consulting the healthcare practitioner. On the same note, withdrawing from Seroquel could be a major challenge and although it hardly occurs can go for many weeks based on the duration and dosage recommended for the client (Sthal (2013).

Decision #2

             Immediately she returned from the four weeks follow up, the client appeared sedated and sluggish. Sadly, no one expected such response from the visit. The mother is escorting the client and complains that the client has been depicting these signs for the past one week she has been taking Risperdal prescribed to her. At this point, there are myriad of options that include stop the Risperdal and begin taking Lithium, reduce the Risperdal to 1 mg at bedtime or increase the dosage of Risperdal to 2mg at bedtime.

            It would be appropriate for the healthcare practitioner to reduce the Risperdal dose to 1 mg at bedtime due to the increased lethargy and sedation. As already discussed, the client has tested positive for CYP2D6 that prolongs the effects and reduces clearance rate. As such, it is needless to introduce an immediate change to another medication such as Lithium. Therefore, reducing the initial dosage and only taking the medication during bedtime should help manage the lethargy and sedation. The client should be able to function the whole day after a restful night sleep. The option of increasing to Risperdal dosage to 2 mg at bedtime as posited by Salloum, McCarthy, Leckband and Kelsoe (2014) could possibly increase lethargy and sedation and therefore would not benefit the client. As such, it is prudent to begin at a low dose and increase the dosage with time. In the subsequent follow up, the client should depict reduced lethargy and sedation in addition to improved thought process and mania.

Decision #3

             A month after she returned from her follow up, the client manifested better alert and improved symptoms. Reviewing using the Young Mania Rating Scale revealed that the client showed a 25% decline in symptoms. At this point, the healthcare practitioner should not change the client’s medications but instead assess her again in the next four weeks. The client is responding positively to the medication and therefore it would be unwise to increase the dosage of Risperdal back to 1 mg two times a day because of the sedative effects observed in the past. Given that the client is positively responding to Risperdal, it is needless to immediately shift to a different medication. It is expected that the client will continue improving on the present dose and that no change is expected in the future.

Ethical Considerations

             In the Asian culture, mental illness is viewed as stigma and those suffering from such disorders are often neglected (Wang, 2018). This culture tends to keep the family and personal challenges secretive instead of seeking external counseling or help. The healthcare practitioner should educate the clients on psychotherapy at every visit and foster client’s participation in the treatment. Similarly, clients who test positive for CYP2D6 should formulate a treatment plan that encompasses close supervision since they are poor metabolizers of Risperdal and can be detrimental as a relatively lower dose than other patients (Tse, Ran, Huang & Zhu, 2013). Salloum, McCarthy, Leckband and Kelsoe (2014) indicated that individuals with Asian origin are to test positive for CYP2D6 and therefore should be treated and monitored frequently to prevent detrimental impacts as evident in this case.

            In conclusion, the paper has discussed the choices of a single healthcare practitioner when administering medication to an Asian American client who has been diagnosed with bipolar disorder. When the case was presented, the healthcare practitioner first considered the ethnic background of the client, especially when making treatment options. The most encouraging thing is that the client adhered to her treatment and showed significant improvements at the end of the third decision.