Mania Healthcare Case Study

Case Study 3: Mania

Answer the questions below regarding the video case study above.

Two treatment goals for the case. State goals using the SMART format (Specific, Measurable, Achievable, Relevant, and have a Timeline for completion) identify the main symptoms/problem in the video.

1)The patient must state two raisons that testify his/her understanding of the Pharmacological treatment especially when it comes to controlling their symptoms and help preventing hospitalizations, by the end of the current session.

2)Patient must state 5 reasons why the therapeutic alliance with the provider is essential in the current case and why this relationship will help his/her case and help them remain in the community by the next session.

Information that I think was missing in this video that I would have liked to have known.

I would have love to have answers to the following questions:

Do your thoughts jump from place to place that makes it difficult for you to keep track of them?

Do you find it hard to stop talking?

Have you been in trouble with the police or your family lately?

Have you been doing things that are out of character for you?

The last two questions are very important as they allow us to assess indiscretion and recklessness than can in some cases be harmful to the patient and to others.

What psychiatric symptom is a priority for treatment based on your assessment?

Mistrust and lack of consideration to healthcare providers, severe deficit of sleep, unawareness about the gravity of the situation.

My first choice of medication that would be appropriate for this case. (Include name, brand & generic with its starting dose).

Eskalith (Lithium Carbonate)

Immediate release: 900-1800 mg/day PO divided q6-8hr

Extended release: 900-1800 mg/day PO divided q12hr

Lower initial dosage may be used to minimize adverse drug reactions (Bowdwn, 1998).

Increase dose as tolerated to target serum lithium concentrations of 0.8-1.2 mEq/L (acute goal) or 0.8-1.0 mEq/L (maintenance goal)

Explanation of my decision making for this choice. What is my reason for choosing this medication?

Study confirm that Lithium improved mania symptoms better than most antipsychotic medications with treatment drop and moderated side effects (Butler et al, 2018).

What laboratory considerations, testing/monitoring are needed to safely prescribe this first choice of medication?

Pretreatment laboratory consideration: before starting treatment, the following labs must be obtained: Thyroid Function test, Renal Function test, Pregnancy test.

Monitoring: Serum lithium should be monitored 12 hours after dose, twice weekly until serum concentration and clinical condition stabilize, and every other month thereafter (Bowden, 1998).

What contraindications or safety issues are associated with this medication, what does the provider have to watch out for? What would you warn the patient about regarding this mediation?

Toxicity is the main issue; it’s is closely related to serum lithium concentrations and may occur at dosages close to therapeutic levels; close monitoring is monitor therapy by measuring serum lithium.

Contraindications to lithium treatment: Documented hypersensitivity, Severe cardiovascular disease, Pregnancy in 1st trimester, Unstable renal function, sodium depletion, severe dehydration and Severe debilitation.

What is My second choice of medication in this case? Include name, brand and generic with its starting dose.

Depakote (Valproic Acid). Literature Indicated that Depakote is efficient for treatment of manic episodes with relatively little side effects and dropout comparable to Lithium carbonate the initial dose for mania is 750 mg/day PO in divided doses; adjust dose as rapidly as possible to desired therapeutic effect; not to exceed 60 mg/kg/day. Depakote ER: 25 mg/kg/day PO/Day; adjust dose to desired clinical effect, as rapidly as possible; not to exceed 60 mg/kg/day (Butler, 2018).

Explanation of my decision making. What is my reason for choosing this second medication?

The medication is pretty if the black box warnings are taken seriously. Particular attention must be given to the liver as Depakote can be aggressive to the liver. Deadly hepatic failure has been evidenced.

What laboratory considerations, testing/monitoring are needed to safely prescribe this second medication?

Measurements of complete blood counts and coagulation tests are recommended before initiating therapy and at periodic intervals; recommended that patients receiving drug be monitored for blood counts and coagulation parameters prior to planned surgery and during pregnancy; evidence of hemorrhage, bruising, or a disorder of hemostasis/coagulation is an indication for reduction of dosage or withdrawal of therapy and therefore the patient should be asked to contact the provider or go to the closest emergency room.

Children younger than 2 years are at increased risk for fatal hepatotoxicity. If used in children with these conditions, it should be administered with extreme caution.

What contraindications or safety issues are associated with this medication, what do you have to watch out for? What would you warn the patient about regarding this mediation? Mania Healthcare Case Study

This medication should not be given to patient with Hypersensitivity to Depakote, to patient with liver disease, significant hepatic impairment

Urea cycle disorder. Also, the medication must be avoided in patient with mitochondrial disorders caused by mutations in mitochondrial DNA polymerase-gamma and children <2 years of age who are suspected of having a POLG-related disorder. Finally, the medication should be avoided in women who are pregnant or plan to become pregnant.

What would be a non-pharmacy treatment for the diagnosis in this case study?

Several non-pharmacological measures have been shown to be efficient against mania: Maintain a stable sleep pattern. Stay on proper daily routine, set up realistic daily goals, do not use alcohol or illegal drugs, be surrounded by a good family support and friends. Reduce any form of stress at home and at work. Keep track of your mood every day and communicate efficiently with a therapist.

Are there any safety concerns for the patient in this case? What are they? What could you do?

Mania brings particular risks of disinhibition, poor judgement, risk taking and sometimes aggression, poor self-care and homicide. Mania also bring a risks of substance misuse and disrupted relationships. The patient in consideration does not show to be in particular danger for the factors we just listed. However, patient and most importantly the family and direct care giver must be educated on the situation and what it can lead to.

What/when would be your follow-up with this patient? Time till next appointment? Mania Healthcare Case Study

One week.

What in your opinion would be a safe alternative to medications for this patient? Complimentary Alternative Medications (CAM)?

Peer Support group: Making connections with people who can relate to what you’re going through can be really helpful.

Adopt healthy lifestyle Thinking about what you eat and drink – food and mood are related, so you might be able to manage your symptoms to some extent by making changes in your diet. See our pages on food and mood for more information.

Exercise – many people find regular exercise helps to lift their mood, boost their energy levels and keep them grounded in reality. See our pages on physical activity, sport and mental health for more information.

Get good sleep – sleep quality is very important for your mental health. See our pages on coping with sleep problems for more information.

Does this patient require psychiatric admission? Why/Why Not?

Not at this time. The patient has no risk of suicide, no risk to harm to self and to others. His support needs to be educated on the issue. They Mania Healthcare Case Study

should have clear when to call 911 in case of worsening. Mania Healthcare Case Study

If your first choice of medication does not seem to help what other medication would you ADD and why?

An antipsychotic medication can be added because the medication chosen can in some case take some time to work. I personally will add Quetiapine (Seroquel). Quetiapine is known as an anti-psychotic drug (atypical type). This medication can decrease hallucinations and improve your concentration, decrease the fly of idea. It can also help the patient think more clearly and positively about self. The medication has been shown to decrease patient anxiety and control episodes of mania allowing patient to take a more active part in everyday life. It may also improve patient mood, sleep, appetite, and energy level considering that the patient in this case has not been sleeping Noor eating. Quetiapine can help prevent severe mood swings or decrease how often mood swings occur. This will be a very good adjunct in the treatment regiment of this patient.

References.

Bowden CL. Key treatment studies of lithium in manic-depressive illness: efficacy and side effects. J Clin Psychiatry. 1998;59 Suppl 6:13-20.

Butler, M., Urosevic, S., Desai, P., Sponheim, S. R., Popp, J., Nelson, V. A., Thao, V., & Sunderlin, B. (2018). Treatment for Bipolar Disorder in Adults: A Systematic Review. Agency for Healthcare Research and Quality (US).

Collins-Yoder, A., & Lowell, J. (2017). Valproic Acid: Special Considerations and Targeted Monitoring. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 49(1), 56–61. https://doi.org/10.1097/JNN.000000000000025

Osborne, V., Davies, M., Layton, D., & Shakir, S. (2016). Utilisation of extended release quetiapine (Seroquel XL™): Results from an observational cohort study in England. European psychiatry : the journal of the Association of European Psychiatrists, 33, 61–67. https://doi.org/10.1016/j.eurpsy.2015.12.004

Mania Healthcare Case Study