Insomnia Assignment Discussion Paper

The patient is a 32-year-old lady from Puerto Rico who presented with complaints of insomnia, a lot of involvement in goal-oriented activities, depressive thoughts with feelings of emptiness, fatigue, and sadness.

Decision 1: Differential Diagnosis

Based on the client’s presentation, the most probable differential diagnosis is Bipolar I disorder. Therefore, the client should be started on Latuda 40mg orally daily, or Lamictal 100mg orally daily. However, I choose to start the client on Latuda 40mg orally daily.

Reason for Selecting This Decision

Latuda typically referred to as lurasidone is an antipsychotic that is frequently prescribed for the management of schizophrenia. In this case of Bipolar I, Latuda is indicated for the management of the depressive symptoms experienced by the patient as it balances serotonin and dopamine to eliminate the depressive symptoms (Johnson, et. al., 2018). Basing on the mentioned medications, Latuda was the best alternative. Lamictal tends to cause adverse effects to a patient and the most notable side effect that results to non-adherence are exanthematous reactions such as a rash, malaise, sore throat, and chills. Insomnia Assignment Discussion Paper

Expected Outcomes

The client will return to the clinic after 4 weeks with marked improvement. The depressive symptoms and insomnia will have diminished significantly and the overall health status of the patient would be improved. The patient will be able to sleep, be organized in performing social and work duties and will be able to embrace happiness and to socialize (Johnson, et. al., 2018). Goal-oriented activities will also diminish alongside feelings of emptiness and fatigue.

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Difference between Expected outcome and Actual Outcome

The client noted some improvement in eliminating the depressive thoughts. She, however, reported on a new problem of inability to sit still thus tends to move after every few minutes due to feelings of non-comfortability, also referred to akathisia (Johnson, et. al., 2018).

Decision 2: Treatment Plan for Psychotherapy

The client will officially be started on therapy more so, CBT.

Reason

Cognitive Behavioral Therapy has proven to be highly effective in patients with bipolar disorders as it helps to decrease rates of relapse and to improve the severity of the maniac and depressive symptoms thus improving the overall psychosocial functioning (Bond & Anderson, 2015). It is the non-pharmacological treatment of choice for patients diagnosed with bipolar disorders who present with anxiety and depression.

Expected Outcome

It is expected that the changes in mood as experienced by the patient that arise from dysfunctional thoughts leading to maladaptive behaviors will be eliminated (Bond & Anderson, 2015). The client will learn newer skills which will increase/ boost her mood and behaviors including the ability to cope with daily life. Insomnia Assignment Discussion Paper

Difference between Expected Outcome and Actual Outcome

An anticipated, the client actually learned how to identify distorted thinking patterns which negatively influenced her thoughts, feelings, and behaviors (Bond & Anderson, 2015). Apart from viewing these thoughts from different positive perspectives, there was a positive change in mood and the client was able to get sleep as compared to before.
Decision 3: Treatment Plan for Psychopharmacology

Despite the fact that Latuda was causing the side effect of akathisia, the client will continue taking Latuda 40 mg orally daily. To clients with bipolar disorders, akathisia can be disturbing just as it was for this patient immediately she was started on the drug. Therefore, to eliminate or reduce the side effect of akathisia, the dosage of Latuda will be reduced to 20mg orally daily (Goodwin, et al., 2016). Besides, the client will frequently be reminded to take the medications with food.

Reason

While weighing the options of effective health outcomes for the patient and the most appropriate drugs used, increasing the dosage of Latuda will definitely be the worst decision as this will intensify the symptoms of akathisia. The only best alternative, therefore, is to reduce the dosage of Latuda to 20mg orally daily so that the severity of the side effect of akathisia will also reduce (Goodwin, et al., 2016). Research suggests that Latuda should be taken with a 350 calorie meal which will ensure efficient absorption of the drug.

Expected Outcome

It is expected that the side effects of akathisia will no longer be present or exist in very low levels that rarely impact social and physical functioning.

Difference between Expected Outcome and Actual Outcome

As expected, there was a significant reduction in the symptom of akathisia since the reduction of the dosage of Latuda to 20 mg orally daily. Besides, the client also noted that she was able to be happy, active and focused on conducting her activities with a marked increase in the depressive symptoms (Goodwin, et al., 2016). This was clear that the treatment regimen was highly effective.

How Ethical Considerations Might Impact Treatment Plan and Communication with Clients and Their Family

Ethical considerations are an integral part of the course of treatment in the management of patients with mental conditions more so bipolar disorders. Therefore, mental health nurses need to consider some of the best available approaches that can be used to ensure highly effective health outcomes. For instance, in this case, the client is generally fatigued, depressed with on and off episodes of goal-oriented activities. Therefore, a mental health nurse needs to determine the most appropriate approach of communicating information to the client for her to understand. Through this understanding, it will be easier for her to make informed decisions of both psychotherapy and psycho-pharmacy (Goodwin, et al., 2016). This approach also helps to uphold the ethical principle of autonomy where the right of the client to make personal decisions regarding her health is upheld. Insomnia Assignment Discussion Paper

References

Bond, K., & Anderson, I. M. (2015). Psychoeducation for relapse prevention in bipolar disorder: a systematic review of efficacy in randomized controlled trials. Bipolar disorders, 17(4), 349-362.

Goodwin, G. M., Haddad, P. M., Ferrier, I. N., Aronson, J. K., Barnes, T. R. H., Cipriani, A., & Holmes, E. A. (2016). Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 30(6), 495-553.

Johnson, S., Persaud, K., Alabedy, M. A., Nayak, K., & Syed, O. (2018). The Effects of Lurasidone in Treatment of Bipolar Depression and its Effects on Improving Depressive Symptoms and Psychosocial Functioning: With Case Studies. GSTF Journal of Advances in Medical Research (JAMR), 2(1).

Song, J., Bergen, S. E., Kuja‐Halkola, R., Larsson, H., Landén, M., & Lichtenstein, P. (2015). Bipolar disorder and its relation to major psychiatric disorders: a family‐based study in the Swedish population. Bipolar disorders, 17(2), 184-193.Insomnia Assignment Discussion Paper

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