TY - CHAP M1 - Book, Section TI - Bipolar Disorder A1 - Drayton, Shannon J. A1 - Fields, Christopher S. A2 - DiPiro, Joseph T. A2 - Talbert, Robert L. A2 - Yee, Gary C. A2 - Matzke, Gary R. A2 - Wells, Barbara G. A2 - Posey, L. Michael PY - 2017 T2 - Pharmacotherapy: A Pathophysiologic Approach, 10e AB - Patient Care Process for the Management of Bipolar DisorderCollectPatient characteristics (e.g., age, race, sex, pregnant)Patient psychiatric, medical, social, and family history Current medications and prior medication useCurrent and past sleep habits/patternsObjective dataBP, heart rate, height, weight, and BMILaboratory test (e.g., serum electrolytes, Scr, LFTs, TSH)Rating scale scores (YMRS, HAM-D, PHQ-9)AssessPresence of hypomania, mania or depression (see Table 69-2)Adherence to medication regimenAppropriateness and effectiveness of current medication regimenSerum concentration of medication if appropriate (e.g., lithium)Current medications that may contribute to or worsen mania or depressionSuicidalityCurrent sleep patternsIf no response to current medication regimen, reassess diagnosisPlan*If euthymic, continue current regimen if appropriateIf manic, immediately discontinue antidepressant, optimize regimen, and consider short term use of benzodiazepine (see Table 69-5)If depressed, optimize regimen and consider adding antipsychotic (i.e., quetiapine or lurasidone) (see Table 69-5)Lifestyle modifications (e.g., nutrition, sleep, exercise, stress reduction)Monitor for efficacy and safety of medications (see Table 69-7)Treat comorbid psychiatric disease statesPatient education (e.g. purpose of treatment, lifestyle modification, drug therapy)Self-monitoring for new mood episodes (daily mood chart) and sleep patternsReferrals to other providers when appropriate (e.g., psychologist, psychiatrist)Implement*Provide patient education regarding all elements of treatment plan Use motivational interviewing and coaching strategies to maximize adherenceSchedule follow-upFollow-up: Monitor and EvaluatePatient's psychiatric status (rating scale) and safety (suicidality)Presence of adverse effects (e.g., weight gain, sedation)Laboratory test (see Table 69-7)Patient adherence to treatment plan using multiple sources of information and presence of residual symptoms*Collaborate with patient, caregivers, and other health professionals SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1148576151 ER -