RT Book, Section
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
SR Print(0)
ID 1148576151
T1 Bipolar Disorder
T2 Pharmacotherapy: A Pathophysiologic Approach, 10e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259587481
LK accesspharmacy.mhmedical.com/content.aspx?aid=1148576151
RD 2024/04/25
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