Treating Bipolar In Children And Adolescents Discussion Paper

Treating Bipolar In Children And Adolescents Discussion Paper

Use the library to research evidence-based treatments for bipolar disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.

• Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating Bipolar disorder in children and adolescents.
• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources. Treating Bipolar In Children And Adolescents Discussion Paper Treating Bipolar In Children And Adolescents Discussion Paper
  

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Treating Bipolar In Children And Adolescents

Bipolar is a manic-depressive illness mental illness with acute severe and persistent episodes. It presents with alternating episodes of deep prolonged and profound depression alternating with persistently elevated mood. Manic episode presents one week after profound mood disturbance or depression. Manic symptoms are grandiosity, pressured speech, racing thoughts, and excessive pleasurable activities. Hypomanic episodes are characterized by depressed mood, loss of interest and pleasure, hypersomnia, and loss of energy (Carvalho, et al, 2020). In this paper, i will describe the FDA-approved drugs for bipolar, off-label drugs, non-pharmacological treatment for bipolar and the risk assessment before treatment of bipolar.

Risperidone

Risperidone is an antipsychotic medication FDA-approved for treating bipolar and schizophrenia. It is a first-generation antipsychotic that antagonizes with D2 receptors thus inhibiting serotonin and norepinephrine uptake. The D2 receptors are specific in the mesolimbic pathways at the prefrontal cortex. Risperidone helps in controlling symptoms such as aggression and agitation. It is available in form of oral tablets and injection. The dosage in bipolar is 6mg per kg body weight in to divided doses. It has a peak plasma time of 6hours, 70% bioavailability, and 90% is protein bound while 77% is a metabolite. It has a plasma half-;life of 9dats and is excreted in urine (Maguire, et al, 2021). Risperidone is well tolerated in children because of its less side effects. However, when given in a higher dosage it may cause muscle rigidity, akathisia, dystonia, and tremors. It is contraindicated in children and adolescents using hallucinogens. Treating Bipolar In Children And Adolescents Discussion Paper

Clonazepam

Clonazepam is a benzodiazepine FDA-approved for panic disorder, epilepsy, and non-convulsive epilepticus. It is used as an off-label drug for treating mania, insomnia, bipolar, and restless leg syndrome. It is a benzodiazepine that works on GABA receptors to increase the frequency of chloride channel opening resulting to hyperpolarization of neurons thus producing a calming effect (Dokkedal-Silva, et al, 2019). It is more effective than lithium because it has both anticonvulsant and serotonin agonist activity. Clonazepam is administered orally 1mg at bedtime. It is readily absorbed and has a bioavailability of 90% with a plasma peak time of four hours. It is protein bound metabolized in the liver, has a half-life of 60 hours, and is excreted in urine. It is effective and well tolerated in children and adolescent because it has fewer side effects. It has an immediate therapeutic effect on the patient. The common side effects are lethargy, fatigue, sedation, drowsiness, dizziness, and impaired balance. Before prescription in children, assess for thrombocytopenia, liver function test, and immunity status. Watch out for withdrawal symptoms in children such as anxiety, irritability, hallucinations, and seizures. Treating Bipolar In Children And Adolescents Discussion Paper

Non-Pharmacological Treatment

Psychotherapy sessions are important in treating the patient with bipolar. It helps in closely evaluating and monitoring patients for depression and risk for mood destabilization. Examples of effective psychotherapies are cognitive behavioral therapy, interpersonal and social rhythm therapy, and family focused therapy. However, the type of psychotherapy depends patients response to pharmacological treatment (Carvalho, et al, 2020). Patients in depressed and manic phase with no response to treatment are transferred to electroconvulsive therapy. A combination of cognitive based mindfulness therapy and cognitive behavioral therapy helps ease the symptoms of depression and anxiety.

Risk Assessment When Treating Bipolar

Bipolar is a mental illness with significant risks to the patient and the surroundings. The nurse should assess for symptoms of psychosis and suicidal attempt before drug administration. The adolescents patients on antipsychotics have a higher risk of substance abuse and engaging in harmful activities (Carvalho, et al, 2020). Before prescriptions, the care provider should have an evaluation of psychiatric history, current medication, substance abuse, family history of psychiatric diseases, and suicidal risks. The off-label drugs are preferred during treatment of bipolar because they are safe and have an existing evidence of efficacy. For example, clonazepam is effective in treating manic phase of bipolar and prevents progress to hypomanic phase unlike mood stabilizers. However, the off-label drugs are used together with mood stabilizers to enhance its effectiveness. FDA approved drugs are more preferred compared to the off-label drugs because they have evaluated the safety and efficacy of the drug. Additionally, the specific use of the drug is labeled and its benefits outweighs the risks. Treating Bipolar In Children And Adolescents Discussion Paper

Clinical guidelines for bipolar

According to the American psychiatric association atypical antipsychotics are the first-line treatment in bipolar because it its effectiveness and safety. However, the nurse should regularly monitor blood sugar and cholesterol because they slow down metabolism. Mood stabilizers such as lithium are prescribed in low doses because they have side effects such as dizziness, nausea, restlessness, trembling, and increased thirst. Treating Bipolar In Children And Adolescents Discussion Paper

 References

Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66. DOI: 10.1056/NEJMra1906193

Dokkedal-Silva, V., Berro, L. F., Galduróz, J. C. F., Tufik, S., & Andersen, M. L. (2019). Clonazepam: indications, side effects, and potential for nonmedical use. Harvard Review of Psychiatry, 27(5), 279-289. DOI: 10.1097/HRP.0000000000000227

Maguire, G. A., Yoo, B. R., & SheikhBahaei, S. (2021). Investigation of risperidone treatment associated with enhanced brain activity in patients who stutter. Frontiers in Neuroscience, 15, 598949. https://doi.org/10.3389/fnins.2021.598949 Treating Bipolar In Children And Adolescents Discussion Paper