Using the information from the following case study answer these questions.
Case Study Jeremy Stewart is a 44-year-old married father of three who sees you for a psychiatric evaluation. Jeremy is a professor at a local college, where he teaches art. He also has a small art studio close to campus where he paints. As his psychiatric nurse practitioner, you diagnose Jeremy with bipolar I disorder, most recent episode depressed. When treating a patient for bipolar disorder, you have several medications from which to choose. You decide to start him on Lamictal (lamotrigine).
1. What psychiatric disorders and/or symptoms is Lamictal indicated to treat?
2. What phase of bipolar (manic, mixed, or depressed) is Lamictal most effective in managing?
3. How does Lamictal work and what is the mechanism of action?
4. What is the dosing titration schedule for Lamictal?
5. What are the most serious adverse effects you would educate Jeremy to immediately report to you?
6. Identify any important drug-drug, food-drug, substance-drug, or herb-drug interactions with Lamictal.
7. What is Stevens-Johnson syndrome (SJS)? What are the risk factors for SJS? What are the signs and symptoms of a rash due to SJS versus a benign rash?
8. What are the FDA-approved treatment options for bipolar depression?
9. Compare and contrast these treatment options and describe when you might consider using each of them and why (such as patient symptoms, side effects you want to avoid, or side effects you’d want, and so on).
10. What role do antidepressants have in treating bipolar depression?
11. Provide a link (or upload a PDF) to a clinical practice guideline in the U. S. on the treatment of bipolar depressed phase.
Two resources to include are:
Stahl, S. (2013). Stahl\’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
and
Stahl, S. (2017). Essential psychopharmacology prescriber’s guide (6th ed.). New York, NY: Cambridge University Press.
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