Please respond to this post! Direction Propose an alternative on-label, off-labe
Please respond to this post! Direction Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature. Bipolar Disorder in Pregnancy According to Gooding, Wolford, and Gooding (2021) bipolar disorder is described as a serious mental illness that is characterized by depressive and manic episodes. The main treatment interventions include lithium, mood-stabilizing anticonvulsants, antipsychotics, and psychotherapy. Optimum long-term management is a preventive strategy that combines pharmacological, psychological, and lifestyle approaches from the first episode, with lithium being one of the most effective treatments of both manic and depressive episodes (Gilden et al., 2021). Women who discontinued lithium during pregnancy, were two times the risk for relapse compared to women who continued treatment (Poels et al., 2018). Lithium treatment during pregnancy has been associated with cardiovascular malformations, including Ebstein anomaly, a congenital malformation characterized by an abnormal development of the tricuspid valve and the right ventricle, with highly variable prognosis (Poels et al., 2018). The prevalence in the normal population is estimated to be about 1 per 20,000 live births. And based on data from the Register of Lithium Babies, estimated a fivefold increase in the risk of congenital heart-disease and about a 400-fold increase in the risk of Ebstein anomaly (Poels et al., 2018). FDA-Approved Medication for Bipolar Disorder Since the first line treatment for bipolar disorder, Lithium, is teratogenic, I would recommend the FDA-approved drug Lamictal (Lamotrigine). Lamictal is a neuroscience-based nomenclator: glutamate, voltage-gated sodium channel blocker, anticonvulsant, mood stabilizer, and voltage sensitive sodium channel antagonist (Stahl et al., 2021). Data suggests that exposure to lamotrigine is associated with an increase in the risk of oral clefts (Kong et al., 2017). However, teratogenicity was lower in association with lamotrigine than other mood stabilizers. And the risk of malformation among infants who were exposed to lamotrigine as monotherapy was even lower (1.9%) than that reported following an observation of the Australian Pregnancy Registry, which confirmed that lamotrigine was one of the safest AEDs for use in pregnancy (Kong et al., 2017). Resulting in Lamotrigine as the safest mood stabilizer for use during pregnancy (Kong et al., 2017). Risks of Lamotrigine use during pregnancy are increased risk of isolated cleft lip and palate during the first trimester, and reduced plasma concentration levels during pregnancy due to increased fluid volume (Stahl et al., 2021). Benefits of Lamotrigine during pregnancy is the decreased teratogenic risk that other anticonvulsants have, and the prevention of mood cycling during pregnancy. Non-FDA-Approved Medication for Bipolar Disorder Aside from recommending Lamotrigine, a non-FDA-approved medication is Iloperidone. Iloperidone is a neuroscience-based nomenclature dopamine and serotonin receptor antagonist, atypical antipsychotic (Stahl et al., 2021). This medication is frequently prescribed for schizophrenia; however, off-labeled use for bipolar disorder is common. The risks associated with pregnancy are abnormal muscle movements and withdrawal symptoms in newborns whose mothers took Iloperidone during the third trimester. When studies were conducted in pregnant rats, Iloperidone was not teratogenic at doses up to 26 times the maximum recommended dose (Stahl et al., 2021). Benefits of Iloperidone are that of decreased risk of mood cycling. Nonpharmacological Intervention for Bipolar Disorder Cognitive behavioral therapy (CBT) is a type of psychotherapy aimed to treat mood disorders such as depression (2022). A recent study suggests that both offering CBT in group interventions and sequence analysis of time series data are helpful routes to further explore when improving standard CBT interventions for patients suffering from bipolar disorder (Henken et al., 2020). One randomized controlled trial reported that patients who received 12–14 sessions of CBT were less likely to have depressive episodes and had better social functioning than patients in routine care for 30 months (Naik, 2015). Clinical Practice Guidelines Clinical practice guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence, and an assessment of the benefits and harms of alternative care options (Shah et al., 2017). A pregnant patient should have Lamotrigine recommended, as this is the least teratogenic psychopharmacological intervention for mood stability. Studies have shown that Lamotrigine has the lowest risk to fetus and mother during pregnancy. References American Psychological Association. (2022). What is cognitive behavioral therapy? American Psychological Association. Retrieved April 24, 2022, from Gilden, J., Poels, E. M. P., Lambrichts, S., Vreeker, A., Boks, M. P. M., Ophoff, R. A., Kahn, R. S., Kamperman, A. M., & Bergink, V. (2021). Bipolar episodes after reproductive events in women with bipolar I disorder, a study of 919 pregnancies. Journal of Affective Disorders, 295, 72–79. Gooding, D. C., Wolford, K., & Gooding, D. C. (2021). Bipolar disorder. Salem Press Encyclopedia of Health. Henken, H. T., Kupka, R. W., Draisma, S., Lobbestael, J., van den Berg, K., Demacker, S. M. A., & Regeer, E. J. (2020). A cognitive behavioural group therapy for Bipolar Disorder Using Daily Mood Monitoring. Behavioural and Cognitive Psychotherapy, 48(5), 515–529. Kong, L., Zhou, T., Wang, B., Gao, Z., & Wang, C. (2017). The risks associated with the use of lamotrigine during pregnancy. International Journal of Psychiatry in Clinical Practice, 22(1), 2–5. Naik, S. K. (2015). Management of bipolar disorders in women by Nonpharmacological Methods. Indian Journal of Psychiatry, 57(6), 264. Poels, E. M., Bijma, H. H., Galbally, M., & Bergink, V. (2018). Lithium during pregnancy and after delivery: A Review. International Journal of Bipolar Disorders, 6(1). Shah, N., Grover, S., & Rao, G. P. (2017). Clinical practice guidelines for management of bipolar disorder. Indian Journal of Psychiatry, 59(5), 51. Stahl, S. M., Grady, M. M., & Muntner, N. (2021). Stahl's essential psychopharmacology: Prescriber's Guide (7th ed.). Cambridge University Press.

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