Assignment: Assessing and Treating Patients With Bipolar Disorder – Asian American Woman Case Study
The client in this scenario is a 26-year-old Korean woman who presents to the hospital for the onset of acute mania after 21 days of hospitalization. The patient was previously diagnosed with bipolar 1 disorder. In the office, the client seems “busy,” plays with objects on the desk, and keeps shifting on her chair. Ideally, the client is in a hyper mood, and she doesn’t think that she has any disorder. The patient weighs 110 lbs and is 5’ 5” high. Based on the weight and the height of the patient, she has a BMI of 18.3 kg/m3, an indication that she is underweight. Subjectively, the patient reports having a fantastic mood. Although she reports that she hates sleep, she reports sleeping for about 5 hours per night. Her medical records reveal that the patient has been worked up by physicians and the reports indicate the patient is generally in good health. Besides, laboratory investigations are within the normal limits Assignment: Assessing and Treating Patients With Bipolar Disorder – Asian American Woman Case Study.
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However, the patient tests positive for the CYP2D6*10 allele predisposing her to non-response to drugs. CYP2D6 is an enzyme that plays a key role in the metabolism of therapeutic medications. In East Asian populations such as the Chinese, Korean, Thai, and Taiwanese, the function of CYP2D6*10 is significantly reduced (Lu et al., 2021). The testing was carried out after the patient was not responding to any medication. The patient was discharged from the hospital with Lithium; however, she admits to non-adherence. On further investigation, the patient denies providing more details. The mental examination results reveal that the patient is oriented X4. She is inappropriately dressed for the appointment, and her speech is fast, anxious, and divergent Assignment: Assessing and Treating Patients With Bipolar Disorder – Asian American Woman Case Study. Self-reported is euthymic and affects broad. She denies auditory or visual hallucinations; delusional or paranoid thoughts are absent. She has an intact judgment, but her thoughts are impaired. She denies current suicidal or homicidal ideations. The Young Mania Rating Scale (YMRS) is 22. The total score for YMRS is 0-60, and the higher the score, the more severe the mania. Scores ranging from 20-25, 26-37, and 38-60 indicate mild, moderate, and severe mania (Mohammadi et al., 2018). In this scenario, the patient has mild mania. The fact that the patient has lithium non-adherence tests positive for the CYP2D6*10 allele and the YMRS rating will guide the psychopharmacological treatment of the patient.
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Decision #1; Begin Seroquel XR 300 mg Orally at HS
Seroquel (Quetiapine) has demonstrated effectiveness in the treatment of acute bipolar depression and the prevention of manic or hypomanic episodes (Patino et al., 2021). Quetiapine is an atypical antipsychotic medication used in the treatment of schizophrenia. Current evidence recommends the use of Quetiapine as the first-line treatment for acute bipolar disorder (Patino et al., 2021). However, Quetiapine is associated with adverse effects such as constipation, sedation, dry mouth, increased appetite, weight gain, fatigue, and dizziness. Although the patient reports side effects of the medication after four weeks, there is a significant improvement in manic symptoms as indicated in the YMRS scale.
Although the patient can also receive Risperdal and Lithium, the main focus is achieving positive outcomes while ensuring patient safety. First, the patient cannot be given Lithium because she has received the same medication previously without any positive outcomes. Research shows that Lithium takes a long time to control manic symptoms; thus, an atypical antipsychotic should be administered to the patient (Volkmann et al., 2020) Assignment: Assessing and Treating Patients With Bipolar Disorder – Asian American Woman Case Study. For instance, as indicated in the case scenario, after giving Lithium 300 mg orally BID, the patient returns after four weeks with the same symptoms as the first visit. Moreover, although Risperdal demonstrated a 50% reduction of manic symptom scores among patients with mania, it takes longer to start working (Lu et al., 2021). Besides, the client presents with severe sedation and lethargy and no significant improvement since day one. Thus, Seroquel is the most effective medication for the patient. Effective communication improves medication adherence. The patient should be educated on medication adherence and the possible side effects, and their management.
Decision #2; Discontinue Seroquel and Initiate Geodon 40 mg Orally BID Plus 500 calorie meal
Evidence suggests that a patient on psychotic medication should report at least a 50% decrease in symptoms in 50%. In this scenario, after four weeks, the client demonstrates a 50% improvement in symptoms scores on the scale. Besides, the patient has further weight gain and any additional side effects. Randomized controlled studies demonstrate that Geodon was well-tolerated among patients treated with Geodon. About 12.6% of the intervention group discontinued Geodon due to adverse events compared to 14.3% in the placebo (Kadakia et al., 2021). Administration of Geodon with a 500 mg calorie diet ensures optimal and dose-dependent bioavailability, thus, achieving predictable control and predictability of symptoms (Chakrabarty et al., 2020). Considering the safety of the patient, an increased dose of Seroquel XR cannot be given due to further adverse events. Giving increased Seroquel dose worsens constipation and causes further weight gain, and the client is concerned about the weight and is upset. Besides, the medication does achieve a 50% improvement in symptom scores. Excessive weight gain would predispose the patient to cardiovascular disease and other lifestyle conditions such as for overweight and obesity. Furthermore, the client cannot continue with the same dose of Seroquel due to increased adverse events and failure to achieve the required symptom improvement scores. In healthcare practice, patient safety and adherence to the legal and ethical healthcare practices and regulations are key. The patient has the right to make informed decisions concerning their health (Kadakia et al., 2021). She has the right to choose the most effective and safe medication to improve the treatment outcomes while promoting patient safety and improving their quality of life. Nevertheless, patient education empowers them and creates self-awareness, promotes self-care, and enhances patient understanding hence achieving maximum benefits from the treatment (Chakrabarty et al., 2020).
Decision #3; Increase Geodon to 60 mg Orally BID with a 500 calorie meal
Evidence shows that intake of oral Ziprasidone with food increases the bioavailability of the medication (Kadakia et al., 2021). The patient in this scenario should receive an increased dose of Geodon at 60 mg orally BID to achieve optimal alleviation of manic symptoms and improve his quality of life. Ziprasidone is a second-generation antipsychotic medication that works by balancing brain neurotransmitters such as dopamine and serotonin, hence improving thinking, mood, and behavior (Lu et al., 2021). However, higher doses of Ziprasidone may be associated with adverse events such as hallucinations, delusions, disorganized thinking, troubled speech, and isolation. Therefore, the patient should be counseled on the side effects of the medication, such as weight gain, constipation, and dry mouth. Patient education empowers them, leading to medication adherence and achievement of positive outcomes. Since the Geodon has improved the symptoms and curbed weight gain in this scenario, the aim of increasing the dose is to fasten the symptom improvement.
However, the patient cannot receive the same dose of Geodon since the main focus is to achieve 100% symptom improvement. Besides, the patient cannot receive Augment with sustained Lithium release. This option would be suitable if the goal is to stop antipsychotics and initiate Lithium monotherapy. However, the patient can benefit from the extended-release formulation of Lithium. Extended-release Lithium formulation is associated with fewer adverse events and better therapy adherence (Volkmann et al., 2020). The ethical consideration in this scenario is achieving the maximum benefits from the therapy while reducing side events. To achieve this goal, the patient should be educated on the importance of increased fluid intake and fiber in the diet to combat constipation. She should also chew hard candies or gums to prevent dry mouth and dental problems.
Conclusion
In summary, the case scenario involves a Korean Woman who presents with bipolar one disorder with manic symptoms. The psychopharmacological treatment of the patient depends on a number of individual factors. First, the patient is positive for the CYP2D6*10 allele. CYP2D6 is an enzyme that plays a key role in the metabolism of therapeutic medications (Lu et al., 2020). CYP2D6 allele is common among various ethnic and ancestral populations. In the East Asian populations, such as the Chinese, Korean, Thai, and Taiwanese, the function of CYP2D6*10 is significantly reduced. Besides, the patient presents with mania; thus, the first choice of medication should be to reduce the mania symptoms within the shortest time and have little or no side effects. The first choice for treating the patient is Seroquel (Quetiapine)XR 300 mg orally which has demonstrated effectiveness in the treatment of bipolar disorder and reduction of mania symptoms. Secondly, due to the side effects of Quetiapine, giving Geodon 40 mg orally BID plus 500 calorie meals improves mania symptom score on the YMRS scale by 50% with no side effects. Therefore, the third choice of treatment is increasing the Geodon dose to 60 mg orally BID plus the 500 calorie diet to increase the bioavailability of Geodon and reduce the adverse events. However, patient education is essential to communicate the side effects of the medication and propose possible interventions to curb the effects.
References
Chakrabarty, T., Keramatian, K., & Yatham, L. N. (2020). Treatment of mixed features in bipolar disorder: an updated view. Current Psychiatry Reports, 22(3), 1-13.
Kadakia, A., Dembek, C., Heller, V., Singh, R., Uyei, J., Hagi, K., … & Loebel, A. (2021). Efficacy and tolerability of atypical antipsychotics for acute bipolar depression: a network meta-analysis. BMC psychiatry, 21(1), 1-16.
Lu, J., Yang, Y., Lu, J., Wang, Z., He, Y., Yan, Y., … & Zhao, J. (2021). Effect of CYP2D6 polymorphisms on plasma concentration and therapeutic effect of risperidone. BMC psychiatry, 21(1), 1-12.
Mohammadi, Z., Pourshahbaz, A., Poshtmashhadi, M., Dolatshahi, B., Barati, F., & Zarei, M. (2018). Psychometric properties of the young mania rating scale as a mania severity measure in patients with bipolar I disorder. Practice in Clinical Psychology, 6(3), 175-182.
Patino, L. R., Klein, C. C., Strawn, J. R., Blom, T. J., Tallman, M. J., Adler, C. M., … & DelBello, M. P. (2021). A Randomized, Double-Blind, Controlled Trial of Lithium Versus Quetiapine for the Treatment of Acute Mania in Youth with Early Course Bipolar Disorder. Journal of Child and Adolescent Psychopharmacology, 31(7), 485-493.
Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium treatment over the lifespan in bipolar disorders. Frontiers in Psychiatry, 11, 377.
Assignment: Assessing and Treating Patients With Bipolar Disorder
Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.
To prepare for this Assignment:
- Review this week’s Learning Resources, including the Medication Resources indicated for this week.
- Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring bipolar therapy.
The Assignment: 5 pages
Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
- Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
- Which decision did you select?
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
- Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Bipolar Therapy
Client of Korean Descent/Ancestry
BACKGROUND INFORMATION
The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.
Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”
She weights 110 lbs. and is 5’ 5”
SUBJECTIVE
Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”
You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.
Genetic testing reveals that she is positive for CYP2D6*10 allele.
Patient did well enough on Lithium to be discharged from the hospital but admits she has not been taking it as prescribed. When further questioned on the subject, she provides no additional details.
MENTAL STATUS EXAM
The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.
The Young Mania Rating Scale (YMRS) score is 22
RESOURCES
§ Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6
Select what the PMHNP should do:
Begin Lithium 300 mg orally BID
Begin Risperdal 1 mg orally BID
Begin Seroquel XR 300 mg orally at HS| Excellent
Point range: 90–100 |
Good
Point range: 80–89 |
Fair
Point range: 70–79 |
Poor
Point range: 0–69 |
|
|---|---|---|---|---|
| Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. |
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.
The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. |
8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.
The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient Assignment: Assessing and Treating Patients With Bipolar Disorder – Asian American Woman Case Study. |
7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.
The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.
The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
| Decision #1 (1–2 pages)
• Which decision did you select? |
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
16 (16%) – 17 (17%)
The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing Assignment: Assessing and Treating Patients With Bipolar Disorder – Asian American Woman Case Study. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
| Decision #2 (1–2 pages)
• Which decision did you select? |
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
16 (16%) – 17 (17%)
The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
| Decision #3 (1–2 pages)
• Which decision did you select? |
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided Assignment: Assessing and Treating Patients With Bipolar Disorder – Asian American Woman Case Study. |
16 (16%) – 17 (17%)
The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
| Conclusion (1 page)
• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. |
14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.
The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. |
12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient.
The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. |
11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.
The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. |
0 (0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.
The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing. |
| Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. |
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. |
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
Purpose, introduction, and conclusion of the assignment is vague or off topic. |
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
No purpose statement, introduction, or conclusion were provided. |
| Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
|
4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
|
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
|
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
|
| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
5 (5%) – 5 (5%)
Uses correct APA format with no errors.
|
4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
|
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
|
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors Assignment: Assessing and Treating Patients With Bipolar Disorder – Asian American Woman Case Study.
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| Total Points: 100 |
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