Diagnosis of Bipolar Disorder: "Bipolar disorder is a serious disease characterized by recurrent biological changes in mood Typically, patients experience alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is relatively normal .." (Lehne , 2004, p. 321)
The following is a brief synopsis in accordance with DSM-IV-TR, "Criteria for bipolar disorder"includes a distinct period of abnormality and persistently elevated, expansive or irritable mood for at least:
- 4 days for hypomania
- week for mania
the period of mood disorders, at least three or more of the following symptoms have persisted and were present in significantly:
- inflated self-esteem or grandiosity
- decreased need for sleep
- More talkative than usual or pressure to talk
- Excessive involvement in pleasurable activities that have a high potential for painful consequences (American Psychiatric Association [APA], 2000 ).
Psychodynamics of disease onset usually occurs during late adolescence or in the mid twenties. However, the disease is known to occur in the fifth decade of life. mood swings that accompany this disorder are of several kinds. They are as follows: Pure Manic Episode, as evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep,
an impairment of normal social functioning usually requiring hospitalization, Hypomanic Episode, evidenced a mild form of Pure Mania, without loss of normal functioning that would require hospitalization, depressive episodes, characterized by depressed mood is composed of symptoms such as as anhedonia, avolition, Alogia, affective flattening and thoughts of suicide and death, the last episodes associated with bipolar disorder, a mixed episode in which "patients experience symptoms of mania and depression simultaneously a combination of high energy and depression puts them in. significant risk of suicide. "(Lehne, 2004, p. 321)
Case
Caucasian women in the mid twenties presented signs and symptoms of self-mutilation with a straight edge razor inflicted gash across her lower abdomen approximately six inches below the navel. Depth gash just stopped at the abdominal fascia. The patient was sent to the emergency room at the psychiatric floor. After meeting the patient one day after her entry into the ER, she appeared dressed in pajama bottoms and t-shirt, shuffling down the hallway in your socks. She was holding her stomach with one hand and appeared in some discomfort. Her black hair was short and messy. When the patient arrived at her room she sat on her bed. She acknowledged with blunted affect that she can not stop just mutilation, and described how she herself cut through the muscles in the abdomen almost down to the fascia. Her voice was tremulous and fast paced. This may be due to the fact that she only gave her first dose of Clozaril. She stated that her mouth was dry and that she should drink some water. She then went on to say that it is getting very sleepy. client felt comfortable with the interview.
She shared personal information in relation to sexually abuse her mind starting at the age of seven to fifteen years. Her brother was two years older than her, and died in an automobile accident at the age of eighteen years. She went on to say that her mother never knew or admitted sexual abuse and that she could not tell because the mother idolized the son. The client was susceptible to cognitive reframing, however it is very critical of himself and said that he felt worthless and ashamed. She appeared very tired and said she wanted to sleep.
Table 1
The textbook characteristics of bipolar disorder in relation to client characteristics observed
Textbook Characteristics:
Pure Manic Episode
Hypomanic Episode
Depressive episodes-
Affective Flattening
Alogia
Avolition-apathy
Anhedonia
Mixed Episode
Rapid-Cycling Bipolar Disorder Patients experience four or client
Characteristics Observed:
There are no current symptoms
Rapid breathing, rapid speech, but because of the drugs the client at the same time exposing lethargy
The client acknowledged sadness / worthlessness
Flat facial expression
Thoughts of death, it's hard to focus
Hair / clothes unkempt
Expressed no interest in children or own
Client's Symptoms
1st Hypomania
2nd Depression
a.) Affective Flattening
b.) Alogia
b.) Alogia ...
d.) anhedonia
3rd Mixed Episode
4th Rapid Cycling
(Varcarolis, 2004, p. 485)
nursing interventions
1 Observe the client every 15 minutes while suicidal, remove all dangerous, sharp objects out of the room.
2 Reinforce that it's worth,
a.) Assist the client in evaluating the positive and negative aspects of her life
b) Encourage the appropriate expression of angry feelings.
c.) Schedule regular periods throughout the day for recreational / occupational therapy, encourage client to groom self, offer praise for completing grooming.
d) To ensure client participation in the stabilization of mood medication. Watch a customer to swallow medicine.
3rd Engage client in interpersonal therapies, cognitive-behavioral therapy,
4th Encourage clients to attend group therapy, and journal episodes.
Table 2
Medical interventions, Bipolar Disorder
Drug Therapy
Mood stabilizer
Antidepressants
Antipsychotics
Education and Psychotherapy
ECT
(Varcarolis, 2002, p. 483)
Clients of medical intervention
Drug therapy includes
Lithium 300 mg every h.s.
Not taking any Clozaril
The client receives psychotherapy, family counseling, group therapy, while in the hospital, and cognitive restructuring.
None
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