bipolar diagnosis criteria
Diagnosis of Bipolar Disorder: "Bipolar disorder is a severe biological illness characterized by recurrent fluctuations in mood. Typically, patients experience alternating episodes in which mood is abnormally high or abnormally depressed, separated by periods in which mood is relatively normal. "(Klaus-Heiner Lehne, 2004, p. 321)
The following is a brief synopsis according to DSM-IV-TR, "Criteria for Bipolar Disorder" includes a distinct period of abnormally and persistently elevated, expansive or irritable mood for at least:
– 4 days for hypomania
– Weeks for mania
During the period of mood disturbance, at least three or more of the following symptoms persist and have been present in a significant degree:
– Self-esteem or grandiosity
– Decreased need for sleep
– More talkative than usual or pressure to keep talking
– Excessive involvement in pleasurable activities that have a high potential for painful consequences.
(American Psychiatric Association [APA], 2000).
The psychodynamics of the disease the onset of illness usually occurs during late adolescence or twenty-five. However, the disease has been known to occur up in the fifth decade of life. Mood swings that accompany this disorder are of several types. These are: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of ideas, constant wakefulness without sleep,
Impairment of normal social functioning usually require hospitalization; hypomanic, as evidenced by a milder form of mania pure, without loss of normal operation requiring hospitalization; Major depressive episodes characterized by depressed mood that consists of symptoms such as anhedonia, apathy, Alogia, affective flattening and thoughts of suicide and death, the last episode associated with bipolar disorders is the Mixed Episode in which, patients experience symptoms of mania and depression simultaneously. The combination of high energy and depression puts in significant risk of suicide. (Lehne, 2004, p. 321)
Case Presentation
A white woman in their twenties to mid showed signs and symptoms of self mutilation with a straight Razor Edge inflicted cut on her lower abdomen approximately six inches below the navel. The depth of the wound only stopped at the abdominal fascia. The patient was sent from the emergency room at the psychiatric facility. When meeting with the patient the day after his admission to the ER, appeared dressed in pajama pants and a shirt, shuffling down the hallway in your socks. She said his abdomen with one hand and appeared in some discomfort. His black hair was short and disheveled. When the patient reached her room, sat on his bed.
He acknowledged with blunted affect that she can not stop self mutilation, and described how she cut through the muscles in his abdomen almost to the fascia. His voice was tremulous and fast. This could be due to the fact that she had just received their first dose of Clozaril. He said his mouth was dry and had to take some water. She then went on to say that she was very sleepy. The client felt comfortable with the interview.
She shared personal information about being sexually abused by his annoyance that begins at the age of seven until the age of fifteen. His brother was two years older than her and died in an automobile accident at age eighteen. She continued that her mother never knew or acknowledged the sexual abuse and that she could not tell because the mother idolized child. The client was receptive to new cognitive frame, however was very critical of herself and said she felt worthless and ashamed. She appeared very tired and said he wanted to sleep.
Table 1
Features textbooks bipolar disorder versus client characteristics observed
Textbook Features:
Pure Manic Episode
Hypomanic
Major depressive episode —
Affective flattening
Alogia
Avolition
Anhedonia
Mixed Episode
Rapid Cycling Bipolar Disorder-Patients experience four or Client
Observed characteristics:
No symptoms are present
Rapid breathing, rapid speech, however, due to medication a client at the same time are presented lethargy
Customer acknowledges sadness / worthlessness
Flat facial expression
Thoughts of dying, hard to focus
Hair / clothing neglected
Expressed no interest in children or self
Customer Symptoms
1. Hypomania
2. Depression
a.) Affective flattening
b.) Alogia
c) The lethargy and apathy
d) Anhedonia
3. Mixed Episode
4. Rapid cycling
(Varcarolis, 2004, p. 485)
Nursing Interventions
1. Note that the client every 15 minutes while suicidal, remove all dangerous, sharp objects in the room.
2. Strengthen worth,
a.) Assist the client in evaluating the positive and negative aspects of his life
b) Encourage the appropriate expression of feelings of anger.
c.) Schedule regular periods of time throughout the day for recreational therapy / occupational, encourage client to groom self, offer praise for completing WC.
d) Ensure the client's participation in taking mood stabilizing medications. See Customer swallowing medication.
3. Involve customers in the interpersonal therapy, cognitive-behavioral therapy,
4. Encourage client to attend group therapy, and episodes of the magazine.
Table 2
Interventions medical, bipolar disorder
Drug therapy using
Mood stabilizer
Antidepressants
Antipsychotics
Education and Psychotherapy
TEC
(Varcarolis, 2002, p. 483)
Customers medical interventions
Drug therapy includes
Lithium 300 mg every h.
Not taking any Clozaril
Client is receiving psychotherapy, family therapy, group therapy, while in the hospital, and cognitive restructuring.
None
References
Lehne, R. (2004). Pharmacology for Nursing Care. Missouri: Saunders
Varcarolis, E. (2002). Fundamentals of Psychiatric Mental Health Nursing: A clinical approach. Pennsylvania: Saunders
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