What is Bipolar Disorder?

Introduction

The following case study consists of 50 outpatients diagnosed with Bipolar Disorder Type 1. It focused on some patients who took their medications regularly and some who decided to treat their disorder non-pharmacologically. Some people prefer a spiritual or a finding of one's self approach for treatment. Overall this case study was performed to observe the patient's perceptions of the disorder and the psychiatric medication management.

Compare and Contrast

According to my text book, less than 2% of the population are diagnosed with bipolar disorders. The case study claims that 4-17% are diagnosed with bipolar disorders. They both agree that if this disorder is treated properly with the correct medications, the effected person can live a pretty normal life, meaning they would have less severe and less frequent states of mania or depression. Both the text book and the case study agree on the type of medications that are taken for bipolar disorder. Individuals suffering from a bipolar disorder are usually prescribed antipsychotic mood stabilizers, anticonvulsive mood stabilizers, and lithium. Antipsychotic mood stabilizers are typically used as short-term treatment of hallucinations, delusions, or mania symptoms. Sometimes it is used long term to prevent future occurrences of mania or depression. Anticonvulsive mood stabilizers used to be prescribed to people who didn't respond to lithium, but now they are given with lithium, alone, or with an antipsychotic drug. They are used to treat or prevent mood or manic episodes. Lithium is a dangerous medication because it has a narrow margin of safety which is 0.6-1.2 mEq/L. Sometimes the doctor may refer the patient to a psychiatrist to talk about their behavior patterns, thought and feelings. The doctor may also run some lab test or a physical exam to find any other problems that could be the cause of your symptoms. An example of mood charting is having a patient keep a daily record of their moods, sleep patterns, or activity level. There are many other behaviors that are monitored that could help with finding the right treatment for the patient. (MFMER, 2018) The case study mentions some non-pharmacological treatments like massages and other stress relieving activities.

Diagnostic/Laboratory Procedures

The case study used the Structured Clinical Interview for DSM-5, the young mania rating scale (YMRS), and the Hamilton Depression Scale (Ham-D-17) to exclude any patients experiencing a current affective episode and to establish criteria for euthymia. The book recommends also using the DSM-5 diagnostic criteria for bipolar 1 disorder. It shows the subjective signs that a nurse should monitor. It shows signs of manic episodes, hypomanic episodes, major depressive episodes, and bipolar 1 disorder. (Box 28-6 pg. 1810). The YMRS is an eleven-question test with multiple answers used to measure how severe a manic episode is in children and young adults. The Ham-D-17 is also a questionnaire, but it is used to indicate depression and as a guide to evaluate recovery. According to webmd.com, the best way to diagnose bipolar disorder is by talking openly with a patient. The doctor must know the signs and symptoms the patient is experiencing to diagnose and treat the disorder.

Other Therapies

St. John's Wort is known for its ability to naturally enhance a person's mood. St. John's Wort would be beneficial when the person is in a depressive state. It could help them to feel happier and overcome that depressive episode. Patients should be notified about the dangers of this medicine. Studies have shown that St. John's Wort can cause a potentially life-threatening increase in serotonin. Some reports have stated that it can worsen the symptoms of bipolar depression and schizophrenia (PubMed, 2017). Meditation is another way to boost a person's mood when they are in a depressive state. This is a great way to boost your mood because there are a variety of ways to do it. There is concentration meditation, mindfulness meditation, and yoga are also a form of meditation. Concentration meditation is exactly what it sounds like. It's is when you concentrate on one thing, like a candle flame, and don't like your mind think about anything else. This improves your ability to concentrate. Mindfulness meditation is when you pay attention to your wandering thoughts and try not to judge them as good or bad. This meditation helps a person to not be so quick to judge something. Yoga is a way to free your mind through exercise and focus on nothing but that one pose and your breathing. Meditation has may benefits, lower blood pressure, improved blood circulation, less anxiety, lower blood cortisol levels, more feelings of well-being, less stress, and deeper relaxation. (Galam, 2018) Another nonpharmacological treatment for bipolar disorder is light therapy.It has been suggested that on dark days, the serotonin in your skin decreases. Serotonin is a chemical in the body that helps to regulate mood and social behavior. Light therapy is used to replace sunshine with a bright white light. It is usually set in a box, similar to a desktop computer. It is believed to mimic sunshine and boost serotonin levels on dark and gloomy days. Acupuncture can also help to treat bipolar disorder During a session of acupuncture, a provider will apply pressure to the skin with very fine needles. It helps the patients to respond to stress in a more positive way. It stimulates the central nervous system allowing endorphins to be released that may not be produced at normal rates in a bipolar patient.

Cultural Considerations

In Italy, health care providers have noticed that people with bipolar disorder tend to avoid doctor visits during the time of euphoric periods. Euphoric periods have two parts. In the beginning, the patient will feel like they are on top of the world, they will have a high level of confidence with all situations. It can be addictive. The second part of the euphoric period is completely different. The patient will begin to have bad judgement and perform out of the ordinary behavior. You may do things to harm yourself, your family, career, and all the things you care about. The patient won't be able to think or care about the consequences of their actions. (Fast,J.A., 2012) Since patients don't usually attend doctor visits during this phase, it makes it extremely hard to accurately diagnose bipolar disease. In fact, there is research showing that only 21.3% of patients that where prescribed anti-depressants for depression in Italy really had bipolar disorder. Since patients tend to visit the doctor during the depression state, it has been recommended to health care providers to consider bipolar disease with all patients that come in the office with signs and symptoms of depression. (Carta et al; 2011)

Prevention/Promotion Teaching

At this time, it is believed that bipolar disease is not preventable, but there are some non-pharmacological activities that can help to manage mood swings of this disorder. Eating healthy helps to prevent so many diseases and makes you feel better. It is believed to help manage mood swings in bipolar disease also. Eating healthy helps the brain and the nervous system to work efficiently. Studies have shown that a deficiency of vitamins and minerals in the body can lead to more frequent mood swings. Eating foods high in sugar and low in nutrients cause blood sugar levels to fluctuate causing mood swings. Bipolar disorder patients should manage the use of any mood-altering substance including caffeine and alcohol.

A healthy diet consists of foods from all food groups each time you eat. An easy way to keep track of this is you want your plate to mimic a rainbow. You can do so by eating fruit, vegetables, dairy, grain, and protein. Eating healthy isn't easy in the beginning, you should start out with small things like filling half of your plate with fruits and vegetables. You can also ensure that half of your grains are whole grains. In the beginning, people make the mistake of trying to cut out all the bad foods that they crave (cookies, chips, ice cream) and end up falling short of their goal. Most of the time those who fall short end up splurging and gorging themselves in the exact foods that they were trying to cut out in the first place. Normally the fast-paced short cuts that are taken end up coming to just as fast of an end. There is a term the slow and steady win the race which can apply here. The goal is not to see how fast a person can change but how long they can maintain a positive correlated mood. Therefore, patients should allow themselves to eat the foods that they crave, but they should eat it in moderation, only one serving size. Sometimes it is easier to substitute a healthy food for a junk food if they are the same texture. For example, trading peanut butter for almond butter, or ice cream for yogurt.

Conclusion

Overall, bipolar disorder is a complex disorder because it varies from person to person, and there is no distinct cure. Depression, euphoric, or manic states can last for different amounts of time depending on the person. There are many pharmacological and non-pharmacological ways to treat this disorder. Antipsychotic medications are the most common drug given for this disorder. They are used to help control psychotic symptoms of bipolar disease like hallucinations and delusions. Non-pharmacological treatments are things like yoga and meditation which helps to clear and strengthen the mind. According to webmd.com, the best way to diagnose bipolar disease is by talking openly with the patient. Another way that is commonly used to diagnose this disorder is the DSM-5. It tells a list of the subjective signs that a nurse should monitor for in the patient. It shows signs of manic episodes, hypomanic episodes, major depressive episodes, and bipolar 1 disorder in general.

References

Vargas-Huacachina*, L. Huicochea , C. Berlanga* and A. Fresan*

Huicochea,V., Huicochea, L., Berlanga, C. (2014). Taking or not taking medications: psychiatric treatment perceptions in patients diagnosed with bipolar disorder. Clinical pharmacy and therapeutics, 39,pp.673-679 Retrieved from NCLIVE.com

Trakalo, K. (2015) Nursing: a concept-based approach to learning. Boston, Massachusetts: Alexander, J. American psychiatric association. (2013) Desk reference to the diagnostic criteria from DSM-5th ed. Arlington, VA: American Psychiatric Publishing

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