NATIONAL CENTER FOR MENTAL HEALTH

Nursing Education Training and Research

nursing.training@ncmh.gov.ph

RESIDENTS NAME: Mio Franco Quilit

DATE SUBMITTED:

GRADE:

ENTRANCE TO DUTY: August 10, 2015

NURSING HISTORY No. 1
Nursing History Clients & Family perception about the present condition of the client.
PATIENTS PERSONAL DATA
Name
Age
Gender
Civil Status
Place of Birth
Occupation
Religion

E.A.M.
17 years old
Female
Single
Northern Samar
none
Catholic

REASON FOR CONFINEMENT

Chief Complaint: Disruptive and assaultive behavior
The patient is uncooperative, irritable, very sensitive, and agitated. She have poor eye
contact, with shouting spells and irrelevant when talked to. She was brought to NCMH by
her father, according to her father naglalayas, salita ng salita, di natutulog.
HISTORY OF PRESENT ILLNESS
The patient was brought for admission last October 31, 2012 by his father due to disturbed
behavior. She was reported of smoking a lot, taking off her clothes at public, having different
boyfriends, and working in a club at Olongapo City. She was noticed to have visual and auditory
hallucinations by seeing thing that are not there and talking to herself. The patient was initially
admitted to ACIS 3. She is presently confined at Pavillion 12 (Zonta) of National Center for Mental
Health.
PAST MEDICAL HISTORY
She was mentally ill since 2011 and had re-admissions in and out at Pavillion 2 of NCMH. No head
trauma, no known disease and allergies.
FAMILY MEDICAL HISTORY
The patient is the eldest among three siblings. No known hypertension and diabetes from both
mother and father side. The patients grandfather has schizophrenia.

c. Symptomatology
The diagnosis of bipolar I (BPI) disorder requires the presence of a manic episode of at least 1
weeks duration that leads to hospitalization or other significant impairment in occupational or
social functioning. The episode of mania cannot be caused by another medical illness or by
substance abuse. These criteria are based on the specifications of the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).
Manic episodes are characterized by at least 1 week of profound mood disturbance,
characterized by elation, irritability, or expansiveness (referred to as gateway criteria). At least 3
of the following symptoms must also be present:

Grandiosity

Diminished need for sleep

Excessive talking or pressured speech

Racing thoughts or flight of ideas

Clear evidence of distractibility

Increased level of goal-focused activity at home, at work, or sexually

Excessive pleasurable activities, often with painful consequences

The mood disturbance is sufficient to cause impairment at work or danger to the patient or
others. The mood is not the result of substance abuse or a medical condition.
Hypomanic episodes are characterized by an elevated, expansive, or irritable mood of at least 4
days duration. At least 3 of the following symptoms are also present:

Grandiosity or inflated self-esteem

Diminished need for sleep

Pressured speech

Racing thoughts or flight of ideas

Clear evidence of distractibility

Psychomotor agitation at home, at work, or sexually

Engaging in activities with a high potential for painful consequences

The mood disturbance is observable to others. The mood is not the result of substance abuse or
a medical condition.
Major depressive episodes are characterized by the following: For the same 2 weeks, the person
experiences 5 or more of the following symptoms, with at least 1 of them being either a
depressed mood or characterized by a loss of pleasure or interest:

Depressed mood

Markedly diminished pleasure or interest in nearly all activities

Significant weight loss or gain or significant loss or increase in appetite

Hypersomnia or insomnia

Psychomotor retardation or agitation

Loss of energy or fatigue

Decreased concentration ability or marked indecisiveness

Preoccupation with death or suicide; patient has a plan or has attempted suicide

The symptoms cause significant impairment and distress.

The mood is not the result of substance abuse or a medical condition.

Mixed episodes are characterized by the following:

Persons must meet both the criteria for mania and major depression; the depressive event
is required to be present for 1 week only.

The mood disturbance results in marked disruption in social or vocation function.

The mood is not the result of substance abuse or a medical condition.

The mixed symptomatology is quite common in patients presenting with bipolar

symptomatology. This often causes a diagnostic dilemma.
d. Use the DSM IV Criteria
The Diagnostic and Statisticl Manual, 4 th Edition, Text Revision (DSM-IV-TR) uses Axis I to
set a criteria for diagnosing Bipolar Disorder Type I. This diagnostic tool provides a helpful guide
in understanding and managing the disorder.
Bipolar I Disorder
1. The patient had 1 manic episode
2. The patient has or hasnt had major deppressive episode
3. These symptoms cause clinically impportant distress or impaired work, social, or personal
functioning.
4. Current Episode: Manic
BIOLOGICAL BASIS
A number of factors contribute to bipolar disorder, including genetic, biochemical,
psychodynamic, and environmental factors.
Genetic factors
Bipolar disorder, especially BPI, has a major genetic component. First-degree relatives of
people with BPI are approximately 7 times more likely to develop BPI than the general
population. Remarkably, offspring of a parent with bipolar disorder have a 50% chance of
having another major psychiatric disorder. Twin studies demonstrate a concordance of 3390% for BPI in identical twins. As identical twins share 100% of their DNA, these studies
also show that environmental factors are involved and there is no guarantee that a person
will develop bipolar disorder, even if they carry susceptibility genes.

Adoption studies prove that a common environment is not the only factor that makes
bipolar disorder occur in families. Children whose biologic parents have either BPI or a
major depressive disorder remain at increased risk of developing an affective disorder,
even if they are reared in a home with adopted parents who are not affected.
Gene expression studies demonstrate that persons with bipolar disorder, major
depression, and schizophrenia share similar decreases in the expression of
oligodendrocyte-myelin-related genes and abnormalities of white matter in various brain
regions.
Biochemical factors
Multiple biochemical pathways likely contribute to bipolar disorder, which is why detecting
one particular abnormality is difficult.
A number of neurotransmitters have been linked to this disorder, largely based on
patients responses to psychoactive agents as in the following examples.
Drugs used to treat depression and drugs of abuse (eg, cocaine) that increase levels of
monoamines, including serotonin, norepinephrine or dopamine, can all potentially trigger
mania, implicating all these neurotransmitters in its etiology.
Evidence is mounting on the contribution of glutamate to both bipolar disorder and major
depression. A postmortem study of the frontal lobes
from persons with both these disorders revealed that the glutamate levels were increased.
Calcium channel blockers have been used to treat mania, which also may result from a
disruption of calcium regulation in neurons as suggested by experimental and genetic
data. The proposed disruption of calcium regulation may be caused by various neurologic
insults, such as excessive glutaminergic transmission or ischemia. Interestingly, valproate
specifically up-regulates expression of a calcium chaperone protein, GRP 78, which may be
one of its chief mechanisms of cellular protection.
Hormonal imbalances and disruptions of the hypothalamic-pituitary-adrenal axis involved
in homeostasis and the stress response may also contribute to the clinical picture of
bipolar disorder.
Neurophysiological factors
In addition to structural neuroimaging studies that look for volumetric in brain regions
regardless of brain activity, functional neuroimaging studies are performed to find regions
of the brain, or specific cortical networks, that are either hypoactive or hyperactive in a
particular illness. For example, a meta-analysis
found decreased activation and
diminution of gray matter in a cortical-cognitive brain network, which has been associated
with the regulation of emotions in patients with bipolar disorder. An increased activation in
ventral limbic brain regions that mediate the experience of emotions and generation of
emotional responses was also discovered. This provides evidence for functional and
anatomical alterations in bipolar disorder in brain networks associated with the experience
and regulation of emotions.
NOTE: May use another sheet when necessary.