BIPOLAR

DISORDER
Introduction
Bipolar disorder, also known as manic-depressive illness, is
a brain disorder that causes unusual shifts in mood,
energy, activity levels, and the ability to carry out day-to-
day tasks. Symptoms of bipolar disorder are severe. They
are different from the normal ups and downs that
everyone goes through from time to time. Bipolar disorder
symptoms can result in damaged relationships, poor job or
school performance, and even suicide. But bipolar
disorder can be treated, and people with this illness can
lead full and productive lives.
Symptoms of Bipolar Disorder
People with bipolar disorder experience unusually
intense emotional states that occur in distinct
periods called "mood episodes."
Symptoms of mania or a manic episode include:
Mood Changes
A long period of feeling "high," or an overly happy or outgoing mood
Extremely irritable mood, agitation, feeling "jumpy" or "wired."
Behavioral Changes
Talking very fast, jumping from one idea to another, having racing thoughts
Being easily distracted
Increasing goal-directed activities, such as taking on new projects
Being restless
Sleeping little
Having an unrealistic belief in one's abilities
Behaving impulsively and taking part in a lot of pleasurable,
high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.
Symptoms of depression or a depressive episode include:

Mood Changes
A long period of feeling worried or empty
Loss of interest in activities once enjoyed, including sex.
Behavioral Changes
Feeling tired or "slowed down"
Having problems concentrating, remembering, and making decisions
Being restless or irritable
Changing eating, sleeping, or other habits
Thinking of death or suicide, or attempting suicide.
Patient’s Profile
 Patient’s Name: Patient UW
 Age: 56yrs. Old
 Date of Birth: January 1, 1954
 Address: No Address
 Civil Status : Married
 Date of Admission: September 7, 2010
 Time of Admission: 2:16 PM
 Escorted by: Rowena B. Casa
 Admitting Physician: Dr. Anne Margaret Ramirez
 Chief Complain: According to her escort, Ms. Casa a Kagawad
from Brgy. 124 Zone 10 Balut, Tondo, Manila the patient was:
 Naghuhubad
 Nagmumura
 Nagsisisigaw
 Nambabalibag ng bote sa kalsada
 Nagsasalita magisa
 Kung anu- ano sinasabi
 Walang tulog
Diagnosis: Bipolar Disorder
Reliability of informant : 60%
Duration of illness: Unknown
Anamnesis: Unknown
Educational Background: Unknown
Past Medical History: Unknown
Family History: Unknown
Psycho Social History: Unknown
Substance History: Unknown
History of Present Illness:
 Before the admission of the client in the said
institution, the client was seen roaming and
wandering aimlessly along the street in Brgy. 124 Zone
10 Balut Tondo, Manila. Four days prior to admission
she was seen naked talking to self with shouting spells.
Then she became violent and disruptive prompting
consult to their center.
Pre Morbid Personality:
 The patient claimed to be married to a certain
Eladio Gorgonia and have 3 children namely Mylene,
Justine and Jimuel all of whom are said to be in her
husband’s custody.
 Her parents Mr. and Mrs. Baturino are known to be
a residents of Roxas Mondragon Palapag, Northern
Samar.
 
 
Anatomy and
Physiology
What do Oligodendrocytes do? They help increase the
speed of neuronal transmission and also protect the
neuron from variations in the extracellular environment
and thus injury-thus they play a role in cell-cell
communication! They also influence how brain injuries
heal. Understanding how oligodendrocytes work much
better will be essential to not only treating bipolar
disorder, but various other types of brain and nervous
disorders in which oligodendrocytes play a significant
role—, i.e. hypoxia, epilepsy, cerebral palsy, multiple
sclerosis, and spinal cord injuries
Psychodynamics
THEORIES
Catecholamine Hypothesis
The earliest theory along these lines was the
catecholamine Hypothesis (Schildkraut, 1965), which
asserts that a relative change shortage of
norepinephrione (a catecholamine) causes depression,
and an overabundance of norepinephrine causes
mania. The catecholamine hypothesis emerged from
several lines of observation of people’s reactions to
medications that affect this neurotransmitter’s
functioning.
Psychoanalytic Theory
One of the first psychoanalytic theorists, Karl
Abraham (1911, 1968), focused on the notion that
depression is triggered by a reaction to loss. Freud
(1917) took Abraham’s ideas and expanded them in
what has become a central paper in Psychoanalysis,
“Mourning and Melancholia.” However, the reaction to
loss involved in depression is not a straightforward of
grief or sadness. Instead, the loss is felt at an
unconscious level in a way that causes the person to
feel a combination of guilt and abandonment. In other
words, guilt may arise in response to mixed feelings
that the depressed person had about the other, but
when that other person is gone, a sense of emptiness is
experienced.
Cognitive Theory
 Cognitive theorists such as Clark and Beck (1999)
believe that depression results from impaired
cognition, or distorted thinking processes. People who
think negative thoughts evaluate themselves critically
and interpret stressful events as having a powerful,
global impact on them. They feel guilty, inadequate,
and hopeless about the future.
Biologic theory
Gender
 Women are prone to major depression and dysthymia
than are men. This is true across cultures. Endocrine and
reproductive cycles may play a role, although menopause
alone, contrary to popular belief, does not appear to be a
risk factor for depression in women. It is also unclear
whether prenatal and postpartum depression is hormonal
in nature, result from the increased stress of motherhood,
or represent an interaction of these and other factors. It is
clear, however, that of all population groups, those at
greatest risk for depression are rural elderly with very few
close friends, some financial strain, and a recent emergency
department visit (Friedman, Conwell, &Delavan, 2007).
Mental Status
Examination
General Appearance
The client is appropriately dressed, clad in hospital uniform. She is unkempt. She
has fair complexion, medium muscular built, no tattoo with poor posture. She
seems well-nourished. The patient looks sad.
 
Motor Behavior
At the start of the interview, the client was noted to have a slouched posture, but as
the interview progresses, she was slightly relaxed, with back inclined on the seat.
Eye contact was minimal.
 
Speech and Language
The client answers spontaneously except on topics regarding her family history. She
seems hesitant upon speaking.
She does not elaborate her answers when asked for more details. Her voice has
normal tone and is audible with regular rhythm.
Mood and Affect
Her mood was labile with flat affect. She experiences anhedonia. When addressed,
she interacts minimally with a few words or a gesture.
 
Thought Process and Content
With looseness of association, neologisms, shouting spells, and (+) flight of ideas.
She claimed to be Lucia Bartolino, 47 years old, married to Eladio with three
children. Her parents are residents of Roxas Mondragon, Palabag, Northern Samar.
She also claimed to have a relative in Taguig named as Boy Using. She could not give
any personal details.
She claimed that her second husband resides in a subdivision with high economic
status.

Sensorium and Intellectual Processes

Patient is alert, disoriented to date, time, place, and person. She is uncooperative
with poor abstract thinking.

Judgement and Insight

Client has poor insight of her illness and exhibits poor judgement. Patient has poo
account of herself.
NURSING CARE
PLAN
Drug Study
Laboratory Findings
Discharge Planning
Medication
Advise client to:
Keep a written list of the medicines that she is taking, the amounts, and when and why
you take them.
Bring the list of her medicines or the pill bottles when she sees her caregivers.
Do not take any medicines, over-the-counter drugs, vitamins, herbs, or food
supplements without consulting caregivers.
Always take her medicine as directed by caregivers. Call her caregiver if she thinks her
medicines are not helping or if she feels she is experiencing side effects.
Do not quit taking her medicines until she discusses it with her caregiver.
Avoid alcohol intake for it can affect the way your bipolar medicine works 
Exercise
Advise client to talk to her caregiver before she starts exercising. Together they can plan
the best exercise program for her. It is best to start slowly and do more as she gets
stronger. Exercising makes the heart stronger, lowers blood pressure, and keeps her
healthy.

Treatment
Instruct and explain to the patient’s relative that the medications are very important to
continue depending on the duration that the doctor ordered for the total recovery of
the patient.
Health Teaching
Carefully watch for things that may trigger bipolar disorder symptoms. These include emotional
upset, physical changes, or her medicine. Tell her caregiver if she feels a manic or depressive period
might be coming. Ask a family member or close friend to also watch her for bipolar symptoms. Ask
caregivers if there are certain conflicts or problems with people that make her disorder worse. Work
with her therapist to develop skills to deal with these problems.
Teach her that stress may slow healing and cause illness later. Since it is hard to avoid stress, learn to
control it. Learn new ways to relax (deep breathing, relaxing muscles, meditation, or biofeedback).
Talk to someone about things that upset her.
Advise client to avoid smoking.
 
Outpatient follow-up
Advise client to keep all appointments. Write down any questions she may have. This way she will
remember to ask these questions during her next visit.
 
Diet
Diet as tolerated, meaning, the patient can eat everything until she can. Diet plays a big role in fast
recovery. Instruct the client’s relative not to give foods with chocolate and caffeine. Only ample
amounts of sweets are advised.
Eat healthy foods from all food groups including fruits, vegetables, breads, dairy foods, and meat and
fish. This may help her feel better and have more energy.
 
Spiritual
Advise client to pray for her total recovery and keep faith to the Almighty God.
ThankYou for listening.