Introduction
Nearly 2.2 million Americans are afflicted with bipolar disorder (also known as manic depressive illness) (What is, 2019). People as young as early adolescence are afflicted by the illness, and it continues throughout life. Around 15 per cent of these people end their lives with suicide (What is, 2019). While the consequences are dire, various medical treatments exist, and a wide field of study seeks to explore new ways to understand the illness, and deal with it one patient at a time.
Pathophysiology
According to Richard Maddock, occasional boughts of depression and mania that are associated with bipolar disorder are part of life for most people as a normal response to dangerous situations, uncertainty or stress, but it can also be a sign of bipolar disorder, which is a condition that could benefit from medical treatment (Culpepper, 2014). Scientific research is currently investigating the biological predisposition to bipolar disorder in these various forms.
Health Promotion and Disease Prevention
The research reveals that exercises such as limiting alcohol and illicit drugs, being involved in the community, stopping the attempt of trying to be perfect, taking time to relax, talking to someone, and finding triggers to the bipolar disorder (Bipolar Disorder, 2019). The Counseling and Mental Health Center at the University of Texas at Austin suggests that while depression is hardwired into people’s brains, and is necessary in the fight-or-flight response, some people may suffer from an bipolar disorder if common everyday events trigger severe and persistent panic or depression, though the aforementioned methods can act to reduce that.
Assessment
Risk Factors
Various life situations can cause bipolar disorder, and it is frequently a combination of life events that cause this (Culpepper, 2014). “Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms” (Culpepper, 2014). Trauma is a leading cause of bipolar disorder, and this can lead to long-term effects, though some individuals could be predisposition to experience chronic mania and depression.
Expected Findings
One of the most severe forms of bipolar disorder is mania and the state of depression related to bipolar disorder. It is expected that the thought processes and behaviors or bipolar disorder are linked to either genetic predispositions or to traumatic events that occur in a person’s life and leaves scars on their psyche, making it difficult for the person to utilize one of the aforementioned methods available to reduce the occurrence of mania and depression. Despite utilizing thought processes that have positive impact on many sufferers of the disease, it is expected that these remedies can have little effect on people suffering from bipolar disorder due to trauma and/or genetic linkage associated with their disease. “The person may develop thinking that is out of step with reality – psychotic symptoms – such as false beliefs (delusions) or false perceptions (hallucinations)” (Bipolar, 2019). The periods of high or irritable moods are referred to as manic episodes. The person is extremely active, but in a very unproductive and scattered way.
Laboratory tests
A laboratory test and imaging is not needed to diagnoses bipolar disorder (Culpepper, 2014). However, laboratory tests are useful when in conjunction with a physical examination. The laboratory tests can include urine toxicology screening when substance use is suspected. A complete blood count meant to exclude anemia or infection as being potential reasons for depression (Culpepper, 2014).
Diagnostic Procedures
A comprehensive diagnostic evaluation in a clinical interview, along with various case supportive finding tools are imperative to reaching an accurate diagnoses of bipolar disorder (Culpepper, 2014). However, providing a diagnosis can be problematic, given the diversity of the symptoms that might suggest various alternative diagnoses. According to Larry Culpepper, the person who is diagnosing bipolar disorder should be highly suspicious.
Patient-Centered Care
Nursing Care
A nursing staff is typically involved in the organization of a practice team. However, the team is not typically limited to nurses. This team usually includes community support workers, nursing staff, phycologists and specialist psychiatrics. The primary care physician usually takes a coordinating role. The psychiatrist and primary care physician communicates often about any change in the patient’s symptoms. Pharmacologic acute and maintenance treatment therapy is most appropriate for the majority of patients (Culpepper, 2014). This has the objective at reducing the symptoms quickly with tolerability and acceptable safety.
Medications
The US Food and Drug Administration has approved various oral medications to treat adults with bipolar disorder. For mania, doctors can prescribe Lithium, Carbamazepine, Divalproex, Aripiprazole, and Asenapine. For depression,, Lurasidone is approved. For a mixture of mania and depression, Carbamazepine, Aripiprazole, and Asenapine are often used as medications. Lithium is a typical mood stabilizer that has a slower onset action than many of the antipsychotics (Culpepper, 2014). The side effects of lithium include excessive urination, thirst, diarrhea, tremor, and nausea (Gitlin, 2016). Selective serotonin reuptake inhibitors include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram. While these are typically considered safe, many patients could develop skin rashes, insomnia, joint and muscle pain, headaches, diarrhea and nausea (What Are, 2019).
Therapeutic Procedures
When communicating with a person who is suffering from an acute episode of bipolar disorder, it is important not to startle the person. Speaking calmly and not aggravating their stress is vital to properly interacting with someone who is suffering from an episode. It is important to take care of yourself before a person takes care of someone else. It can help if a person tries to integrate the person with bipolar disorder with the community (Maddock, 2008).
Client Education
It is important for the patient to understand what they are going through. A patient who is knowledgeable about their condition will learn to accept their various moods, and this will help them to maintain objectivity about the condition when dealing with it in their daily lives. A psychiatrist can help the patient to come to a better understanding about the disease, and this can allow them to utilize various coping mechanisms whenever the situation should arise that would require each (Culpepper, 2014).
Interprofessional Care
Various professionals make up the team that cares for a person suffering from bipolar disorder. “A patient-centered, collaborative team approach that includes health care professionals with complementary skills offers the greatest likelihood of success” (Culpepper, 2014). These professionals include psychiatrists, specialty psychologists, community support workers, and nurses.
Complications
The most severe cases of bipolar disorder includes suicide. However, Lithium has been proven to reduce the likelihood that someone will commit suicide (What is, 2019). Other complications include drug and alcohol abuse, poor school or work performance, damage to relationships, and legal and financial issues.
Conclusion
Certainly, bipolar disorder can be a challenging illness to live with. While medications and holistic practices exist to limit and manage the negative impacts of the conditions, often these do not work for those who have suffered severe trauma or who are have genetics that predisposition them to bipolar disorder. As a member of a broader team, a nurse can make a major difference in the lives of people suffering from bipolar disorder. However, much more needs to be done to help sufferers live a rich and fulfilled life.
References
“Bipolar Disorder (Manic Depressive Illness or Manic Depression.)” (2019). Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/a_to_z/bipolar-disorder-manic-depressive-illness-or-manic-depression-a-to-z
Culpepper, L. (2014). The diagnosis and treatment of bipolar disorder: Decision-Making in primary care. US National Library of Medicine. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195640/
Gitlin, M. (2016). Lithium side effects and toxicity: prevalence and management strategies. US
National Library of Medicine. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/27900734
“What is Bipolar Disorder?” (2019). Bipolar Disorders Clinic. Retrieved from
http://med.stanford.edu/bipolar/bipolar.html
“What are the real risks of antidepressants?” (2014). Harvard Health Publishing. Retrieved from
https://www.health.harvard.edu/mind-and-mood/what-are-the-real-risks-of-antidepressants
