Diagnosis Bipolar Disorder: “Bipolar disorder is a extreme biologic illness characterized by recurrent fluctuations in mood. Generally, sufferers encounter alternating episodes in which mood is abnormally elevated or abnormally depressed-separated by periods in which mood is reasonably regular.” (Lehne, 2004, p. 321)

The following is a quick synopsis according to the DSM-IV-TR, “Criteria for Bipolar Disorder” incorporates a distinct period of abnormality and persistently elevated, expansive, or irritable mood for at least: – four days for hypomania – week for mania

For the duration of the period of mood disturbance, at least 3 or much more of the following symptoms have persisted and have been present to a important degree: – Inflated self-esteem or grandiosity – Decreased have to have for sleep – Additional talkative than usual or stress to preserve speaking – Excessive involvement in pleasurable activities that have a higher prospective for painful consequences.” (American Psychiatric Association [APA], 2000).

Psychodynamics of the Illness The onset of the illness typically happens for the duration of late adolescence or in the mid twenties. Nonetheless, the illness has been recognized to take place up into the fifth decade of life. The mood swings that accompany this disorder are of quite a few sorts. They are as follows: the Pure Manic Episode, evidenced by hyperactivity, excessive enthusiasm, and flight of tips, continual wakefulness devoid of sleep,

Impairment in regular social functioning typically requiring hospitalization Hypomanic Episode, evidenced by a milder kind of the Pure Mania, devoid of the loss of regular functioning that would need hospitalization Main Depressive Episode, characterized by depressed mood consisting of symptoms such as anhedonia, avolition, alogia, affective flattening and thoughts of suicide and death the final episode connected with Bipolar problems is the Mixed Episode in which, “sufferers encounter symptoms of mania and depression simultaneously. The mixture of higher power and depression puts them at important danger of suicide.” (Lehne, 2004, p. 321)

Case Presentation A Caucasian lady in her mid twenties presented indicators and symptoms of self mutilation with a straight edge razor inflicted gash across her decrease abdomen roughly six inches under the umbilicus. The depth of the gash just stopped at the abdominal fascia. The patient was sent from the emergency area to the psychiatric floor. Upon meeting the patient 1 day just after her admission to E.R., she appeared dressed in pajama bottoms and a t-shirt, shuffling down the hall in her socks. She was holding her abdomen with 1 hand and appeared in some discomfort. Her black hair was quick and disheveled. When the patient arrived at her area she sat down on her bed. She acknowledged with blunted influence that she can not cease self mutilation, and described how she reduce herself by means of the muscle tissues in her abdomen nearly down to the fascia. Her voice was tremulous and quickly paced. This could be due to the reality that she had just been provided her 1st dose of Clozaril. She stated that her mouth was dry and that she necessary to drink some water. She then went on to say that she was finding quite sleepy. The client felt comfy with the interview.

She shared individual details in regards to becoming sexually abused by her bother starting at the age of seven till the age of fifteen. Her brother was two years older than her and died in an automobile accident at the age of eighteen. She went on to say that her mother under no circumstances knew or acknowledged the sexual abuse and that she could not inform her mainly because the mother idolized the son. The client was receptive to cognitive reframing having said that she was quite essential of herself and stated that she felt worthless and ashamed. She appeared quite tired and stated that she wanted to sleep.

Table 1 Textbook qualities of Bipolar disorder versus client qualities observed

Textbook Traits: Pure Manic Episode Hypomanic Episode Main Depressive Episode- Affective Flattening Alogia Avolition-apathy Anhedonia Mixed Episode Fast-Cycling Bipolar Disorder- Individuals encounter 4 or Client

Traits Observed: No present symptoms Fast breathing, fast speech, having said that due to medication a client was concurrently exhibiting lethargy Client acknowledged sadness/ worthlessness Facial expression flat Thoughts of dying, challenging to concentrate Hair/garments unkempt Expressed no interest in young children or personal

Client's Symptoms 1. Hypomania two. Depression a.) Affective Flattening b.) Alogia c.) Avolition & Apathy d.) Anhedonia three. Mixed Episode four. Fast Cycling (Varcarolis, 2004, p. 485)

Nursing Interventions

1. Observe the client every single 15 minutes whilst suicidal, get rid of all hazardous, sharp objects from area.

2. Reinforce that she is worth whilst,

a.) Help the client in evaluating the good as properly as the damaging elements of her life

b.) Encourage the proper expression of angry feelings.

c.) Schedule normal periods of time all through the day for recreational/occupational therapy, encourage client to groom self, supply praise for finishing grooming.

d.) Guarantee client's participation in taking mood stabilizing drugs. Watch client swallow medication.

3. Engage client in interpersonal therapies, cognitive-behavioral therapy,

4. Encourage client to attend group therapy, and journal episodes.