Bipolar Disorder Type One - Description of the Disorder, Diagnosis, and Treatment - Research Paper Example

Bipolar I Disorder: of the disorder, Diagnosis, Treatment, Impact of the disorder on stakeholders involved and comprehension of the essential nursing care related to the disorder. Nicole Jacquez National American University Abstract Health system has been faced a range of medical complications calling for relevant nursing and health care facilities and services. Bipolar I disorder affects people from all walks of life including children and adults. The disorder is characterized by a case of at least one full-blown manic episode and depressive moods that result in disruptive behavior. The condition affects the patient’s normal life calling for well-defined diagnostic criteria to initiate the best treatment procedure. Self-awareness in the patient and the family is vital for successful treatment and health care. Treatment is demanding with stakeholders having to deal with the commitments and outcomes that come with treatment and post-treatment procedures. Society has to address the needs of such patients hence need for efficient nursing and health care. With proper medical attention, patients can turn their lives around and become productive in the society. The disorder can be addressed with timely diagnosis and efficient treatment procedures. Health facilities have a key role to play in nursing and care of the affected patients regardless of age. Bipolar I Disorder: Description, Diagnosis, Treatment, Impact and nursing care Bipolar is a disorder that is characterized by episodic manic and depressive moods that have extremes in polarity, and may impair the patient resulting in the inability to function in daily life activities. The patient portrays inflated self-esteem, has a tendency to be overly talkative, and has reduced desire to sleep or rest. The patient tends to have new ideas. He engages more in goal and objective oriented activities, and his focus is easily distracted from a given issue. Moreover, patients also portray a daring attitude in engaging in risky activities (Bengesser, 2013). The patient at time is disrupted as the symptoms are severe enough to hamper his ability to engage in constructive activities and engage socially with others. The patient tends to be unrealistic and illogical, and the situation can escalate making him psychotic (Goodwin, 2010). A patient with Bipolar I disorder could experience a minimum of one “mixed” incident at a given time. As such, the patient goes through phases of ups and downs (Bengesser, 2013). The patient at one moment is excited, has remarkable self-esteem, but then the situation reverses to a low mood hence the term mixed episode. The patient has no stable mood sequence and the reactions to everyday social situations are varied. The mood swing disrupts him/her and performs poorly in constructive activities (Goodwin, 2010). This would have some implication on nursing as the clinicians would have to identify clear cut symptoms between bipolar I and bipolar II disorders. Diagnosis The diagnosis of the disorder is pretty involving, and the level of the patient’s condition can be addressed using the DSM-5 diagnostic codes (American-Psychiatric-Association, 2013). The patient should register presence of five of nine diagnostic symptoms within a minimum duration of two weeks and a change in previously normal functioning. Symptoms may be mild, moderate or severe, and may portray psychotic features (Severus & Bauer, 2013). The mood change must be attended by consistently increasing energy levels (Sie, 2014). The disorder is described as Single Manic Episode if the patient experiences only one manic episode and has no record of Depressive Episodes (American-Psychiatric-Association, 2013). A diagnosis would be described as Most Recent Episode Manic if the patient is suffering or has recently experienced a manic episode. The patient must have experienced at least one major depressive episode, mixed episode or manic episode (American-Psychiatric-Association, 2013). A diagnosis would otherwise be termed as Most Recent Episode Mixed if the patient has had or is currently in a Mixed episode. Moreover, he or she must have recently recorded cases of Major Depressive Episode, a manic episode or a Mixed Episode (Berk, 2013). The DSM-5 provide clinician with a great deal of information that would help identify patients. This makes it easy to identify many undiagnised cases. Medical assessments are conducted to establish the cause of Bipolar I Disorder. It serves to identify or eliminate a somatic cause for the related symptoms. The tests involve ultrasounds of the head, electroencephalogram, computerized X-ray scans, and an HIV test. Test includes a blood count, thyroid, and liver function test. In addition, it includes a measure of creatinine and urea levels in the blood, drug tests, and a measure of the degree of exposure to toxins (Goodwin, 2010). All these tests serve to ensure that symptoms identified are strictly a result of Bipolar I disorder. The appropriate treatment can be extended. Treatment Medication to treat the disorder features a range of evidence-based prescriptions in an attempt to address the symptoms. Lithium is used to treat a manic high (N, 2013). It is prescribed for acute manic attacks and as a long term treatment. It diminishes the symptoms within a span of five days to two weeks. It is administered along with antipsychotic prescriptions that work to address the symptoms until the effectiveness of lithium is realized. Patients respond differently to lithium treatment with some showing positive outcomes while others do not benefit at all. Some may recover fully while others experience recurrent symptoms. 2 in every three patients respond positively to lithium (Marangell & McLaren, 2004). Clinicians have to be keen to identify those patients who would need alternative prescriptions. Anticonvulsants are issued to patients who respond poorly to lithium treatment. Patients who show manic-depressive symptoms are prescribed Carbamazepine, an anticonvulsant that works well with them. Many respond positively to the treatment and the ‘up’, and ‘down’ experiences through the day are calmed. Patients respond differently to Carbamazepine due to the ingredient-content of this drug. Antipsychotics are administered to address unstable moods. Antipsychotics like quetiapine and olanzapine are issued periodically to address the disorder (Hermsen, 2011). Patients are made to undergo electroconvulsive therapy where seizures are electrically induced to bring about a therapeutic effect on anesthetized patients. Such therapies unify energy distribution in the body cells. This serves to calm the patients over and curb depression. A range of antidepressants are issued to address manic episodes (Marangell & McLaren, 2004). All these treatments leave the patient at a situation where he is entirely dependent on the choices made by the clinicians. Nursing care would have to see the implications of this factor on the patient and the entire health system. Medications and treatments come with complications from side effects. They have their limitations. Carbamazepine is believed to lead to disturbed vision, memory impairments and perceptual distortions (N, 2013). It may contribute to bone marrow depression leading to low white blood cell count. This affects the patient’s general state of health worsening the situation. Side effects pose a hurdle and barriers in drug selection and general nursing and health care. There have been cases of misdiagnosis among patients leading to administration of drugs that affect their health, in the long run. The other side of misdiagnosis is untreated Bipolar I Disorder, which can be attributed to a high rate of suicide among patients. There is a need to make the correct diagnosis. Another challenge is having the patients adhere to the therapy to overcome the chronic condition. Patients’ adherence to treatment procedures is dependent on age, social status, and psychiatric comorbidities. Some patients are located far away from health facilities and may not access them. All these factors pose a challenge to the treatment of the disease as cases of the disorder may go untreated, unattended to and thus the efforts to address the condition stall. (Bengesser, 2013). This implies the need by the health system to have in place the right mechanism to establish the best drugs preferable in treating the disorder. Alternative treatments are also available to ease the symptoms of the condition. Doctors and psychologists may suggest an adjusted lifestyle that would suppress factors that trigger manic and depressive episodes (Copeland, 1994). Regular physical exercise is strongly suggested as it stimulates the release of endorphins that create euphoric feelings hence better sleep (Copeland, 1994). In addition, the patient sleeps better, has stable moods and reduced irritability. Patients are advised to make company with morally upright people to avoid peer pressure and behaviors that may trigger bipolar symptoms. Alcohol and illicit substances should be avoided. Use of appropriate herbs and supplements is advised with consultation with a doctor. Mind-body techniques have been suggested to relieve the symptoms; such as yoga, meditation, and acupressure help release stress and depression (Copeland, 1994). Nursing care would thus see the need to supplement clinical treatment with these alternatives that pose no side effects to the patient. Psychotherapy is a treatment used to supplement medication (Sajatovic, 2004). There are several types of approaches used in the counseling process. Cognitive behavioral therapy teaches the patient to change negative thought patterns to avoid behaviors that may be harmful to them (Tai, 2006). Family-focused therapy serves to help the patient’s family deal with the challenges that come with the bipolar disorder and improve communication between family members. Psychoeducation serves to help patients understand their condition and possibly seek treatment before the onset of a manic episode. Family members also benefit from this counseling procedure (Sajatovic, 2004). Psychotherapy proves useful to the nursing care system as all stakeholders are assisted to go through the treatment procedure. The disorder poses so many implications for the patient, the family, as well as society. Bipolar disorder subjects the patient to social isolation from the period of diagnosis through treatment. Lack of proper understanding of the ailment leads a patient to withdrawal and a life of solitude. The patient is more likely to abuse substances causing the situation to deteriorate. The disorder leaves the patient with varied feelings upon recovery such as disgrace, ignominy on past reflections an element that affects their self-esteem. Cases of discrimination of bipolar patients in workplaces have been recorded. The health system would have to help these patients handle such injustices without provoking extremity of symptoms of the disoder. Relationship with family members suffers especially due to misunderstanding between the patient and family members (Alakus, 2007). The patient may be abandoned if perceived as being intentional in his conduct. This worsens his condition. Parents, couples and relatives may break up as they take sides. Medication and management of the condition are expensive and involving. Families are pressed to commit funds and time during the treatment. The insurance firms are forced to pay more for such patients while the government has to extend more funds to that area. This affects the economy and the society. Unhealthy individuals cannot work effectively (Alakus, 2007). These factors have some implication on nursing as the entire health system has to establish the most appropriate approach to the disorder. Patients and family members would need counseling for the best results to be realized. Bipolar I Disorder has to be addressed pretty first to reduce the number of those affected in the society. The health system, the government, families and the society have to take part in this. DSM-5 diagnostic codes help to reduced undiagnosed cases and help extend relevant nursing and health care attention to the affected. Many patients are yet to be identified due to lack of sufficient information regarding assessment of the disorder. Treatment is an important element in addressing the disorder. Treatment and medication ease the symptoms of the condition. There is a need to improve the range of drugs available to cut on side effects and better their effectiveness. Alternative treatments should not be overlooked. Exercise, psychotherapy, and other procedures can supplement medication. Nursing care for the patients should be bettered through education and practice for effective results. The implications of the condition on the patient, family members, and the society should be well addressed. The patients should be assisted through the recovery period and assured that their lives matter. Counseling to family members would help cope with the burden. References Alakus, C. C. (2007). The needs for parents with a mental illness who have young children. International journal of psychiatry, 8, 333-339. Retrieved Jan 8th, 2015, from Beyond Blue Limited: www.beyondblue.org American-Psychiatric-Association. (2013). DSM-5 Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington DC: Arlington. Retrieved Jan 8th, 2015, from Psych Central: www.psychcentral.com Bengesser, S. &. (2013). genetics of Bipolar Disorder (1st ed.). Frankfurt am Main: Peter Lang AG. Retrieved Jan 8th, 2015, from The two types of bipolar disorder: www.psychcentral.com Berk, M. (2013, May). The DSM-5: Hyperbole, Hope or Hypothesis? BMC Medicine, pp. 11-128. Retrieved from The CME Institute of Physicians Postgraduate Press: http://www.psychiatrist.com/_layouts/PPP.Psych.Controls/ArticleViewer.ashx?ArticleURL=/PCC/article/Pages/2014/v16n02/13r01599.aspx Bipolar disorder nursing care plan. (n.d.). Retrieved Jan 8th, 2015, from iStudentNurse: www.istudentnurse.com Copeland, M. E. (1994, Aug 8th). Living Without Depression and Manic Depression: A Workbook for Maintaining Mood Stability (1st ed.). New York: New Harbinger. Retrieved Jan 8th, 2015, from Healthline: www.healthline.com Goodwin, G. a. (2010). Fast facts : Bipolar Disorder (2nd ed.). Abingdom: Oxford. Hermsen, L. (2011). Manias Mad History and Its Neuro-Future. Piscataway (1st ed.). new Jersey: Rutgers University Press. Marangell, L., & McLaren, K. (2004). Special Considerations In The Treatment Of College Students With Bipolar Disorder. Journal of American College Health, 6, 3-7. N, M. J. (2013, Oct 25). Bipolar Disorder. The Gale Encyclopedia of Nursing and Allied Health, 1, 462-467. Retrieved Jan 8th, 2015, from Psych central: www.psychcentral.com Palkhivala, A. (2006, may 24th). APA: Diagnostic And Treatment Challenges In Bipolar Disorder Remain. Retrieved Jan 8th, 2015, from Medpage Today: www.medpagetoday.com Sajatovic, M. (2004). Bipolar disorder (1st ed.). Dordrecht: Springer. Severus, E., & Bauer, M. (2013). Diagnosing bipolar disorders in DSM-5. International Journal of Bipolar Disorders, 18(6), 1-14. Sie, M. (2014, June 5). Mood stabilisers in the management of bipolar affective disorder. Progress in Neurology and Psychiatry, pp. 22-32. Tai, S. (2006). Bipolar disorder. In encyclopaedic dictionary of psychology (1st ed.). London: Routledge. Read More