Bipolar Disorders: of Mr Mary - Case Study Example

Bipolar disorders Author’s Name: Instructor’s Name: Course Details: Institutional Affiliation: Date of Submission: Mental health problems are a serious threat to the health and well being of any individual. Bipolar disorders are among the mental health problems which pose a serious health threat to susceptible individuals. Bipolar disorder is a very complicated mental illness affecting the brain. Lives of people who live with this disorder are characterized by expression of this disease condition in irregular patterns of mood changes, thinking and energy. Bipolar is a name that describes a set of conditions of mood swings. The most sever form of this condition is known as mania or manic depression. This is an exaggerated mood swing, energy in both extremes and cognition. These are also among the characteristics of this mental disorder. Patients who suffer from bipolar diseases tend to experience recurrent episodes characterized by elevated or high moods (mania or hypomania) and depression. Majority of the patients experience both the lows and highs and in some instances susceptible individuals experience a mixture of the two cases of mood swings. Sometimes a switch is experienced during daytime such that a mixed picture of symptoms is realized. Normal moods are otherwise experienced by these people between their swings of mood. Every patient, according to studies, presents with a unique pattern of mood swing. Some of the patients experience mania episodes once in a decade while in other patients, daily episodes of mania may be evident (Kilbourne et al., 2010, p. 894). Diagnosis of bipolar disorder sometimes fails to be straightforward. Majority of people suffer from this condition which may go unnoticed for up to more than ten years before it is diagnosed. It is otherwise important noting that people have their own mood swings which come at different times with the respective individuals. Changes in these moods such that they appear to be very extreme and at the same time affecting the private and professional life of an individual may demonstrate existence of a bipolar disorder and as such prompting seeking of medical assessment. The two important signs for diagnosis of bipolar disorder is the existence of highs where the moods are elevated than the usual levels and one seems to be a hyper. This is what is commonly known as mania and it is sometimes difficult to be differentiated with happiness. The following features can be critical towards identification of episodes of mania and hypomania. The features are also characteristic features as depicted from Mary`s case. They include; positive moods, inappropriate behaviors, irritability, mystical experiences and creativity that appears to be heightened (Ghaznavi and Deckersbach, 2012, p. 2). Mary`s characters include her uncontrolled spending of money on things that are not important, she has started taking too much alcohol, she talks too much about alcohol to many people. This is unusual for her husband who fails to understand her. The mental health team also report that she has no sleep and she has an extremely elevated mood. She pays much attention to her personal grooming as well as body language which portrays sexy motives. She also talks much and there is no sense in whatever she is taking about. In the craft tasks that she is given, she proves to be very creative. She also demonstrates that she is not sick and would wish to go home so that she would show love to other people. The extended period of highs and psychotic episodes which have led to her hospitalization is an indication that Mary suffers form bipolar I disorder. The prevalence of bipolar disorders within Australian communities is stated at 4%-5%. It is also stipulated that bipolar disorders is ranked at position six among the diseases that take lead in causing disabilities in the Australian populations. The exact prevalence of bipolar disorder is however not known with regard to general practice. Data from the Bettering and the Evaluation and Care of Health (BEACH) from the year 2007 to 2008 indicated that 36 patients out of 3374 sampled in a study recorded a history of having suffered from bipolar disease in their lifetime. Lack of accurate data to indicate the actual prevalence of bipolar diseases in Australian population is attributed to several reasons. They may include; failure of diagnosis of the mental disorder, poor and erratic participation of susceptible individuals, cases of inaccurate diagnosis of the disorder where it is confused with unipolar depression, comorbidity of the disorder with other psychotic problems and especially those linked to alcohol and drug abuse, which in most case tend to override the bipolar disorder diagnosis. These reasons are also not limited to the methods used by the BEACH in capturing of data. The methods, in other words tend to hinder collection of accurate prevalence data (Pitterman, Jones and Castle, 2009, p.14). A number of factors hinder management of bipolar disorder by the mental health staff or by the general practitioners. These factors include; problems linked to dual diagnosis, differential diagnosis, erratic attendance and poor treatment compliance and physical comorbidity. Differential diagnosis may involve psychiatric disorders including; anxiety episodes, unipolar depression, drug and alcohol abuse, eating disorders, personality disorders and hyperactivity. There are also physical disorders which accompany bipolar disorders. They may include; acquired brain injury, dementia, multiple sclerosis, cerebrovascular accidents, hyperthyroidism and hypothyroidism. Sometimes there is delayed diagnosis of bipolar disorder in patients due to the fact that, late onset or atypical onset of this mental disorder is very common (Pitterman, Jones and Castle, 2009, p.14). Patients who suffer from this mental illness tend to seek alternative means to avert their mood problems and depression symptoms. The consequent of this is the development of interpersonal differences between the patients and the general practitioners who attend to them. Case where the general practitioner is not experienced in handling such patients may lead to development of difficultness in treating patients with bipolar disorder. This presents a challenge towards managing of bipolar diseases in Australian communities. There is also the issue of negative attitudes which is developed by these patients who fail to undertake interviews that are motivational and aim to improve the gradual process of behavioral change among mentally disabled patients (Pitterman, Jones and Castle, 2009, p.15). Consumer oriented mental health care is a type of health care that is patient centered. This type of care exists in multiple dimensions which involve respecting the patients` beliefs, values as well as preferences. This type of approach to health care is also involved in the customization of care to the individual patients and ensuring that competencies are maintained culturally, and also recognition of the preferences of patients which may change. These changes in preferences may be attributed to responses towards shifts in clinical aspects as well as other different circumstances. Mental health care services are well coordinated and integrated taking into account continuity of services from all mental health care settings, including hospitals and homes. Exchange of health information and patient progress between the mental health staff and patient`s support team is also on time and done in a more accurate fashion. This means that all protocols for information exchange are observed and ethics followed too. This approach ensures that there is effective communication between the relevant individuals which may include the mental health staff, patient and patients` support team. The patient can also have a chance of being given information about his or her diagnosis, prognosis, and the available options for treatment. These treatment options are offered to respective patients in a fashion that reflects the best available clinical options guided by evidence based practice (Marshall, Oades and Crowe, 2010, p.199). Consumer oriented approach is advantageous in a number of ways. This is because; patients` physical comfort is endured, by way of realizing expert management so that mental health patients are free from all the risks associated with bipolar disorders. This is achieved through provision of additional services like emotional support with the aim of driving away their fears and anxieties by making follow ups on their experiences of loneliness, uncertainties, negative financial impacts as a result of the mental illness and resultant disabilities. Patients support team including family and friends are also included in the patients` care plans. They are involved in decision making processes with regard to patients` treatment options, recognition of patients` needs, possible contributions. They are also invited to the patients` care environment to the extent in which the patient seems satisfied. The ultimate results which are possible from this mental health care approach is the accomplishment of treatment objectives such as build up of strong relationships and sensitive interpersonal interactions between the general practitioners and their patients. Patients realize that their preferences are respected and this is facilitates patients` recovery process (Edward et al., 2011, p. 311; (Marshall, Oades and Crowe, 2010, p.199). Drugs which fall can be sued as mood stabilizers are the best treatment intervention for bipolar disorders. Olanzapine (Zyprexa) has had a track record in the treatment of bipolar disorders especially for interventions that are aimed towards preventive treatment. Olanzapine is known to be associated with a number of side effects which require attention of nurses in their management. These side effects can be categorized in to two including serious side effects and the less serious side effects. The serious side effects include; rash or hives, seizures, swelling of face, eyes, extremities, uncontrollable or unusual facial movements, vision changes, difficulty in swallowing or breathing, rigidity of muscles and irregular heartbeats. The less serious side effects include; dizziness, drowsiness, or weakness, depression, dry mouth, insomnia, agitation or restlessness, weight gain, constipation, joint pains, breast discharge or enlargement, decreases sexual abilities, late or sometimes missed menstrual periods, sensitivity to the sun and difficultness in moving around or walking (McIntyre, Danilewitz and Liauw, 2010, p. 375). This side effect can be managed by experienced mental health staff to prevent them from getting to the point of severity. Nurses should observe that the right dosage is administered. For Mary`s case, single 10mg tablets are advised on a daily basis. This dosage should be carefully maintained to avoid omissions or possible hoarding. During instances of dizziness, hypotension and syncope especially in elderly patients, patients are advised to rise slowly from a sitting or lying position. Supervision of ambulation is also important in this case. For cases of constipation, fluids and highly fibred diets can be encouraged. This side effect can be monitored if patients are instructed to always take the right dosage at correct time intervals without skipping. Patients are not supposed to stop taking the drug unless instructed so by the physician. Patients are supposed to report to the physicians about their side effects are the activities they are planning to involve themselves. Women who plan to get pregnant should discuss first with the physician (Usher et al., 2009, p. 41). Also in case of dizziness, lightheaded and blurred vision patients should be advised not to operate any machinery or drive. During such instances, patients are also advised to stop taking alcohol while they are still under medication. Case of overdose can also be evident and may cause dystonic reaction of the neck and head, seizures and obtundation which may lead to a risk of aspiration and emesis. Cardiovascular monitoring is advised and should include electrocardiographic. Occasionally, an airway can be established and maintained to ensure adequate ventilation and body oxygenation which may be done via intubation (McIntyre, 2009, p.20). Mary`s mental health condition presents several risks for her physical health. This may include; increased weight, metabolic syndrome, alcohol consumption, eating disorders with increase appetite, insomnia. Mary may also become diabetic and this may contribute development of cardiovascular diseases and early death. Olanzapine drug may result in development of comorbidities that are treatment related. This may contribute to Mary`s low QoL. Self medication as well as abuse of substances might be Mary`s options for relief from symptoms of comorbidity and depression (Young and Grunze, 2013, P. 7). Various physical and mental health promotional strategies can be employed to ensure Mary lives comfortable despite her mental state. The mental health team is supposed to monitor her moves and behaviors on a time to time basis. She is supposed to be provided with a healthy diet to monitor her weight, hypertension and also development of diabetes. Meals that posses a high fibre content like vegetables, while grains like wheat and those that have a lower fat content and cholesterol free including white meat (chicken or fish) are the best choice for her. She should also be restricted to abuse of alcohol and other drugs since they may facilitate development of anxiety, depression and other comorbidities in future. Mary`s physical fitness if also a prime factor towards ensuring a better recovery process. As a result an exercise plan should be devised so that she exercises regularly. She can do light exercises like aerobics daily to maintain her blood circulation levels and keep away from being obese. The mental health team can also organize for motivational interviews where they can counsel her on the bad effect of alcohol consumption with regard to her current health status. Regular laboratory screens for development of diabetes, abnormalities of thyroid and lipid should be considered. It is also important that her BMI and baseline weight are measured after certain time periods to keep track of weight records (Edward et al., 2011, p.323; Buhagiar, Parsonage and Osbom, 2011, p. 7). Different strategies can be used to assess Mary`s condition regarding her mental health. Risk assessment is most crucial are may involves assessment of risk which are associated with mania. Assessment of risks is important since it aids in the management of the same risks. It`s important for clinicians to first clarify the nature of the problem at hand and determine the current form of bipolar disorder. For Mary, mania is evident. She has also developed personality disorders, substance use and eating disorders. Her husband also states that she never sleeps and spends more than enough money on useless things; she also has disinhibited characters including the way she presents herself in terms of sexual matters. All these are risk factors which require critical assessment in order to manage them. She is thus vulnerable to a number of things which may worsen her condition. These include; abuse of drugs, for example, smoking. She may also become a victim of suicidal thoughts and attempts. She may fail to take proper care of her self in terms of diets taken and poor hygiene. This may endanger her marriage and other family relationships. There is also the possibility of failing to follow the treatment regime by skipping taking olanzapine tablets for some days (Basset, 2010, p. 21). Mania may be associated with risks of self injury including suicidal attempts. Mental health staff can involve Mary in interviews where they can question her if she has ever had suicidal thoughts running through her mind. The staff can also probe her views for the reasons she should stay alive. They can also make her confess some statements which can keep her going. Occasionally, she can be requested to say that she will strike to keep away from danger until they meet again. The mental health can the offer a clear understanding of the Mary`s thoughts incorporating the instilling of confidence in her that she will fully recover. The general practitioners can also monitor on her eating habits, alcohol consumption, exercising and adherence to treatment in order to assess her physical health (Edward et al., 2011, p. 322; Basset, 2010, p. 22). Mary`s mental health condition as well as the medication selected presents several health and well being problems. According to her husband, Mary is taking too much alcohol, a behavior that she did not have before. This makes her vulnerable to alcohol addiction. There are also chance that she will be addicted to abuse of other drugs as well as smoking. Depression and other comorbidities may become part of her health if necessary measures are not taken. Alcohol consumption may also render Mary susceptible to development of metabolic syndrome which posses more serious threats to her life. According to various researches conducted, the development of metabolic syndrome is linked to consumption of alcohol in patients who suffer from bipolar disorders. Development of metabolic syndrome is also linked to other factors like overweight, and disturbances of the regulation of glucose levels in blood (Fagiolini, Chengappa, Soreca and Chang, 2008, p.658). Metabolic syndrome may have impact on the presentation of her mental illness and may also affect they way she responds to treatment (Young and Grunze, 2013, p. 7; Fiedorowicz and Palagummi, 2008, p.134). Mary may also be at a risk of developing diabetes which may be caused as a side effect of olanzapine drug that she is taking. Diabetes may also be linked to consumption of alcohol which in most cases in known to cause pancreatitis. Pancreatitis is a condition which is directly linked to development of diabetes. Diabetes may also be linked to her increase in weight. Apart from being diabetic, she may also develop other cardiovascular diseases like hypertension. Exercises might help her in fighting such conditions as being obese and developing diseases such as diabetes and hypertension (Sylvia, Ametrano and Nierenberg, 2009, p. 90). Continued consumption of alcohol and comorbid development of depression may lead to the development of suicidal thoughts, and this is a threat to her life and that of relatives and friends too. The other behaviors including overspending money on things that do not matter, talking too much about sex and drinking alcohol may not please her husband and therefore present a threat to her marriage. Consequently, she may become a victim of issues related isolation. The best intervention to help monitor the effects related to alcohol consumption is to watch Mary from time to time, engage her in motivational interviews and keeping her away from alcohol and other drugs (Kilbourne et al., 2009, p. 898). In conclusion, mental health problems are serious health problems which may cause serious impacts of the lives of susceptible individuals. The fact that some mental health problems like bipolar disorders may go undiagnosed for many years or may be under diagnosed is hindrance to the efforts which can be made to treat individuals who suffer from the disease. This is evident in most communities in Australia where bipolar disorders tend to affect members of certain communities. It is important that patients who are suspected to have developed bipolar disorder in their early stages be hospitalized and treatment be commenced at an early stage. Different researches approve that treatment interventions especially with the use of olanzapine is associated with side effects which range from less serious to severe side effects. These side effects can however be monitored until the medication period is over and the patient fully recovers. If nurses fail to monitor these side effects, the risks to patients` physical health and well being may worsen off thus posing danger to the lives of affected individuals including that of their relatives and friends (Kilbourne et al., 2009, p. 898). A patient centered approach would be the best approach since the patients preferences are considered during treatment and this significantly facilitates recovery process of patients suffering from bipolar disorders. Researches on how to detect early signs of development of bipolar disorders are supposed to be done so that in future bipolar disorders are not diagnosed at a late stage (Pitterman, Jones and Castle, 2009, p.14). References Bassett., D.L. (2010). Risk Assessment and Management in Bipolar Disorders. MJA 193(4): S21–S23. Bettering the Evaluation and Care of Health (BEACH) program (2008). Australian GP Statistics and Classification Centre SAND abstract: Schizophrenia and Bipolar disorder in general practice patients. 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Elevated Prevalence of Obesity, Metabolic Syndrome, and Cardiovascular Risk Factors in Bipolar Disorder. Ann Clin Psychiatry. 20(3):131-137 Kilbourne, A.M., Perron, B.R., Mezuk, B., Welsh, D., Ilgen, M., & Bauer, M.S. (2009). Co-occurring Conditions and Health-Related Quality of Life in Patients with Bipolar Disorder. Psychosomatic Medicine 71:894-900. Marshall, S.L., Oades, L.G & Crowe, T.P. (2010). Australian Mental Health Consumers` Contribution to the Evaluation and Improvement of Recovery-oriented Service Provision. Israel. Journal of Psychiatry and Related Sciences 47(3): 198-205. McIntyre, R.S. (2009). Overview of Managing Medical Comorbidities in Patients with Severe Mental Illness. Journal of Clinical Psychiatry 70(6):17-22 McIntyre, R.S., Danilewitz, M., & Liauw, S.S. (2010).Bipolar Disorder and Metabolic Syndrome: An international Perspective. Journal of Affective Disorder. 126(3):366-387 Piterman, L., Jones, K.M., & castle, D.J. (2010). Bipolar Disorder in General Practice: Challenges and Opportunities. MJA 193(4): S14-S17. Sylvia, L.G., Ametrano, R.M., & Nierenberg, A.A. (2010). Exercise Treatment for Bipolar Disorder: Potential Mechanisms of Action Mediated through Increased Neurogenesis and Decreased Allostatic Load. Psychother Psychosom 79:87-96. Usher, K., & Grigg, M. (2009). Mental Health Nursing: Trends and issues. Switzerland: International Council of Nurses. Young, A.H & Grunze, H. (2013). Physical Health of Patients with Bipolar Disorder. Acta Psychiatr Scand Suppl (442):3-10. Read More