Introduction Bipolar disorder or manic–depressive disorder, also referred to as bipolar affective disorder or manic depression, is a psychiatric diagnosis that

describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or more depressive episodes. The elevated moods are clinically referred to as mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experience depressive episodes, or symptoms, or a mixed state in which features of both mania and depression are present at the same time. These events are usually separated by periods of "normal" mood; but, in some individuals, depression and mania may rapidly alternate, which is known as rapid cycling. Extreme manic episodes can sometimes lead to such psychotic symptoms as delusions and hallucinations. Definition Recurrent attack of both mania and depression, in the same patient at different time or this disorders characterized by mood distribution( in appropriate depression or elation) it is usually accompanied by the abnormalities in thinking and perception arising out of mood disturbances. Bipolar disorder is a condition in which people go back and forth between periods of a very good or irritable mood and depression. The "mood swings" between mania and depression can be very quick

bipolar disorder type I was called manic depression. Instead they experience periods of high energy levels and impulsiveness that are not as extreme as mania (called hypomania). In the past. In most people with bipolar disorder. People with this form alternate between hypomania and mild depression.People with bipolar disorder type I have had at least one manic episode and periods of major depression. there is no clear cause for the manic or depressive episodes. The following may trigger a manic episode in people with bipolar disorder: • • • • Life changes such as childbirth Medications such as antidepressants or steroids Periods of sleeplessness Recreational drug use .A mild form of bipolar disorder called cyclothymia involves less severe mood swings. • Bipolar II disorder-People with bipolar disorder type II have never had full mania.Types of Bipolar Disorder: • Bipolar I disorder. People with bipolar disorder type II or cyclothymia may be wrongly diagnosed as having depression. • Cyclothymic disorder. These periods alternate with episodes of depression.

diurnal rhythms and environmental stressors. which causes the person to have a severely abnormally elevated or irritable mood. and/ or energy levels. even those who never experience depression experience cyclical changes in mood. Mayou and Geddes (2005) suggests that it is vital that mania is predicted in the early stages because the patient becomes reluctant to comply to the treatment. where episodes of mania may alternate with episodes of major depression. arousal. These cycles are often affected by changes in sleep cycle (too much or too little). it is the opposite of depression. Gelder.Mania It is a mood disturbance. Classification of Mania o o o o o Hypomania Mania Mania with psychotic symptoms Mania without psychotic symptoms Mania Associated disorders . In a sense. Episodes of mania are generally associated with bipolar disorder. Regardless. The criteria for bipolar do not include depressive episodes and the presence of mania in the absence of depressive episodes is sufficient for a diagnosis.

Etiological factors Biological • Neurotransmitters • Endocrine system • Family and genetics • Sleep • Dysfunction • Woman & mood disorders Psychological • Stressful life events • Behavioral factors • Cognitive factors • Psychodynamic Social • Support system • Woman & mood disorders .

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Because he has the three signs of mania which are Auditory Hallucinations.It is according to Freud’s Psycho-social theory. social withdrawal B.Overproduction of dopamine causes the nerve circuits to misfire and create a split state in the mind where delusions and hallucinations make the reality of the outside world easier to accept A. lack of close friends.2 Increase Serotonin level .3 Decrease Serotonin Level .An increase in serotonin levels indicates Mania / Manic in Bipolar Disorder. low selfesteem and persistent sadness B.1 Being Shy . Neurotransmitter Alteration A. unable to express feelings. Cultural Norms Because they have a close-knit family . He has the symptoms of depression like social withdrawal. delusions and paranoia A.1 Increase Dopamine . Development of Mistrust . Genetic Predisposition B. Presented by poor IPR to other people. Biological Cause A. isolates self.PSYCHOPATHOLOGY 1.A decrease in serotonin levels indicates depression.He has the presence of the type A personality. which is inherently acquired thus he has poor IPR to others 2. Psychosocial Causes A.

Use of Defense Mechanism -Ineffective use of Denial as manifested by unrealistic perception of the situation .C.3 Living alone for several years .Being alone and independent in an area that is unfamiliar C.1 Separation from family member . Traumatic Experience C.2 Death of his Sister .As presented by Long term depression C.As manifested by anxiety and fear D.

It can include the following symptoms: • • • • • Easily distracted Little need for sleep Poor judgment Poor temper control Reckless behavior and lack of self-control • • • • Binge eating.Symptoms The manic phase may last from days to months. and/or drug use Poor judgment Sex with many partners (promiscuity) Spending sprees Excess activity (hyperactivity) Increased energy Racing thoughts Talking a lot Very high self-esteem (false beliefs about self or • Very elevated mood • • • • • abilities) • • Very involved in activities Very upset (agitated or irritated) . drinking.

In people with bipolar disorder II. .These symptoms of mania occur with bipolar disorder I. the symptoms of mania are similar but less intense.

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.Symptoms of mania or a manic episode include: According to Book Mood Changes A long period of feeling "high. feeling "jumpy" or "wired." or an overly happy or outgoing mood Extremely irritable mood." Behavioral Changes • According to Patient • Irritable mood • Headache • Body ache • Chest pain • Insomnia • Hyperactivity Talking very fast. jumping from one idea to another. and impulsive business investments. such as spending sprees. • • • • • • . having racing thoughts Being easily distracted Increasing goal-directed activities. impulsive sex. high-risk behaviors. agitation.

60%  Lymphocyte-40%  Monocytes.0%  According to Book • History taking • Radiological examination o Skull X-Ray o o Computed Tomography (CT) Scan Magnetic (MRI) Resonance Imaging • Electroencephalography (EEG) • Psychological Assessment • Physical Investigation o Routine –  TC  DC  Esinophil-0%  Basophil – 0% Hemoglobin.  liver function test o Non.900 mm3 o Hb-11.Routine  Thyroid Function Test .  Urine analysis.` Diagnostic Finding According to Patient • History taking o Mental status examination • Hematological test o WBCs-5.000 ↓ o Differential Count  Neutrophil.5gm/dl o Platelets.60.

Antipsychotic Medications 1st Generation Medications Chlorpromazine. Fluphenazine 2nd Generation Medications Clozapine. Olanzapine-5mg-SOS d. Quetiapine.BD b. Carbamazepine. Olanzapine. Risperidone. c. Ziprasidone 3rd Generation Medications Aripiprazole 2) 3) According to Patient 1) Pharmacological Management a. Sodium Valporate 500mg. Thioridazine. Valproic Acid. Tab. Lithium. Haloparidol 5mg-TDS c. Atenolol 5mg-TDS 2) Psychosocial Therapy a.Medical Management According to Book 1) Pharmacological Management Mood Stabilizing Agents e. Electroconvulsive Therapy Psychosocial Therapy • Cognitive behavior therapy • Interpersonal therapy • Psychoanalytic psychotherapy • Behavior therapy • Group therapy • Family and maternal therapy . Individual Family Psychotherapy Group Psychotherapy Psychotherapy b.g. Haloperidol.

• Plan time for listening to the client’s concerns.Nursing Intervention • Assess client’s perception of self and situation. • Give positive reinforcement for client’s efforts. • Observe/ listen for early clues of distress/ increasing anxiety. non. acting as if the client has control and is responsible for own behavior. • Encourage walking or exercise as activities that may diffuse aggression • Note concomitant medical and psychological problem that may be factors for care. Note use of defense mechanism. • Perform/ assist with meeting client’s needs when she is unable to meet own needs. . • Maintain calm. • Provide a safe/ quiet environment and remove items from the client’s environment that could be use to inflict harm to others.judgemental attitude. • Develop plan of care appropriate to individual situation.of-fact. Acknowledge reality of client’s feelings. matter. • Identify degree of individual impairment or functional level. • Approach in positive manner. • Make time to listen to expressions of feelings. • Ask directly if the person is thinking of acting on thoughts/ feelings. • Develop and maintain therapeutic nurse-client relationship.

care practices that promote health.• Provide for communication among those who are involved in caring. • Provide privacy and equipment within easy reach during personal care activities. . • Impart health teachings about self-care and emphasize the importance of it. • Support client in making health related decisions and assist in developing self.

2 Dizziness PHYSICAL Headache Dry mouth Muscle cramping Burning sensation Chest pain Abdominal pain 2068/03/14 2068/03/15 .Symptom chart S.N. DATE/SYMPTOM 2068/03/13 1 PSYCHOLOGICAL Agitation Amotivation Insomnia Poor attention. concentration. Drowsiness.

Mood chart DATES AND DAY/ MOOD 2068/03/13 OF THE PATIENT 2068/03/13 2068/03/13 DEPRESSED EUTHYMIC EUPHORIC .

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