Bipolar disorder

  • April 10, 2021/

Bipolar disorder was previously known as manic depression as it causes moods to shift between mania and depression. It may also be classified as a biological brain disorder causing severe fluctuations in mood, energy, thinking and behaviour. This disorder results in frequent anxiety and low frustration level in the young people (CABF 2007). Depression, in this situation, means a situation where you feel very low while mania would refer to a situation where you feel very high (NHS 2009). Sometimes, symptoms of mania and depression can also occur simultaneously (CABF 2007). These episodes can last for several weeks or longer. “The high and low phases of the illness are often so extreme that they interfere with everyday life” (NHS 2009).

In bipolar disorder, the depression phase often comes first. One can be diagnosed with clinical depression before having a manic episode. The manic episodes usually take place after some time, after which the diagnosis might change. These episodes of depression may lead to overwhelming feelings of worthlessness, which often lead to thoughts of suicide. The manic phase may make you feel very creative and view mania as a positive experience. This is the time when you may also have symptoms of psychosis. During this phase you may feel very happy and have lots of ambitions, plans and ideas. Lack of sleep and appetite are other also common characteristics of bipolar disorder (NHS 2009).

“People with bipolar disorder fluctuate between intense depression and mania, interspersed by periods of relative calm” (Macnair 2008).

The causes of bipolar disorder aren’t completely known, but are often hereditary. A cluster of factors both genetic and environmental, such as personal traumas or stress, can highly influence systems. The initial manic or depressive episodes of bipolar disorder usually take place early in the teenage years or early adulthood (Macnair 2008) At least half of all cases start before age 25 (Kessler et al., 2005). The symptoms of the disorder can be fairly subtle and may result in being overlooked or misdiagnosed. This could result in unnecessary suffering while on the other hand, with proper treatment and support; a fulfilling life can be lived (Macnair 2008).

In severe forms of mania, there are chances of a person becoming psychotic, with delusions. There is a conflict in perception and reality and there may be hallucinations and delusional beliefs about being persecuted. In some of the worst cases, people in mania become unintelligible and neglect themselves. The symptoms have varying patterns, frequencies and order. While in some case, where symptoms of mania are followed by symptoms of depression in a predictable pattern, some people have mixed symptoms – it’s possible to have many of the symptoms of mania and also suffer from severely depressive thoughts (Bhugra and Flick, 2005).

Although there’s no cure for bipolar disorder, many people find that an understanding of their illness and what triggers episodes can help them live a relatively normal life Macnair 2008). Patients could monitor their moods and thoughts and ask someone they trust to help them cope with the disorder. But, sometimes some people have extreme mood swings that can’t be managed by monitoring alone. There may be a need for antidepressants, antipsychotic medication, drug lithium, which seem to stabilise mood swings. High level of lithium in blood can be poisonous while too little will have no effect. So, its important to be seen regularly by the mental health team and have the blood levels checked (Smith et al., 2009).

John’s Condition

John had a bipolar disorder with first episode happening when he was 19. At 28, John had evidently had manic episodes, as he had been known to contact his colleagues and clients at odd hours to discuss novel ideas. He kept enthusing about his designs being imaginative and original. At the workplace, clients and colleagues would complain about John’s unprofessional behaviour suggesting a lack of understanding on the part of his workplace. John’s denial of his illness further aggravated his situation. John had already quit two excellent jobs because of his condition.

John’s younger brother, Michael, managed to get John back to his consultant psychiatrist and pushed him to take his medicines regularly. With continuous support from his brother, John started responding well to the treatment. Although medication seemed to have positive effect on John, he would give up the medicines as soon he started feeling better. This resulted in relapses and repeated episodes. “And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they interfere with the patients ability to function” (Smith et al., 2009). John did not participate actively in social activities making it difficult for others to recognize his needs.

John could not focus on his work due to his medical condition being too unstable. John was not offered any job at the five places he had applied despite an impressive CV. This was due to the fact that John had mentioned his illness on all the forms raising doubts in John’s mind about disclosing his illness until it was specifically stressed upon.

Work labelling and stereotyping – Theory of stigma

Stigma is the difference between the virtual social identity and the real social identity. Stigma has three forms, which can be characterised as external, personal and tribal. The first form of stigma relates to external or overt deformations like scars, leprosy, physical disability and social disability. The second form relates to deviations in personal traits, including mental illness, drug addiction, alcoholism and criminal backgrounds. The third form, tribal stigmas, are imagined or real traits of ethnic groups, nationalities or religions that are deemed to constitute a deviation from what is perceived as to be the prevailing ethnicity, nationality or religion (Geoffman 1963).

eoffman (1963) also went on to describe 3 levels of deviance. He described them as primary, secondary and tertiary deviances. Primary deviance would refer to original violation/deviance/and societal reaction to this non-conformity to societal norms. The secondary deviance is the deviant’s reaction to the negative societal reaction and the tertiary deviance is the reaction of the stigmatised person to the stigma from other leads to master status. The secondary deviant attempts to re-label certain behaviours as normal rather than deviant. This is an attempt to create a label that overshadows all other characteristics.

The stigmatised person is seen as inferior by others and seen as having a perpetually flawed social identity and is thus discriminated. The stigmatised individual might also have additional imperfections imputed to them on the basis of the original stigmata thus creating stereotypes (Geoffman 1963).

Stigma can also be differentiated as felt and enacted. The felt stigma is the condition where one feels the shame of being identified with a discrediting condition and the fear of encountering enacted stigma. Enacted stigma is the actual episode of discrimination, both formal and informal against people with stigmata solely on the grounds of their having a stigmatising condition (Scambler 2004).

Scrambler (2004) through the Hidden Distress Model highlighted that people with a stigmata are fearful of experiencing enacted stigma and pursue an active policy of non-disclosure. The stigma has a far more disruptive effect on their lives as this also increases the stress of managing their disorder. The socio-cultural values can be viable in influencing the level of felt and enacted stigma.

According to Geoffmann’s (1963) classification of stigma, John fell in the second form due to hid bipolar disorder. As stated by Geoffmann (1963), John was ill treated and faced discrimination, which is quite evident from the behaviour of his clients and colleagues at work.

Sociology of Health and Illness

“The sociology of health and illness argues that socio-cultural factors influence people’s perceptions and experiences of health and illness, which cannot be presumed to be simply relations to physical bodily changes” (Nettleton 2006).

Defining Health and Disease

In the constitution of WHO established nearly half a century ago, health is defined as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity” (Saracci 1997). Temple et. al., in 2001 proposed a definition of disease though the approach did little to improve on previous attempts. They defined disease as a state that places individuals at increased risk of adverse consequences. Adopting this definition, every activity involving voluntary action carry a “risk of adverse consequences”.

The problem with the concept of health and disease is that it is associated with social concepts such as normality and abnormality, normality and abnormality being relative terms. “In common parlance, disease means a deviation from the established “norm”, consequently abnormal, with connotations of weirdness, strangeness, repulsiveness, viciousness, sickness, derangement, impairment, and disorder” (Landy 1977). Conditions may be characterised as normal or abnormal based on the ‘arbitrary diagnostic criteria’ as in most common diseases like diabetes, hypertension, etc. A condition is considered to be normal if it is prevalent amongst the population largely.

But this issue seems to be complicated by the ‘question of medicalization versus criminalization of abnormal social behaviour’ (Rosen 1968 and Foucalt 1972).

Often the clinicians’ diagnosis is influenced by social views on mental diseases. In cases where mental disorders are involved, judging a sick person is to be avoided at all costs. Instead, the situation and the effects of the disease should be judged (Scheff 1979). “The patient is worried with his own private and particular condition, while the doctor tries to make a diagnosis in the same way a zoologist or a botanist does with a specimen under the microscope: to weight individual variances against general signals and symptoms that agree with those of a recognized category of disease” (de Avila Pires 2008).

Failure to Recognize Mental States and Provide Required Support

Radley (1994) reported that it was very difficult to live with illness in today’s world where “health is more than meeting the demands of specific tasks or fulfilling particular duties.” Mental disorders may lead to the patient becoming socially isolated as was seen in John’s case.

Figure 1. The patient suffering from chronic illness faces various modes of adjustment. (Figure adapted from Radley and Green 1985, cited in Radley 1994)

According to the ‘modes of adjustment to the chronic illness’ put forward by Radley and Green in 1985 (cited in Radley 1994) John was in the phase of active denial. He resisted the illness symptoms and participated in the normal life, treating his illness as of little importance. Even his colleagues failed to recognize his condition and complained calling John’s behaviour unprofessional.

Factors that Pushed John to Seek Medical Help

Despite John’s being a talented architect, he had already quit two good jobs. The reasons attributed to this may be an atmosphere of discriminative behaviour in the workplace. John had developed a stage of Bipolar disorder where regular attacks of mania took place. He might also have developed psychosis suggested by the novel ideas and strange behaviour.

John’s brother, Michael actually got John to go back to the medicines. He tried to know what had happened and made sure John took his medicines regularly. Michael also managed to get John back to his consultant psychiatrist. So, it may be perceived that it was support of his brother, family support coupled with a discriminative behaviour at the workplace that pushed John to medications.

Social Inequalities

Disability and social inequality go hand in hand. The proof is well documented and evident in socio-economic circumstances (Nettleton 2006). Disabled people face many problems in their working life. In certain cases like accidents, a person may loose his value overnight while as, in case of recurrent illnesses, the patient goes through a gradual downfall Blaxter 1976). Lack of support from other people (family, friends, colleagues) often aggravates the medical condition of the patient (Radley 2004).

John’s medical condition became a cause of concern for his employers and clients alike. He had to quit two jobs to cope with the situation. Despite having experience and impressive CV, John was not able to get a job at any of the five places he had applied to. Evidently, his revealing his bipolar disorder would have put his future employers on alert and thus the discrimination. Instead, of understanding John’s condition and helping him overcome his disability he was rejected every time.

Community Care

The World Health Organization recognizes primary health care to be effective in preventing illness. There has been a shift from primary health care to community care and this shift could be a result of three factors – therapeutic, economic and reforms in the medical model (Busfield 1986, cited in Nettleton 2006).

The entire concept of community care relies on the priority being given to the patient and not the disease. Social perceptions about the disability or the disabled, plays an important role in community-based rehabilitation. “The term community care is used both in a perspective sense to related to how people should meet the health and social needs of the dependent people and also a description of the set of services that are currently provided” (Stevenson 2008).

Many people often object to being referred to as disabled. It leads to the segregation and often discrimination (Blaxter 1976). As was seen in John’s case, despite being an impressive architect he was refused job at five places, which he thought was because of him disclosing his bipolar disorder.

The local authorities along with voluntary bodies are responsible for looking after the social needs of a disabled. This concept is based on the fact that community has to be involved in deciding the social needs of a disabled member and then making sure that those needs are taken care of in local conditions (Blaxter 1976).

Michael, John’s brother played a major role in John’s rehabilitation. He understood his needs and convinced him to see his doctor. As is the concept of community care, Michael gave priority to his brother and his needs rather than his disease. The same cannot be said about his colleagues or his clients. Instead of understanding John’s special needs, they deemed him unfit to work with them.

Cognitive Therapy of Depression

Beck et al., (1979) defined cognitive therapy as an “active, directive, time-limited, structured approach used to treat various mental disorders.” The rationale behind this definition is based on how a disabled person perceives and structures the world. His previous experiences and relation with other people affect his ‘cognitions’. “For example, if a person interprets all his experiences in terms of whether he is competent or adequate, his thinking might be dominated by the schema, ‘Unless I do everything perfectly, I am a failure.’ In such case he would react to all situations in terms of his competence even if those situations were not related to his competence in any way.

John’s getting rejected at five interviews, despite of an impressive CV, made him feel disadvantaged. He thought it was due to his mental disorder. These inequalities made him want to conceal his illness and not reveal it unless it was specifically asked about.

Chronic Illness

“People experience serious chronic illness in three ways: as an interruption of their lives, as an intrusive illness, and as immersion in illness. Rather, from their perspectives, illness disrupts their lives; it intrudes upon the day-frequently each day; it engulfs them” (Charmaz 1997).

John’s illness was an interruption in his life. He had to quit two jobs because of his illness and was further rejected a job at another five places due to his illness.

Parson’s Sick Role Theory

According to Parson (1951), sickness is not merely a ‘condition’ or a ‘state of fact’, it is rather a specifically patterned social role. The sick people have the right to be exempted from the normal social role. They cannot be blamed for their medical condition and have to be taken care of. On the other hand, they are expected to seek professional guidance and show a willingness to get well. The disabled people are either vulnerable and are often exploited by others or they may adopt deviance to evade responsibilities and can prove to be threat to the society.

John was vulnerable. He tried to get well and used to take medication as well, but his colleagues blamed him for his condition. They often complained against him. Moreover, after quitting his job, he could not get another job due to his disability.

Zola’s Theory

According to Zola (1973, cited in Scambler 2008) most of the patients would over look their symptoms for quite some time before consulting a doctor. He also found that there had to be something else ‘a trigger’ apart from the symptoms to convince patients to seek medical intervention. The characterised five types of ‘triggers’ – First, “the occurrence of an interpersonal crisis (e.g., death in the family),” second, perceived interference with social or personal relations,” third, “sanctioning (pressure from others to consult),” fourth, perceived interference with vocalization or physical activity,” and fifth, ” a kind of temporalizing of symptomatology (the setting of deadline).” Moreover, patient’s personal and social circumstances also affect the patient’s decision to seek help.

Applying Zola’s theory to John’s case, one would realize that John did overlook his symptoms. He used to deny his illness and stop his medication as soon as he felt better. It was ‘sanctioning’ (pressure from his brother Michael) that acted as a trigger and convinced him to consult his psychiatrist and start his medication again.

Conclusion

A certain medical condition or disability refers to be presented with problems and face problems earning ones living or any other day to day activities. Many disabled people find it hard or lack the willingness to participate in the social activities. They isolate themselves from the society and in certain cases from family as well. But constant support from family and friends coupled with proper medication can help the patient recover and rise above his disability (Blaxter 1976).

Bipolar disorder being a chronic mental disorder has serious consequences on patients in particular and their families and societies in general. Effective treatment for bipolar disorder is available, but patients often hesitate to report their condition due to various social, economic and personal barriers. Patients often go into self-denial and try to remain away from social activities. There are two ways of caring for the bipolar disordered person; one, primary healthcare, that is consulting a general physician or a psychiatrist and second being community care. Concerted efforts on all levels (patient, family, community, healthcare provider and government) are required to improve the quality of care among the bipolar community (Bhugra and Flick, 2005).

Apart from the professional help, self-help can greatly improve the condition of a person with bipolar disorder. The patient should learn about his condition. It will help him understand his needs better as well as help him in recovery. They should try and avoid stress, participate in social activities and indulge in hobbies. The patient should keep a track of his mood swings and watch out for the symptoms that have deleterious effects on their mood. Doing so would help them prepare better for adverse conditions. Maintaining a healthy schedule (healthy food habits, exercising, and proper sleep) can greatly influence the moods of a patient (Smith et al., 2009).

References:

Beck AT, Rush AJ, Shaw BF, and Emery G. 1979. Cognitive Therapy of Depression. New York, The Guilford Press

Bhugra D. and Flick GR. 2005. Pathways to care for patients with bipolar disorder. Bipolar Disorder 7; 236-245

Blaxter M, 1976. The meaning of disability. London. Heinemann.

CABF (Child and Adolescent Bipolar Foundation), Educating the Child with Bipolar Disorder, 2007

Charmaz K. 1997. Good Days, Bad Days-Illness and Time. USA, Rutgers University Press

de Avila-Pires FD. 2008. On the concept of disease. Revista de Historia & Humanidades Medicas, Vol. 4, No. 1

Foucault M. 1972. Histoire de la folie à l’âge classique, Paris, Gallimard

Goffman E. 1963. Stigma: Notes on the management of spoiled identities

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. 2005. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 62(6):593-602.)

Landy D. [Ed.], 1997. Culture, disease, and healing. Studies in medical anthropology. NewYork, Macmillan

Macnair T. 2008. Bipolar disorder. Available at: http://www.bbc.co.uk/health/conditions/bipolar1.shtml [Accessed on 12/01/20101]

Nettleton S. 2006. The Sociology of Health and Illness; Cambridge, Polity Press

NHS 2009. Bipolar disorder. Available at: http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx [Accessed on 12/01/2010]

Parson T. 1951. The Social System. New York, Free Press.

Radley A. 1994. Making sense of illness. London, SAGE Publications  

Rosen G. 1968  Madness in Society. Chapters in the historical sociology of mental illness, New York, Harper & Row

Saracci R.1997. The world health organisation needs to reconsider its definition of health BMJ1997;314:1409

Scambler G, 2004. A jigsaw model of health-related stigma, University College of London

Scambler G. [Ed.] 2008, Sociology as applied to medicine. (6th ed.) Saunders, Elsevier

Scheff T. 1979. Decision rules, types of error, and their consequences in medical diagnosis. In Albrecht G. and Higgins P. [Eds.] Health, Illness, and Medicine. A reader in medical sociology, Chicago, Rand McNally, pp. 313-326.

Smith M, Segal J, and Segal R. 2009. Understanding bipolar disorder. Available at: http://www.helpguide.org/mental/bipolar_disorder_symptoms_treatment.htm [Accessed on 13/10/2010]

Temple LK, McLeod R, Gallinger S, and Wright J. 2001. “Defining disease in the genomics era”. Science, Vol. 293, No. 5531, New York, pp. 807-808

Bipolar disorder was previously known as manic depression as it causes moods to shift between mania and depression. It may also be classified as a biological brain disorder causing severe fluctuations in mood, energy, thinking and behaviour. This disorder results in frequent anxiety and low frustration level in the young people (CABF 2007). Depression, in this situation, means a situation where you feel very low while mania would refer to a situation where you feel very high (NHS 2009). Sometimes, symptoms of mania and depression can also occur simultaneously (CABF 2007). These episodes can last for several weeks or longer. “The high and low phases of the illness are often so extreme that they interfere with everyday life” (NHS 2009).

In bipolar disorder, the depression phase often comes first. One can be diagnosed with clinical depression before having a manic episode. The manic episodes usually take place after some time, after which the diagnosis might change. These episodes of depression may lead to overwhelming feelings of worthlessness, which often lead to thoughts of suicide. The manic phase may make you feel very creative and view mania as a positive experience. This is the time when you may also have symptoms of psychosis. During this phase you may feel very happy and have lots of ambitions, plans and ideas. Lack of sleep and appetite are other also common characteristics of bipolar disorder (NHS 2009).

“People with bipolar disorder fluctuate between intense depression and mania, interspersed by periods of relative calm” (Macnair 2008).

The causes of bipolar disorder aren’t completely known, but are often hereditary. A cluster of factors both genetic and environmental, such as personal traumas or stress, can highly influence systems. The initial manic or depressive episodes of bipolar disorder usually take place early in the teenage years or early adulthood (Macnair 2008) At least half of all cases start before age 25 (Kessler et al., 2005). The symptoms of the disorder can be fairly subtle and may result in being overlooked or misdiagnosed. This could result in unnecessary suffering while on the other hand, with proper treatment and support; a fulfilling life can be lived (Macnair 2008).

In severe forms of mania, there are chances of a person becoming psychotic, with delusions. There is a conflict in perception and reality and there may be hallucinations and delusional beliefs about being persecuted. In some of the worst cases, people in mania become unintelligible and neglect themselves. The symptoms have varying patterns, frequencies and order. While in some case, where symptoms of mania are followed by symptoms of depression in a predictable pattern, some people have mixed symptoms – it’s possible to have many of the symptoms of mania and also suffer from severely depressive thoughts (Bhugra and Flick, 2005).

Although there’s no cure for bipolar disorder, many people find that an understanding of their illness and what triggers episodes can help them live a relatively normal life Macnair 2008). Patients could monitor their moods and thoughts and ask someone they trust to help them cope with the disorder. But, sometimes some people have extreme mood swings that can’t be managed by monitoring alone. There may be a need for antidepressants, antipsychotic medication, drug lithium, which seem to stabilise mood swings. High level of lithium in blood can be poisonous while too little will have no effect. So, its important to be seen regularly by the mental health team and have the blood levels checked (Smith et al., 2009).

John’s Condition

John had a bipolar disorder with first episode happening when he was 19. At 28, John had evidently had manic episodes, as he had been known to contact his colleagues and clients at odd hours to discuss novel ideas. He kept enthusing about his designs being imaginative and original. At the workplace, clients and colleagues would complain about John’s unprofessional behaviour suggesting a lack of understanding on the part of his workplace. John’s denial of his illness further aggravated his situation. John had already quit two excellent jobs because of his condition.

John’s younger brother, Michael, managed to get John back to his consultant psychiatrist and pushed him to take his medicines regularly. With continuous support from his brother, John started responding well to the treatment. Although medication seemed to have positive effect on John, he would give up the medicines as soon he started feeling better. This resulted in relapses and repeated episodes. “And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they interfere with the patients ability to function” (Smith et al., 2009). John did not participate actively in social activities making it difficult for others to recognize his needs.

John could not focus on his work due to his medical condition being too unstable. John was not offered any job at the five places he had applied despite an impressive CV. This was due to the fact that John had mentioned his illness on all the forms raising doubts in John’s mind about disclosing his illness until it was specifically stressed upon.

Work labelling and stereotyping – Theory of stigma

Stigma is the difference between the virtual social identity and the real social identity. Stigma has three forms, which can be characterised as external, personal and tribal. The first form of stigma relates to external or overt deformations like scars, leprosy, physical disability and social disability. The second form relates to deviations in personal traits, including mental illness, drug addiction, alcoholism and criminal backgrounds. The third form, tribal stigmas, are imagined or real traits of ethnic groups, nationalities or religions that are deemed to constitute a deviation from what is perceived as to be the prevailing ethnicity, nationality or religion (Geoffman 1963).

eoffman (1963) also went on to describe 3 levels of deviance. He described them as primary, secondary and tertiary deviances. Primary deviance would refer to original violation/deviance/and societal reaction to this non-conformity to societal norms. The secondary deviance is the deviant’s reaction to the negative societal reaction and the tertiary deviance is the reaction of the stigmatised person to the stigma from other leads to master status. The secondary deviant attempts to re-label certain behaviours as normal rather than deviant. This is an attempt to create a label that overshadows all other characteristics.

The stigmatised person is seen as inferior by others and seen as having a perpetually flawed social identity and is thus discriminated. The stigmatised individual might also have additional imperfections imputed to them on the basis of the original stigmata thus creating stereotypes (Geoffman 1963).

Stigma can also be differentiated as felt and enacted. The felt stigma is the condition where one feels the shame of being identified with a discrediting condition and the fear of encountering enacted stigma. Enacted stigma is the actual episode of discrimination, both formal and informal against people with stigmata solely on the grounds of their having a stigmatising condition (Scambler 2004).

Scrambler (2004) through the Hidden Distress Model highlighted that people with a stigmata are fearful of experiencing enacted stigma and pursue an active policy of non-disclosure. The stigma has a far more disruptive effect on their lives as this also increases the stress of managing their disorder. The socio-cultural values can be viable in influencing the level of felt and enacted stigma.

According to Geoffmann’s (1963) classification of stigma, John fell in the second form due to hid bipolar disorder. As stated by Geoffmann (1963), John was ill treated and faced discrimination, which is quite evident from the behaviour of his clients and colleagues at work.

Sociology of Health and Illness

“The sociology of health and illness argues that socio-cultural factors influence people’s perceptions and experiences of health and illness, which cannot be presumed to be simply relations to physical bodily changes” (Nettleton 2006).

Defining Health and Disease

In the constitution of WHO established nearly half a century ago, health is defined as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity” (Saracci 1997). Temple et. al., in 2001 proposed a definition of disease though the approach did little to improve on previous attempts. They defined disease as a state that places individuals at increased risk of adverse consequences. Adopting this definition, every activity involving voluntary action carry a “risk of adverse consequences”.

The problem with the concept of health and disease is that it is associated with social concepts such as normality and abnormality, normality and abnormality being relative terms. “In common parlance, disease means a deviation from the established “norm”, consequently abnormal, with connotations of weirdness, strangeness, repulsiveness, viciousness, sickness, derangement, impairment, and disorder” (Landy 1977). Conditions may be characterised as normal or abnormal based on the ‘arbitrary diagnostic criteria’ as in most common diseases like diabetes, hypertension, etc. A condition is considered to be normal if it is prevalent amongst the population largely.

But this issue seems to be complicated by the ‘question of medicalization versus criminalization of abnormal social behaviour’ (Rosen 1968 and Foucalt 1972).

Often the clinicians’ diagnosis is influenced by social views on mental diseases. In cases where mental disorders are involved, judging a sick person is to be avoided at all costs. Instead, the situation and the effects of the disease should be judged (Scheff 1979). “The patient is worried with his own private and particular condition, while the doctor tries to make a diagnosis in the same way a zoologist or a botanist does with a specimen under the microscope: to weight individual variances against general signals and symptoms that agree with those of a recognized category of disease” (de Avila Pires 2008).

Failure to Recognize Mental States and Provide Required Support

Radley (1994) reported that it was very difficult to live with illness in today’s world where “health is more than meeting the demands of specific tasks or fulfilling particular duties.” Mental disorders may lead to the patient becoming socially isolated as was seen in John’s case.

Figure 1. The patient suffering from chronic illness faces various modes of adjustment. (Figure adapted from Radley and Green 1985, cited in Radley 1994)

According to the ‘modes of adjustment to the chronic illness’ put forward by Radley and Green in 1985 (cited in Radley 1994) John was in the phase of active denial. He resisted the illness symptoms and participated in the normal life, treating his illness as of little importance. Even his colleagues failed to recognize his condition and complained calling John’s behaviour unprofessional.

Factors that Pushed John to Seek Medical Help

Despite John’s being a talented architect, he had already quit two good jobs. The reasons attributed to this may be an atmosphere of discriminative behaviour in the workplace. John had developed a stage of Bipolar disorder where regular attacks of mania took place. He might also have developed psychosis suggested by the novel ideas and strange behaviour.

John’s brother, Michael actually got John to go back to the medicines. He tried to know what had happened and made sure John took his medicines regularly. Michael also managed to get John back to his consultant psychiatrist. So, it may be perceived that it was support of his brother, family support coupled with a discriminative behaviour at the workplace that pushed John to medications.

Social Inequalities

Disability and social inequality go hand in hand. The proof is well documented and evident in socio-economic circumstances (Nettleton 2006). Disabled people face many problems in their working life. In certain cases like accidents, a person may loose his value overnight while as, in case of recurrent illnesses, the patient goes through a gradual downfall Blaxter 1976). Lack of support from other people (family, friends, colleagues) often aggravates the medical condition of the patient (Radley 2004).

John’s medical condition became a cause of concern for his employers and clients alike. He had to quit two jobs to cope with the situation. Despite having experience and impressive CV, John was not able to get a job at any of the five places he had applied to. Evidently, his revealing his bipolar disorder would have put his future employers on alert and thus the discrimination. Instead, of understanding John’s condition and helping him overcome his disability he was rejected every time.

Community Care

The World Health Organization recognizes primary health care to be effective in preventing illness. There has been a shift from primary health care to community care and this shift could be a result of three factors – therapeutic, economic and reforms in the medical model (Busfield 1986, cited in Nettleton 2006).

The entire concept of community care relies on the priority being given to the patient and not the disease. Social perceptions about the disability or the disabled, plays an important role in community-based rehabilitation. “The term community care is used both in a perspective sense to related to how people should meet the health and social needs of the dependent people and also a description of the set of services that are currently provided” (Stevenson 2008).

Many people often object to being referred to as disabled. It leads to the segregation and often discrimination (Blaxter 1976). As was seen in John’s case, despite being an impressive architect he was refused job at five places, which he thought was because of him disclosing his bipolar disorder.

The local authorities along with voluntary bodies are responsible for looking after the social needs of a disabled. This concept is based on the fact that community has to be involved in deciding the social needs of a disabled member and then making sure that those needs are taken care of in local conditions (Blaxter 1976).

Michael, John’s brother played a major role in John’s rehabilitation. He understood his needs and convinced him to see his doctor. As is the concept of community care, Michael gave priority to his brother and his needs rather than his disease. The same cannot be said about his colleagues or his clients. Instead of understanding John’s special needs, they deemed him unfit to work with them.

Cognitive Therapy of Depression

Beck et al., (1979) defined cognitive therapy as an “active, directive, time-limited, structured approach used to treat various mental disorders.” The rationale behind this definition is based on how a disabled person perceives and structures the world. His previous experiences and relation with other people affect his ‘cognitions’. “For example, if a person interprets all his experiences in terms of whether he is competent or adequate, his thinking might be dominated by the schema, ‘Unless I do everything perfectly, I am a failure.’ In such case he would react to all situations in terms of his competence even if those situations were not related to his competence in any way.

John’s getting rejected at five interviews, despite of an impressive CV, made him feel disadvantaged. He thought it was due to his mental disorder. These inequalities made him want to conceal his illness and not reveal it unless it was specifically asked about.

Chronic Illness

“People experience serious chronic illness in three ways: as an interruption of their lives, as an intrusive illness, and as immersion in illness. Rather, from their perspectives, illness disrupts their lives; it intrudes upon the day-frequently each day; it engulfs them” (Charmaz 1997).

John’s illness was an interruption in his life. He had to quit two jobs because of his illness and was further rejected a job at another five places due to his illness.

Parson’s Sick Role Theory

According to Parson (1951), sickness is not merely a ‘condition’ or a ‘state of fact’, it is rather a specifically patterned social role. The sick people have the right to be exempted from the normal social role. They cannot be blamed for their medical condition and have to be taken care of. On the other hand, they are expected to seek professional guidance and show a willingness to get well. The disabled people are either vulnerable and are often exploited by others or they may adopt deviance to evade responsibilities and can prove to be threat to the society.

John was vulnerable. He tried to get well and used to take medication as well, but his colleagues blamed him for his condition. They often complained against him. Moreover, after quitting his job, he could not get another job due to his disability.

Zola’s Theory

According to Zola (1973, cited in Scambler 2008) most of the patients would over look their symptoms for quite some time before consulting a doctor. He also found that there had to be something else ‘a trigger’ apart from the symptoms to convince patients to seek medical intervention. The characterised five types of ‘triggers’ – First, “the occurrence of an interpersonal crisis (e.g., death in the family),” second, perceived interference with social or personal relations,” third, “sanctioning (pressure from others to consult),” fourth, perceived interference with vocalization or physical activity,” and fifth, ” a kind of temporalizing of symptomatology (the setting of deadline).” Moreover, patient’s personal and social circumstances also affect the patient’s decision to seek help.

Applying Zola’s theory to John’s case, one would realize that John did overlook his symptoms. He used to deny his illness and stop his medication as soon as he felt better. It was ‘sanctioning’ (pressure from his brother Michael) that acted as a trigger and convinced him to consult his psychiatrist and start his medication again.

Conclusion

A certain medical condition or disability refers to be presented with problems and face problems earning ones living or any other day to day activities. Many disabled people find it hard or lack the willingness to participate in the social activities. They isolate themselves from the society and in certain cases from family as well. But constant support from family and friends coupled with proper medication can help the patient recover and rise above his disability (Blaxter 1976).

Bipolar disorder being a chronic mental disorder has serious consequences on patients in particular and their families and societies in general. Effective treatment for bipolar disorder is available, but patients often hesitate to report their condition due to various social, economic and personal barriers. Patients often go into self-denial and try to remain away from social activities. There are two ways of caring for the bipolar disordered person; one, primary healthcare, that is consulting a general physician or a psychiatrist and second being community care. Concerted efforts on all levels (patient, family, community, healthcare provider and government) are required to improve the quality of care among the bipolar community (Bhugra and Flick, 2005).

Apart from the professional help, self-help can greatly improve the condition of a person with bipolar disorder. The patient should learn about his condition. It will help him understand his needs better as well as help him in recovery. They should try and avoid stress, participate in social activities and indulge in hobbies. The patient should keep a track of his mood swings and watch out for the symptoms that have deleterious effects on their mood. Doing so would help them prepare better for adverse conditions. Maintaining a healthy schedule (healthy food habits, exercising, and proper sleep) can greatly influence the moods of a patient (Smith et al., 2009).

References:

Beck AT, Rush AJ, Shaw BF, and Emery G. 1979. Cognitive Therapy of Depression. New York, The Guilford Press

Bhugra D. and Flick GR. 2005. Pathways to care for patients with bipolar disorder. Bipolar Disorder 7; 236-245

Blaxter M, 1976. The meaning of disability. London. Heinemann.

CABF (Child and Adolescent Bipolar Foundation), Educating the Child with Bipolar Disorder, 2007

Charmaz K. 1997. Good Days, Bad Days-Illness and Time. USA, Rutgers University Press

de Avila-Pires FD. 2008. On the concept of disease. Revista de Historia & Humanidades Medicas, Vol. 4, No. 1

Foucault M. 1972. Histoire de la folie à l’âge classique, Paris, Gallimard

Goffman E. 1963. Stigma: Notes on the management of spoiled identities

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. 2005. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 62(6):593-602.)

Landy D. [Ed.], 1997. Culture, disease, and healing. Studies in medical anthropology. NewYork, Macmillan

Macnair T. 2008. Bipolar disorder. Available at: http://www.bbc.co.uk/health/conditions/bipolar1.shtml [Accessed on 12/01/20101]

Nettleton S. 2006. The Sociology of Health and Illness; Cambridge, Polity Press

NHS 2009. Bipolar disorder. Available at: http://www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx [Accessed on 12/01/2010]

Parson T. 1951. The Social System. New York, Free Press.

Radley A. 1994. Making sense of illness. London, SAGE Publications  

Rosen G. 1968  Madness in Society. Chapters in the historical sociology of mental illness, New York, Harper & Row

Saracci R.1997. The world health organisation needs to reconsider its definition of health BMJ1997;314:1409

Scambler G, 2004. A jigsaw model of health-related stigma, University College of London

Scambler G. [Ed.] 2008, Sociology as applied to medicine. (6th ed.) Saunders, Elsevier

Scheff T. 1979. Decision rules, types of error, and their consequences in medical diagnosis. In Albrecht G. and Higgins P. [Eds.] Health, Illness, and Medicine. A reader in medical sociology, Chicago, Rand McNally, pp. 313-326.

Smith M, Segal J, and Segal R. 2009. Understanding bipolar disorder. Available at: http://www.helpguide.org/mental/bipolar_disorder_symptoms_treatment.htm [Accessed on 13/10/2010]

Temple LK, McLeod R, Gallinger S, and Wright J. 2001. “Defining disease in the genomics era”. Science, Vol. 293, No. 5531, New York, pp. 807-808

Bipolar Disorder

  • October 13, 2020/

Bipolar disorders are mood disorders characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy. Learn about the nursing management, assessment, diagnosis, and care planning for bipolar disorder in this study guide.

Types of Bipolar Disorder

  • Bipolar I disorder is the diagnosis given to an individual who is experiencing, or has experienced, a full syndrome of of manic or mixed symptoms; the client may also have experienced periods of depression.
  • Bipolar II disorder. Bipolar II disorder is characterized by recurrent bouts of major depression with the episodic occurrence of hypomania; this individual has never experienced a full syndrome of manic or mixed symptoms.
  • Cyclothymic disorder. The essential feature is a chronic mood disturbance of at least 2 years’ duration, involving numerous periods of depression and hypomania, but not of sufficient severity and duration to meet the criteria for either bipolar I or bipolar II disorder.
  • Bipolar disorder due to general medical condition. This disorder is characterized by a prominent and persistent disturbance in mood (bipolar symptomatology) that is judged to be the direct result of the physiological effects of a general medical condition (APA, 2000).
  • Substance-induced bipolar disorder. The bipolar symptoms associated with this disorder are considered to be the direct result of the physiological effects of a substance (e.g., use or abuse of a drug or a medication, or toxin exposure).

Pathophysiology

The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been determined, and no objective biologic markers correspond definitively with the disease state.

  • The genetics component of bipolar disorder appears to be complex; the condition is likely to be caused by multiple different common disease alleles, each of which contributes a relatively low degree risk on its own.
  • Many loci are now known to be associated with the development of bipolar disorder.
  • These loci are grouped as major affective disorder (MAFD) loci and numbered in the order of their discovery.

Statistics and Incidences

Globally, the life-long prevalence rate of bipolar disorder is 0.3 to 1.5%.

  • The life-long prevalence of bipolar disorder in the United States has been noted to range from 0.9 to 2.1%.
  • For both bipolar I and bipolar II, the age range is from childhood to 50 years, with a mean age of approximately 21 years.
  • BPI occurs equally in both sexes; however, rapid-cycling bipolar disorder is more common in women than in men.

Causes

Predisposing factors to bipolar disorder include:

  • Biological. Twin studies have indicated a concordance rate for bipolar disorder among monozygotic twins at 60% to 80% compared to 10% to 20% in dizygotic twins.
  • Biochemical. Just as there is an indication of lowered levels of norepinephrine and dopamine during an episode of depression, the opposite appears to be true of an individual experiencing a manic episode.
  • Physiological. Right-sided lesions in the limbic system, temporobasal areas, basal ganglia, and thalamus have been shown to induce secondary mania.
  • Medication side effects. Certain medications used to treat somatic illnesses have been known to trigger a manic response; the most common of these are the steroids frequently used to treat chronic illnesses such as multiple sclerosis and systemic lupus erythematosus.

Clinical Manifestations

These are the symptoms of bipolar disorder:

  • Heightened, grandiose, or agitated mood. The affect of a manic individual is one of elation and euphoria- a continuous “high”.
  • Exaggerated self-esteem. Usual inhibitions are discarded in favor of sexual and behavioral indiscretions.
  • Sleeplessness. Sleep patterns are disturbed; client becomes oblivious to feelings of fatigue, and rest and sleep are abandoned for days or weeks.
  • Pressured speech. Loquaciousness, or pressured speech, is so forceful and strong that it is difficult to interrupt maladaptive thought processes.
  • Flight of ideas. There is a continuous, rapid shift from one topic to another.
  • Reduced ability to filter out extraneous stimuli; easily distractible. There is inability to concentrate because of a limited attention span; the individual is easily distracted by even the slightest stimulus in the environment.
  • Increased number of activities with increased energy. Motor activity is constant; the individual is literally moving at all times.
  • Multiple, grandiose, high risk activities, using poor judgement; with severe consequences.

Assessment and Diagnostic Findings

A number of reasons exist for obtaining selected laboratory studies in patients with bipolar disorder; an extensive range of tests is indicated, because bipolar disorder encompasses both depression and mania and because a significant number of medical causes for each state exist.

  • Complete blood count. A complete blood count with differential is used to rule out anemia as a cause of depression in bipolar disorder.
  • Erythrocyte sedimentation rate. The erythrocyte sedimentation rate (ESR) is determined to look for underlying disease process such as lupus or an infection; an elevated ESR often indicates an underlying disease process.
  • Fasting glucose. In some cases, a fasting glucose level is indicates to rule out diabetes.
  • Electrolytes. Serum electrolyte concentrations are measured to help diagnose electrolyte problems, especially with sodium, that are related to depression.
  • Proteins. Low serum protein levels found in patients who are depressed may be a result of not eating.
  • Thyroid hormones. Thyroid tests are performed to rule out hyperthyroidism (mania) and hypothyroidism (depression).
  • Creatinine and blood urea nitrogen. Kidney failure can present as depression; treatment with lithium can affect urinary clearances, and serum creatinine and blood urea nitrogen (BUN) levels can increase.
  • Substance and alcohol screening. Alcohol abuse and abuse of a wide variety of drugs can present as either mania or depression.
  • MRI. The total value of performing MRI in a patient with bipolar disorder remains unclear; however a couple of reasons do exist for performing an imaging study.
  • Electrocardiography. Many of the anti depressants, especially the tricyclic agents and some of the antipsychotics can affect the heart and cause conduction problems.

Medical Management of Bipolar Disorder

The treatment of bipolar disorder is directly related to the phase of the episode (i.e. depression or mania) and the severity of that phase.

  • Psychotherapy. Psychotherapy helps patients with bipolar disorder but does not cure the disorder itself; when Schottle and colleagues looked at psychotherapy for patients, family, and caregivers, they found that although results were heterogeneous, most studies demonstrated relevant positive results in regard to decreased relapse rates, improved quality of life, increased functioning, or more favorable symptom improvement.
  • Electroconvulsive therapy. Electroconvulsive therapy (ECT) is useful in a number of instances in patients with bipolar disorder, such as when rapid, definitive medical/psychiatric treatment is needed; when the risks of ECT are less than that of other treatments; when the bipolar disorder is refractory to an adequate trial with other treatment strategies; and when the patient prefers this treatment modality.
  • Diet. Patients should be advised not to make significant changes in their salt intake, because increased salt intake may lead to reduced serum lithium levels and reduced efficacy, and reduced intake may lead to increased levels and toxicity.
  • Activity. Patients in the depressed state are encouraged to exercise; these individuals should try to develop a regular daily schedule of major activities, especially times of going to bed and waking up.

Pharmacological Management

Appropriate medication for managing bipolar disorder depends on the stage the patient is experiencing.

  • Anxiolytics, benzodiazepines. By binding to specific receptor sites, benzodiazepines appear to potentiate the effects of gamma-aminobutyric acid (GABA) and facilitate inhibitory GABA neurotransmission and the action of other inhibitory neurotransmitters.
  • Mood stabilizers. Lithium is the drug commonly used for prophylaxis and treatment of manic episodes.
  • Anticonvulsants. Anticonvulsants have been effective in preventing mood swings associated with bipolar disorder, especially in those patients known as rapid cyclers.
  • Antipsychotics, 2nd generation. Second generation, or atypical, antipsychotics are increasingly being used for treatment of both acute mania and mood stabilization in patients with bipolar I disease.
  • Antipsychotics, 1st generation. First-generation antipsychotics, also known as conventional or typical antipsychotics, are efficacious in treating both psychotic and nonpsychotic manic and mixed episodes, as well as hypomania.
  • Antipsychotics, phenothiazine. Phenothiazine antipsychotics, which are classified as first-generation antipsychotics, are efficacious in treating both psychotic and nonpsychotic manic and mixed episodes, as well as hypomania.
  • Antiparkinsons agents, dopamine agonists. Dopamine agonists are non-errgot agents that bind to D2 and D3 dopamine receptors in the striatum and substantia nigra.

Nursing Management for Bipolar Disorder

Nursing management of a patient with bipolar disorder include the following:

Nursing Assessment

Assessment of a patient with bipolar disorder include:

  • History. Taking a history with a client in a manic phase often proves difficult; obtaining data in several short sessions, as well as talking to family members, may be necessary.
  • General appearance and motor behavior. Client with mania experience psychomotor agitation and seem to be in perpetual motion; sitting still is difficult; this continual movement has many ramifications; clients can be exhausted or injure themselves.
  • Mood and affect. Mania is reflected in periods of euphoria, exuberant activity, grandiosity, and false sense of well being.
  • Thought process and content. Cognitive ability or thinking is confused and jumbled with thoughts racing one after another, which is often referred to as flight of ideas; clients cannot connect concepts, and they jump from one subject to another.

Nursing Diagnosis for Bipolar Disorder

Nursing diagnoses commonly established for clients in the manic phase are as follows:

Nursing Care Planning and Goals

Main Article: 6 Bipolar Disorders Nursing Care Plans

Nursing care planning goals for bipolar disorders are:

  • Client will no longer exhibit potentially injurious movements after 24 hours with administration with administration of tranquilizing medications.
  • Client will experience no physical injury.
  • Client’s agitation will be maintained at manageable level with the administration of tranquilizing medications during first week of treatment.
  • The customer will not harm self or others.
  • Client will consume sufficient finger foods and between-meal snacks to meet recommended daily allowances of nutrients.
  • Within one week, client will be able to recognize and verbalize when thinking is non-reality based.
  • Client will be able to recognize and verbalize when he or she is interpreting the environment inaccurately.

Nursing Interventions

Nursing interventions for bipolar disorder client are:

  • Offering for safety. A primary nursing responsibility is to provide a safe environment for client and others; for clients who feel out of control, the nurse must establish external controls emphatically and nonjudgementally.
  • Meeting physiologic needs. Decreasing environmental stimulation may assist client to relax; the nurse must provide a quiet environment without noise, television, and other distractions; finger foods or things client can eat while moving around are the best options to improve nutrition.
  • Providing therapeutic communication. Clients with mania have short attention spans, so the nurse uses simple, clear sentences when communicating; they may not be able to handle a lot of information at once, so the nurse breaks information into many small segments.
  • Promoting appropriate behavior. The nurse can direct their need for movement into socially acceptable, large motor activities such as arranging chairs for a community meeting or walking.
  • Managing medications. Periodic serum lithium levels are used to monitor the client’s safety and to ensure that the dose given has increased the serum lithium level to a treatment level or reduced it to a maintenance level.

Evaluation

The goals are met as evidenced by:

  • Customer is able to differentiate between reality and unrealistic events or situations.
  • The Client is able to recognize thoughts that are not based in reality and intervene to stop their progression.
  • Client has gained or maintained weight during hospitalization.
  • There is no evidence of violent behavior to self and others.
  • The Client is no longer exhibiting signs of physical agitation.

Documentation Guidelines

Documentation in a patient with bipolar disorder include:

  • Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
  • Cultural and religious beliefs, and expectations.
  • Plan of care.
  • Teaching plan.
  • Responses to interventions, teaching, and actions performed.
  • Attainment or progress toward the desired outcome.

Practice Quiz: Bipolar Disorder

Quiz time about bipolar disorder from our nursing test bank! For more practice questions, visit our NCLEX practice questions page.

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1. Ralph is admitted at Nurseslabs Medical Center with the diagnosis of bipolar disorder, single manic episode. Which of the following behaviors would the nurse expect to assess?

A. Apathy, poor insight, and poverty of ideas.
B. Anxiety, somatic complaints, and insomnia.
C. Elation, hyperactivity, and impaired judgment.
D. Social isolation, delusional thinking, and clang associations.

1. Answer: C. Elation, hyperactivity, and impaired judgment.

  • Option C: A client with bipolar disorder, manic episode, would demonstrate flight of ideas and hyperactivity as part of the increased psychomotor activity. The mood is one of elation, and the feeling is that one is invincible; therefore, judgment may be quite impaired.
  •  A: The symptoms in option A would be more characteristic of an individual with long-term schizophrenia.
  •  B: The symptoms in option B would be more characteristic of someone with an anxiety disorder, although a manic individual may also not sleep because of excessive energy.
  •  D: The symptoms in option D are more characteristic of schizophrenia.

2. In a day treatment program, a manic client is creating considerable chaos, behaving in a dominating and manipulative way. Which nursing intervention is most appropriate?

A. Allow the peer group to intervene.
B. Describe acceptable behavior and set realistic limits with the client.
C. Recommend that the client is hospitalized for treatment.
D. Tell the client that his behavior is inappropriate.

2. Answer: B. Describe acceptable behavior and set realistic limits with the client.

  • Option B: In this situation, it would be appropriate for the nurse to suggest alternative behaviors in place of unacceptable ones to help the client gain self-control.
  •  A: The peer group is not responsible for monitoring the client’s behavior.
  •   C: The client’s behavior does not warrant hospitalization.
  • D: The client is told only what is unacceptable and is not given any alternatives.

3. Nurse Nadine is assessing James who is diagnosed with bipolar disorder. The nurse would expect to find a history of:

A. A depressive episode followed by prolonged sadness.
B.  Series of depressive episodes that recur periodically.
C. Signs of mania that may or may not be followed by depression.
D. Symptoms of mania that include delusional thoughts.

3. Answer: C. Symptoms of mania that may or may not be followed by depression.

  • Option C: The definition of bipolar disorder is a mood disturbance in which the symptoms of mania have occurred at least one time. Depression may or may not occur as a separate episode in bipolar disorder.
  • Options A, B, D: None of the other options indicate a correct understanding of bipolar disorder.

4. The nurse is planning activities for a client who has bipolar disorder with aggressive social behavior. Which of the following activities would be most appropriate for this client?

A. Ping pong.
B. Writing.
C. Chess.
D. Basketball.

4. Answer: B. Writing.

  • Option B: Solitary activities that require a short attention span with mild physical exertion are the most appropriate activities for a client who is exhibiting aggressive behavior. Writing, walks with staff, and finger painting are activities that minimize stimuli and provide a constructive release for tension.
  • Options A, C, D: Competitive games can stimulate aggression and increase psychomotor activity.

5. The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. The symptom presented by the client that requires the nurse’s immediate intervention is the client’s:

A. Outlandish behaviors and inappropriate dress.
B. Grandiose delusions of being a royal descendant of King Arthur.
C. Nonstop physical activity and poor nutritional intake.
D. Constant, incessant talking that includes sexual innuendoes and teasing the staff.

5. Answer: C. Nonstop physical activity and poor nutritional intake.

  • Option C: Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. Mania is a period when the mood is predominately elevated, expansive, or irritable. All options reflect a client’s possible symptomatology. Option C, however, clearly presents a problem that compromises one’s physiological integrity and needs to be addressed immediately.

References and Sources

Interesting resources for further reading about bipolar disorder:

  • Bartels, S. J., Mueser, K. T., & Miles, K. M. (1997). A comparative study of elderly patients with schizophrenia and bipolar disorder in nursing homes and the community. Schizophrenia Research27(2-3), 181-190. [Link]
  • Black, J. M., & Hawks, J. H. (2005). Medical-surgical nursing. Elsevier Saunders,.
  • Boyd, M. A. (Ed.). (2008). Psychiatric nursing: Contemporary practice. lippincott Williams & wilkins.
  • Keltner, N. L. (2013). Psychiatric nursing. Elsevier Health Sciences.
  • Videbeck, S. L. (2010). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.