SAINT LOUIS UNIVERSITY SCHOOL OF NURSING
Baguio City
CASE ANALYSIS Case 3: Bipola !iso"e
Su#$itte" to: Si %ay A#log
Su#$itte" #y: BABAY, Leanlexoz Valiant MERCADO, Ismael CASTRO, Alyssa Jean CABRITO, Carla Cassandra DEL ROSARIO, atrina !OME", C#arlene De$ MATEO, Lynn Dina# MIRALLES, S#armayne
+ years old, so-#omore, $olle.e !oes /it#o't any slee-, s-ent time in a #ei.#tened state o0 a$ti1ity Des$ri2e #ersel0 as 3O4T O5 CO&TROL6 2e#a1ior is stran.e and .randiose ideas on a mysti$al7sex'al tone
8re$ently -ro$laimed to a .ro'- o0 0riends t#at s#e did not menstr'ate 2e$a'se, s#e /as a 3o0 a t#ird sex, a .ender a2o1e t#e #'man sexes6 ( ex-lained t#at s#e is 3s'-er/oman6 ( $an a1oid #'man sex'ality an still .i1e 2irt#9
Belie1es t#at s#e #ad s/it$#ed so'ls /it# t#at senior senator 0rom #er state ( states t#at it /o'ld ma:e #er -arti$'larly /ell s'ited 0or a #i.# -osition in .o1ernment; -er#a-s e1en t#e -residen$y9
5amily = 0riends :no/n #er 0or 2ein. extremely tidy and or.anized ( room is disarray /it# 0ranti$ and in$o#erent messa.es /ritten all o1er t#e /alls and 0'rnit're9 8messa.es re>e$t #er disor.anized, .randiose t#in:in. a2o't s-irit'al and sex'al t#emes?
Ex-erien$ed t/o -re1io's e-isodes o0 /ild and 2izarre 2e#a1ior ( ALTER&ATED
<#en de-ress ( doesnt attend $lasses, s$#ool a$ti1ities, insomnia, -oor a--etite di$'lty in $on$entratin. Contem-lated s'i$ide
Fa$ily Histoy
!re/ '- in a 3TRADITIO&AL 5ILI%I&O @OME6
si2lin.s ( t#e only one /#o al/ays o2eyed #er -arents and -layed t#e role o0 t#e 3!OOD !IRL6 in t#e 0amily ( s#e des$ri2es as 3Little Miss %er0e$t6
'ite de-endent on #er -arents
Des$ri2es #er si2lin.s as re2ellio's ( #er older sister told #er -arents t#at s#e /as sex'ally a$ti1e in #i.# s$#ool
%arents are stri$t /it# sex'al matters ( ne1er dis$'ssed iss'es r7t to sex ex$e-t to ma:e it $lear t#at t#eir $#ildren /ere to remain 1ir.ins 'ntil t#ey /ere married Mot#er 0or2ade #er to /ear ma:e'-9
BI&OLAR !ISO!ER ACCOR!ING TO !S' ( Bi-olar disorder is a mental #ealt# $ondition t#at is $#ara$terized 2y peio"s o) #ot* 'ANIA a+" !E&RESSION, t#e $riteria 0or 2i-olar re'ires at least one de-ressi1e e-isode and one mania e-isode9
BI&OLAR !ISOR!ER I -'ai+a.s Case/ It in1ol1es one or more mani$ e-isodes or mixed 8mania and de-ression? e-isodes9 T#e e-isodes are not d'e to medi$al $ondition or s'2stan$e a2'se9
'a+i0 Episo"e A9 A distin$t -eriod o0 a2normally and -ersistently ele1ated, ex-ansi1e, or irrita2le mood and a2normally and -ersistently in$reased .oalFdire$ted a$ti1ity or ener.y, lastin. at least * /ee: and -resent most o0 t#e day, nearly e1ery day 8or any d'ration i0 #os-italization is ne$essary?9 B9 D'rin. t#e -eriod o0 mood dist'r2an$e and in$reased ener.y or a$ti1ity, t#ree 8or more? o0 t#e 0ollo/in. sym-toms 80o'r i0 t#e mood is only irrita2le? are -resent to a si.niG$ant de.ree and re-resent a noti$ea2le $#an.e 0rom 's'al 2e#a1iorH * + ) K
In>ated sel0Festeem or .randiosity De$reased need 0or slee%ress're o0 s-ee$# 5li.#t o0 ideas Easily distra$ted Ex$ess -'rs'it o0 .oalFdire$ted a$ti1ities or -sy$#omotor a.itation 8-a$in. , #and /rin.in. and et$9? Ex$ess -'rs'it o0 -leas're /it# #i.# ris: o0 dan.er
C9 T#e mood dist'r2an$e is s'$iently se1ere to $a'se mar:ed im-airment in so$ial or o$$'-ational 0'n$tionin. or to ne$essitate #os-italization to -re1ent #arm to sel0 or ot#ers, or t#ere are -sy$#oti$ 0eat'res9 D9 T#e e-isode is not attri2'ta2le to t#e -#ysiolo.i$al ee$ts o0 a s'2stan$e 8e9.9, a dr'. o0 a2'se, a medi$ation, ot#er treatment? or to anot#er medi$al $ondition9
'a1o !epessi2e Episo"e A 5i1e 8or more? o0 t#e 0ollo/in. sym-toms #a1e 2een -resent d'rin. t#e same +F/ee: -eriod and re-resent a $#an.e 0rom -re1io's 0'n$tionin.; at least one o0 t#e sym-toms is eit#er 8*? de-ressed mood or 8+? loss o0 interest or -leas're *9 De-ressed mood most o0 t#e day, nearly e1ery day, as indi$ated 2y eit#er s'2e$ti1e re-ort +9 Mar:edly diminis#ed interest or -leas're in all, or almost all, a$ti1ities most o0 t#e day, nearly e1ery day 9)9 Si.niG$ant /ei.#t loss /#en not dietin. or /ei.#t .ain 8e9.9, a $#an.e o0
P9 Re$'rrent t#o'.#ts o0 deat# 8not 'st 0ear o0 dyin.?, re$'rrent s'i$idal ideation /it#o't a s-e$iG$ -lan, or a s'i$ide attem-t or a s-e$iG$ -lan 0or $ommittin. s'i$ide9 B T#e sym-toms $a'se $lini$ally si.niG$ant distress or im-airment in so$ial, o$$'-ational, or ot#er im-ortant areas o0 0'n$tionin. C9 T#e e-isode is not attri2'ta2le to t#e -#ysiolo.i$al ee$ts o0 a s'2stan$e or anot#er medi$al $ondition9
BI&OLAR !ISOR!ER II - a""itio+/ 5or a dia.nosis o0 2i-olar II disorder, it is ne$essary to meet t#e 0ollo/in. $riteria 0or a $'rrent or -ast #y-omani$ e-isode and t#e 0ollo/in. $riteria 0or a $'rrent or -ast maor de-ressi1e e-isodeH
Hypo$a+i0 Episo"e A9 A distin$t -eriod o0 a2normally and -ersistently ele1ated, ex-ansi1e, or irrita2le mood and a2normally and -ersistently in$reased a$ti1ity or ener.y, lastin. at least $onse$'ti1e days and -resent most o0 t#e day, nearly e1ery day9 B9 D'rin. t#e -eriod o0 mood dist'r2an$e and in$reased ener.y and a$ti1ity, t#ree 8or more? o0 t#e 0ollo/in. sym-toms #a1e -ersisted 80o'r i0 t#e mood is only irrita2le?, re-resent a noti$ea2le $#an.e 0rom 's'al 2e#a1ior, and #a1e 2een -resent to a si.niG$ant de.reeH *9 In>ated sel0Festeem or .randiosity9 +9 De$reased need 0or slee- 8e9.9, 0eels rested a0ter only ) #o'rs o0 slee-?9 )9 More tal:ati1e t#an 's'al or -ress're to :ee- tal:in.9 9 5li.#t o0 ideas or s'2e$ti1e ex-erien$e t#at t#o'.#ts are ra$in.9 9 Distra$ti2ility 8i9e9, attention too easily dra/n to 'nim-ortant or irrele1ant external stim'li?, as re-orted or o2sen7ed9 9 In$rease in .oalFdire$ted a$ti1ity 8eit#er so$ially, at /or: or s$#ool, or sex'ally? or -sy$#omotor a.itation9 K9 Ex$essi1e in1ol1ement in a$ti1ities t#at #a1e a #i.# -otential 0or -ain0'l $onse'en$es 8e9.9, en.a.in. in 'nrestrained 2'yin. s-rees, sex'al indis$retions, or 0oolis# 2'siness in1estments?9 C9 T#e e-isode is asso$iated /it# an 'ne'i1o$al $#an.e in 0'n$tionin. t#at is 'n$#ara$teristi$ o0 t#e indi1id'al /#en not sym-tomati$9 D9 T#e dist'r2an$e in mood and t#e $#an.e in 0'n$tionin. are o2ser1a2le 2y ot#ers9
Q $#ara$terized 2y a $lini$al $o'rse o0 re$'rrin. mood e-isodes $onsistin. o0 one or more maor de-ressi1e e-isodes 8Criteria AFC 'nder Maor De-ressi1e E-isode? and at least one #y-omani$ e-isode
'a1o !epessi2e Episo"e A9 5i1e 8or more? o0 t#e 0ollo/in. sym-toms #a1e 2een -resent d'rin. t#e same +F /ee: -eriod and re-resent a $#an.e 0rom -re1io's 0'n$tionin.; at least one o0 t#e sym-toms is eit#er 8* ? de-ressed mood or 8+? loss o0 interest or -leas're *9 De-ressed mood most o0 t#e day, nearly e1ery day, as indi$ated 2y eit#er s'2e$ti1e re-ort +9 Mar:edly diminis#ed interest or -leas're in all, or almost all, a$ti1ities most o0 t#e day, nearly e1ery day 9 )9 Si.niG$ant /ei.#t loss /#en not dietin. or /ei.#t .ain 8e9.9, a $#an.e o0 more t#an N o0 2ody /ei.#t in a mont#?, or de$rease or in$rease in a--etite nearly e1ery day 9 Insomnia or #y-ersomnia nearly e1ery day9 9 %sy$#omotor a.itation or retardation nearly e1ery day9 9 5ati.'e or loss o0 ener.y nearly e1ery day9 K9 5eelin.s o0 /ort#lessness or ex$essi1e or ina--ro-riate .'ilt 9 Diminis#ed a2ility to t#in: or $on$entrate, or inde$isi1eness, nearly e1ery day 8eit#er 2y s'2e$ti1e a$$o'nt or as o2ser1ed 2y ot#ers?9 P9 Re$'rrent t#o'.#ts o0 deat# 8not 'st 0ear o0 dyin.?, re$'rrent s'i$idal ideation /it#o't a s-e$iG$ -lan, or a s'i$ide attem-t or a s-e$iG$ -lan 0or $ommittin. s'i$ide9
BI&OLAR
BI&OLAR 4
Mania
@y-omania
5'll 2lo/n mania Mania may in$l'de -sy$#oti$ sym-toms F del'sions or #all'$inations9 Mood is extremely a2normal $om2ined /it#H in$reased a$ti1ity or ener.y t#at is also a2normal9
Mild Mania @y-omania does not #a1e -sy$#oti$ sym-toms9
S'stained mood H ele1ated 8#ei.#tened?, ex-ansi1e 8.rand, s'-erior? or irrita2l e9
5A +ote o+ psy0*osis a+" #ipola II "iso"e: •
someone /it# 2i-olar II MAY ex-erien$e #all'$inations or del'sions d'rin.
FFFFFmay 2e a tem-orary $ondition 0or some -eo-le9
•
6'i7e" )eatues8
Fo$$'rren$e o0 sim'ltaneo's sym-toms o0 o--osite mood -olarities d'rin. mani$, #y-omani$ or de-ressi1e e-isodes9 FIts mar:ed 2y #i.# ener.y, slee-lessness, and ra$in. t#o'.#ts9 At t#e same time, t#e -erson may 0eel #o-eless, des-airin., irrita2le, and s'i$idal9
RIS9S AN !IAGNOSTIC FACTOR
ENVIRON'ENTAL F More $ommon in #i.# in$ome t#an lo/ in$ome $o'ntries9
GENETIC AN! &HYSIOLOGICF 5amily #istory o0 Bi-olar is t#e stron.est and most $onsistent ris:9
GEN!ER RELATE! ( 5emale are more li:ely to ex-erien$e ra-id $y$lin. and mixed states
'E!ICATIONSTREAT'ENTS LITHIU' 8Grst dr'. o0 $#oi$e?
Mood sta2ilizin. dr'.s are 'sed to treat 2i-olar disorder 2y sta2ilizin. t#e $lients mood, -re1entin. or minimizin. t#e #i.#s and lo/s t#at $#ara$terize 2i-olar illness, and treatin. a$'te e-isodes o0 mania9
Me$#anism o0 a$tion ( -oorly 'nderstood
&ormalizes t#e re'-ta:e o0 $ertain ne'rotransmitters s'$# as serotonin, nore-ine-#rine, a$etyl$#oline, and do-amine9
It also red'$es t#e release o0 nore-ine-#rine t#ro'.# $om-etition /it# $al$i'm
T#e ee$ti1e dosa.e o0 lit#i'm is determined 2y monitorin. ser'm lit#i'm le1els and assessin. t#e $lients $lini$al res-onse to t#e dr'.9
Daily dosa.es .enerally ran.e 0rom P to ), m. F ser'm lit#i'm le1el s#o'ld 2e a2o't *9 mE7L9
Ser'm lit#i'm le1els o0 less t#an 9 mE7L are rarely t#era-e'ti$, and le1els o0 more t#an *9 mE7L are 's'ally $onsidered toxi$9
55555555;;;;;;;
Dro/siness La$: o0 $oordination9 M's$le /ea:ness Qi0 'ntreated, t#ese sym-toms /orsen and $an lead to Renal 0ail're Coma, and deat#9 Q<#en toxi$ si.ns o$$'r, t#e dr'. s#o'ld 2e dis$ontin'ed immediately9 I0 lit#i'm le1els ex$eed )9 mE7L, dialysis may2e indi$ated9
> BI&OLAR AN! ANTICONVULSANTS
re$o.nized as mood sta2ilizers to treat or -re1ent mood e-isodes
$alms #y-era$ti1ity in t#e 2rain
-res$ri2ed 0or -eo-le /#o #a1e ra-id $y$lin.F 0o'r or more e-isodes o0 mania and de-ression in a year
De-a:ote, De-a:ene 8di1al-roex sodi'm, 1alr-oi$ a$id, or a1al-roate sodi'm Lami$tal 8lamotri.ine?
4> ANTI&SYCHOTIC !RUGS
Si"e E=e0ts:
Dizziness Dro/siness 5ati.'e &a'sea FOR BI&OLAR Tremor Ras#, $ontrol -sy$#oti$ sym-toms .ain
s#ortFterm treatment to s'$# as #all'$inations, del'sions or mania sym-toms 8o$$'r d'rin. a$'te mania or se1ere de-ression; some also treat 2i-olar de-ression and se1eral #a1e demonstrated lon.Fterm 1al'e in -re1entin. 0't're e-isodes o0 mania or de-ression? A2ili0y 8ari-i-razole? Si"e E=e0ts: Clozaril 8$loza-ine? !eodon 8zi-rasidone?
3> BEN?O!IA?E&INES F#el- $ontrol $ertain mani$ sym-toms 8restlesness, a.itation or insomnia? ; slo/ t#e a$ti1ity o0 2rainFF#el- treat mania, anxiety, -ani$ disorder and seiz'res
Si"e E=e0ts:
Ati1an 8loraze-am?
Dro/siness
@> 'AOI ANTI!E&RESSANTS AN! BI&OLAR !ISOR!ER Fs#o'ld 2e 'sed 0or 2i-olar de-ression only in $om2ination /it# a mood sta2ilizer s'$# as lit#i'm or 1al-roate, to minimize ris: o0 ind'$in. mania
Si"e E=e0ts: &ardil 8-#enelzine? %arnate Di$'lty .ettin. to sleeELECTROCONVULSIVE THERA&Y FOR BI&OLAR -ECT/ 8tranyl$y-romine? Dizziness 8iso$ar2oxazid? Mar-lan s#ortFterm treatment 0or se1ere mani$ or de-ressi1e e-isodes, 8-arti$'larly
/#en sym-toms in1ol1e serio's s'i$idal or -sy$#oti$ sym-toms or /#en Dry mo't# medi$ines seem to 2e inee$ti1e9 It $an 2e ee$ti1e in nearly KN o0 -atients?
@y-ertension
an ele$tri$ $'rrent is -assed t#ro'.# t#e s$al- to $a'se a 2rie0 seiz're in t#e
0astest /ays to relie1e sym-toms in -eo-le /#o t/it$#in. s'er 0rom mania or se1ere M's$le de-ression
&ROCE!URES %rior to ECT , a -erson is .i1en a m's$le relaxant and -'t 'nder .eneral anest#esia9
-
•
•
•
•
Ele$trodes are -la$ed on t#e -atients s$al-, and an ele$tri$ $'rrent is a--lied t#at $a'ses a 2rie0 seiz're9 Be$a'se t#e m's$les are relaxed, t#e seiz're /ill 's'ally 2e limited to sli.#t mo1ement o0 t#e #ands and 0eet9 T#e -atient is $are0'lly monitored d'rin. t#e treatment9 T#e -atient a/a:ens min'tes later, does not remem2er t#e treatment or e1ents s'rro'ndin. t#e treatment, and may 2e 2rie>y $on0'sed 's'ally .i1en '- to t#ree times a /ee: 0or +F /ee:s s#ort term memory loss is a $ommon side ee$t, alt#o'.# t#is 's'ally .oes a/ay *F+ /ee:s a0ter treatment, and $an 2e minimized 2ased on #o/ t#e ele$trodes are -la$ed on t#e s$al- and ot#er te$#ni$al as-e$ts
Side Ee$tsH
Mild na'sea
Diarr#ea
Anorexia
5ine #and tremor
> &SYCHOTHERA&Y 6tal6 t*eapy:
F 2e#a1ioral t#era-y
F $o.niti1e t#era-y
o
%oly'ria
A metalli$ taste in t#e mo't#
5ati.'e or let#ar.y
+9 SU&&ORT GROU&S
3> E!UCATION
@> 'ANAGE'ENT
A$ne
LIFESTYLE
F Esta2lis# ro'tines H slee-, eat, a$ti1ity F Do not 'se al$o#ol or dr'.s
A0ti2ities )o Bipola !iso"e
E7e0ise
Boost endor-#ins d'rin. lo/ -eriods and #elt#ose /it# 2i-olar disorder 0eel more 2alan$ed9 O'tdoor a$ti1ities li:e #i:in., mo'ntain $lim2in., trail o..in. and s:iin. $an 2e #el-0'l sin$e 2ein. in nat're $an #a1e a $almin. ee$t9
StessRe"u0i+g A0ti2ities
Can #el- some -eo-le /it# 2i-olar disorder relax a0ter a #ard day9 Dee-F2reat#in. exer$ises, yo.a, meditation and 1is'alization $an all #el- red'$e stress9 Doin. s'$# a$ti1ities a 0e/ #o'rs 2e0ore 2edtime $an also 2e #el-0'l d'rin. #y-omani$ -eriods, /#en ener.y le1els are #i.#er and restlessness sets in9
So0ial A0ti2ities
Meetin. /it# $lose 0riends and 0amily to tal: or sim-ly s-end time $an 2eneGt -eo-le /it# 2i-olar disorder9
!o$esti0 A0ti2ities
Sedentary a$ti1ities li:e /at$#in. TV $an tri..er de-ression or anxiety 2e$a'se t#ey are not 0'lly stim'latin., a$$ordin. to Jay Mi:lo/itz, a't#or o0 T#e Bi-olar Disorder
Can #el- t#ose /it# 2i-olar disorder Gll time and .i1e 2a$: to t#ose in need, /#i$# $an #el- t#em 0eel more 2alan$ed9 In1ol1e yo'rsel0 in $#arita2le a$ti1ities 2ased on -ersonal interests or #o22ies9
LIST OF NURSING !IAGNOSES
*9 Altered sensory -er$e-tion r7t endo.eno's $#emi$al alteration
+9 Alteration in t#o'.#t -ro$esses related to 2io$#emi$al alteration
)9 Dist'r2ed slee- -attern r7t -sy$#olo.i$al stress
9 Im2alan$ed n'tritionH less t#an 2ody re'irements r7t -oor a--etite
9 Interr'-ted 0amily -ro$esses r7t sit'ational $risis
9 Inee$ti1e indi1id'al $o-in.
K9 Im-aired so$ial intera$tion r7t state o0 de-ression 9 Ris: 0or sel0Fdire$ted or ot#er dire$ted 2e#a1ior r7t /ild and 2izarre 2e#a1ior
Be
Fist &ioitie" Nusi+g !iag+osis: INTERVENTIONS !ISTURBE! &ROCESS sin$ere and #onest THOUGHT /#en En.a.e t#e $lient in oneFtoFone a$ti1ities
$omm'ni$atin. /it# t#e $lient9 A1oid
at Grst, t#en a$ti1ities in small .ro'-s,
1a.'e or e1asi1e remar:s9
and .rad'ally a$ti1ities in lar.er .ro'-s9
Be $onsistent in settin. ex-e$tations,
Re$o.nize
en0or$in. r'les, and so 0ort#9
a$$om-lis#ments 8-roe$ts
Do not ma:e -romises t#at yo' $annot
res-onsi2ilities
:ee-9
initiated?9
and
s'--ort
0'lGlled,
t#e
$lients
$om-leted, interFa$tions
$lients -er$e-tion o0 t#e en1ironment9
Dire$tly
Initially, do not ar.'e /it# t#e $lient or
del'sions as soon as t#e $lient seems
try
ready to a$$e-t t#is 8e9.9, 3I Gnd t#at
to $on1in$e t#e $lient t#at t#e
intere$t
do'2t
re.ardin.
del'sions are 0alse or 'nreal9
#ard to 2elie1e96?9 Do not ar.'e 2't
&e1er $on1ey to t#e $lient t#at yo'
-resent a 0a$t'al a$$o'nt o0 t#e sit'ation
a$$e-t t#e del'sions as reality9
as yo' see it9
Intera$t /it# t#e $lient on t#e 2asis o0 As: t#e $lient i0 #e or s#e $an see t#at real
t#in.s;
do
not
d/ell
on
t#e
del'sional material9
t#e del'sions inter0ere /it# or $a'se -ro2lems in #is or #er li0e9
Se0o+" &ioitie" Nusi+g !iag+osis: !ISTURBE! SLEE& &ATTERN INTERVENTIONS %ro1ide a 'iet en1ironment, /it# a lo/ le1el o0 stim'lation9 Monitor slee-atterns9 %ro1ide str'$t'red s$#ed'le o0 a$ti1ities t#at in$l'des esta2lis#ed times 0or na-s or rest9 Be0ore 2edtime, -ro1ide n'rsin. meas'res t#at -romote slee-, s'$# as 2a$: r'2; /arm 2at#; /arm, non stim'latin. drin:s; so0t m'si$; and relaxation exer$ises
Administer sedati1e medi$ations, as ordered, to assist $lient a$#ie1e slee'ntil normal slee- -attern is restored9 Assess $lients a$ti1ity le1el9 Client may i.nore or 2e 'na/are o0 0eelin.s o0 0ati.'e9 O2ser1e 0or si.ns s'$# as in$reasin. restlessness, G ne tremors, sl'rred s-ee$#, and -'y, dar: $ir$les 'nder eyes9 %ro#i2it inta:e o0 $aeinated drin:s, s'$# as tea, $oee, and $olas9
%OURNALS 'a+age$e+ts )o &atie+ts Dit* Bipola !iso"e
*9 Cog+iti2e #e*a2ioal t*eapy#ase" teat$e+t 0o$pisi+g t*ee $o"ules:
F&'trition tea$#es a--ro-riate ser1in. sizes and 2alan$ed diet; FExer$ise em-#asizes in$reasin. /ee:ly -#ysi$al a$ti1ity; F
+9 &sy0*oe"u0atio+ is a sim-le a--roa$# to s'--ort -re1ention o0 0't're e-isodes 2y deli1erin. 2e#a1io'ral trainin. to im-ro1e illness insi.#t, early sym-tom identiG$ation and de1elo-ment o0 $o-in. strate.ies9
9 &sy0*ologi0al i+te2e+tio+s s#o'ld 0orm t#e 0o'ndation o0 t#era-y 0or adoles$ents and $#ildren, as medi$ines 'sed in 2i-olar disorder $an #a1e a dama.in. ee$t on $#ildrens .ro/t# and de1elo-ment9
9 &'rses are in a -osition to 2'ild ra--ort and $o'nsel t#at 2i-olar -atient on ee$ti1e te$#ni'es 0or mana.in. t#e disorder and maintainin. a .ood state o0 -#ysi$al #ealt#9 Inter1entions 0or t#e -atient ex-erien$in. mania in$l'de e+0ouagi+g patie+ts to eat *ig*0aloie +ge )oo"s to *elp $ai+tai+ +utitio+ "ui+g states D*ee t*e patie+t $ay +ot Da+t to sit "oD+ to 0o+su$e a $ea l85ollin, et al9, +?9 It is also im-ortant to e+0ouage a+" po2i"e a uiet +o+sti$ulati+g e+2io+$e+t a+" uiet a0ti2ities )o t*e patie+t to "o9 D'rin. -eriods o0 de-ression, -atients s#o'ld 2e en$o'ra.ed to -arti$i-ate in .ro'- t#era-y9 It is also #el-0'l to en$o'ra.e -atients to 'se a o'rnal to /rite do/n t#eir 0eelin.s /#en t#ey are #a1in. di$'lties tal:in. a2o't t#em9
REFERENCES:
Ameri$an %sy$#iatri$ Asso$iation9 8+*)?9 Diagnostic and statistical manual of mental disorders 8t# ed9?9 Arlin.ton,VAH Ameri$an %sy$#iatri$ %'2lis#in.9
Medi$ations9 t# Edition9 %#iladel-#ia H 59A9 Da1is Com-any9
S$#'ltz D9%9 = S$#'ltz S9E9 8+?9 T#eories o0 %ersonality9 Belmont, CAH T#omson
To/nsend, M9 8+**?9 &'rsin. Dia.noses in %sy$#iatri$ &'rsin.H Care %lans and %sy$#otro-i$
Vide2e$:, S9 8+?9 %sy$#iatri$Fmental %#iladel-#ia, %AH Li--in$ott
#ealt#
n'rsin. 8t#
ed9?9
