A Client with Bipolar Disorder

Which statement indicates the client diagnosed with bipolar disorder who is taking lithium (Eskalith), an antimania medication, understands the medication teaching  

The 30-year-old client with a urine output of 40 mL/hour. 

The 24-year-old female client with bipolar disorder is prescribed valproic acid (Depakote), an anticonvulsant medication. Which question should the nurse ask the client  

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A confusing aspect of the diagnosis for the client, family, and practitioner is that a client with bipolar disorder may be in a mixed state, which indicates that their mood reflects concurrent depressive, manic or hypomanic symptoms. 

A client with bipolar disorder experiences a mood disorder, not a thought disorder such as schizophrenia. Therefore, this data does not indicate the medication is effective in treating the bipolar disorder. 

This is the scientific rationale for administering lithium to a client with bipolar disorder. 

In clinical situations, clients will often describe the course of these symptoms and their severity as a roller-coaster ride not knowing when to expect the next drop (Hilty, Brady, Hales, 1999). Unlike earlier perceptions, bipolar disorder is now understood as an illness with overlapping states of mood and accompanying symptoms. Mental health professionals also recognize that clients with bipolar disorders can suffer concurrently from other forms of mental illness such as alcoholism, drug use, and anxiety disorders (Cassano, Pini, Saettoni, Dell Osso, 1999). Regardless of how clients experience this disorder, it is important for social work practitioners to become knowledgeable about the types of medications successfully used in its treatment and the psychosocial treatments that can help. 

Social work practitioners in clinical practice quickly learn that as with many other mental illnesses, the psychiatric problems clients present are complex and multifaceted. It is not unusual that clients with bipolar disorders often have other psychiatric problems that require attention and treatment. For example, many clients with bipolar disorder also have alcohol or drug-related problems (Carlson, Bromet, Jandorf, 1998). Identifying other disorders is important during the assessment phase and continues to be so throughout the treatment phase. Clients with a history of alcohol and drug use will require special considerations when it comes to prescribing medications for the bipolar disorder. Failure to obtain this information at the point of assessment can put a client in harm if the client uses medications while taking these substances. 

It is important for social work practitioners to remember that clients with bipolar disorders follow a predictable course of manic episodes followed by depressive states. It is during the depressive episode that the client will need to be assessed for potential suicidal thoughts and behaviors... 

Treatment interventions for bipolar clients should be structured clearly and mapped out in a plan that delineates strategies for handling the problems associated with bipolar symptoms. Social work practitioners will often encounter resistance from clients with bipolar disorders, especially those experiencing a manic episode where energy, creativity, and feelings are at an all-time high. Regardless of the resistance, it is the practitioner s responsibility to help the client and family members formulate, implement, and monitor the interventions necessary to eliminate the bipolar symptoms. 

Clients with bipolar disorders cannot be helped until they have been thoroughly assessed for appropriate medication. Once the need for medication is determined, the goal is to identify the appropriate medication and dosage. Clients with bipolar disorder, and for Aat matter any client with a serious psychiatric illness, should not be prescribed medication as the sole treatment intervention. Although major advances have been made in the field of psychotropic medication, clinical practice and the literature have always emphasized the multifaceted approach for multidimensional problems. It is important to remember that all mental illnesses impact on the biological, social, and psychological spheres of a client s life and functioning (Walsh, 1989). 

Bipolar disorder is a challenging condition for clients and difficult to assess and treat. The bipolar disorders present with a variety of symptoms that often cause major functioning problems in clients and that lead to frustration for their family and support systems. Clients with this disorder are often overwhelmed by the symptoms and by despair over the fluctuating moods, which are difficult to monitor. The client who suffers from bipolar disorder is faced with the challenge of understanding and tracking two separate sets of symptoms within one illness— those that arise during a manic state and those reflected in the depressive phase. 

When working with the bipolar 1 disorders it appears that either depressive episodes, manic episodes, or mixed episodes can be involved (Maxmen Ward, 1995). Practitioners should keep in mind that clients with bipolar I disorders will often report depressive episodes as well as the agitation and hyperactivity that often are associated with it In this condition a full depressive episode is also reported, and 20% to 30% of clients may continue to have mood fluctuations (lability) between episodes that are significant enough to disturb interpersonal or occupational relations. In some cases the development of psychotic features may occur, and when this happens subsequent manic episodes ate more likely to also have psychotic features (American Psychiatric Association, 1994). 

In the bipolar II disorders, there have been one or more major depressive episodes and no history of either a manic or mixed episode. Bipolar II disorders are best described as alternating episodes of major depression and periods of hypomania (Maxman Ward, 1995). These hypomanic symptoms include increased levels of energy and mood that are not as intense as manic episodes, and clients with bipolar II disorder do not become delusional or requite acute hospitalization (American Psychiatric Association, 1994). 

According to the DSM-IV, clients with a diagnosis of cyclothymic disorder have milder experiences than those who suffer from bipolar disorders although the symptoms are more consistent and last for approximately two years. In order to be diagnosed with cyclothymic disorder, the client s history must indicate that he or she has not been without hypomanic and depressive symptoms for a period of two months (American Psychiatric Association, 1994) a client with a major depressive episode only should not be diagnosed as cyclothymia. 

The client diagnosed with bipolar disorder is taking lithium (Lithobid) and has a lithium level of 1.0 mEq/L. Which action should the psychiatric clinic nurse take based on this laboratory result ... 

Pharmacotherapy is very important for treating Bipolar Disorder, and the use of mood stabilizers, such as lithium, is considered the standard of care. However, after you stabilize a person s mood, you may be left with a person who has not learned a great many life skills over the years precisely because of her or his disorder. Fortunately, cognitive behavioral therapy, including skills training, has been used effectively with bipolar clients after they have been stabilized pharmacologically. Obviously the person must be emotionally stable in order to learn new skills. 

This case illustrates the significant impairments that bipolar disorders can cause, especially for young clients. Someone like Michael, exhibiting a manic episode with a history of depressive episodes, is a good candidate for immediate assessment, hospitalization, and stabilization of symptoms. It is important in cases like this to assess the client s potential for suicide, especially once he begins to show depressive signs. It is also a good idea... 

Dealing with any form of mental illness is a major challenge for clients, practitioners, and family members. Bipolar disorders with their varying... 

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