Bipolar manic episode

Identification Data
 Name - Nrusingha Charan Das
 Age - 39yr
 Gender - male
 Marital status - Unmarried
 Religion - Hindu
 Education - 10th
 Occupation - Priest
 Address - At- Bharatpur, Ghatikia,
 Date of admission – 23/01/2018
 Diagnosis – BPAD current episode Mania
 Ip no:- -- 180122062

 II .INFORMANT’S NAME – Sita Das
 Relationship with the patient
- Mother
 CHIEF COMPLAINTS :-
 According to patient
 My blood pressure has increased.
 I suddenly become angry towards my family
member.
 I frequently take cannabis smoke.


 According to Informants
 If I tell something he becomes angry since 2-3
months.
 Most of the time he takes cannabis smoke since
8 years.
 Most of the time he quarrel with others.
 He tells that he is the best priest in India no one
can beat since 1-2 years.
 He was not sleeping properly since 3-4 months
and sleeps at 2-3A.M.

 According to observer
 Logorrhea(excessive talking)
 Aggressiveness
 Delusion of grandiosity
 Irritability
 Elation of mood
 Insomnia
 Self neglect

ILLNESS:-
 Patient had irritability and
aggressiveness before but before 15-20
days of admission it became worse. He
quarrelled with the neighbour ant beat
him before 4 days. He tried to beat his
uncle before the day of the admission
because he (uncle) refused to give him
money for the cannabis.

Treatment history
 He was taking medication for the mentally
illness , but discontinued.
 PAST ILLNESS
 History of past psychiatric illness:
 Before 3 years ago he became violent and
had attacked his family member for that he
got admitted in IMS & SUM hospital.

MENTAL STATUS
EXAMINATION
 Appearance:
 Patients height is 170cm and weight is 66 kg.
He has moderate body built. His grooming
was not appropriate. He weared very dirty
clothes.
 Behavior:
 He had aggressive behaviour towards his
mother.
 Attitude
 He was very open and cooperative.

 Level of consciousness:
 Conscious and alert
 Orientation:
 He is fully oriented to time, place but not to date.
 Speech and Language:
 The patient was talking very rapidly with
adequate volume and there was fluctuation in
speech.

 Mood
 Student nurse :How are you feeling?
 Patient : I feeling good.
 Student Nurse : Do you feel depressed.
 Patient : No and said why should I feel
depressed?
 objective : Looking joyful.
 (f) Affect
 Fluctuation : Elevated
 Range : Full
 Appropriateness : Appropriate

Thought: Felling aggression towards family
member.
Delusion of grandiosity is there.
Perception: Absence of hallucination or illusion.
Cognitive function:
Patient is oriented to place person time.
Attention: it is intact.
Concentration : it is also intact.
Memory: Recent and immediate memory is intact
and remote memory is impaired.

INSIGHT: Grade 4 insight
Judgement: it is also intact.
PHYSICAL EXAMINATION:
Patient has injury in right upper eyelid and left
wrist.
Neurological examination
No significant abnormalities are there

Literature review
Definition:
Bipolar disorder is a mental illness marked by
extreme shifts in mood. Symptoms can include an
extremely elevated mood called mania. They can
also include episodes of depression. Bipolar
disorder is also known as bipolar disease or manic
depression.

ETIOLOGY
BOOK PICTURE PATIENT PICTURE
 Biological Factors
 Genetic
 Monozygotic twins
 Bio chemical Factors
 Excess dopamine
release
 Social pressures
 Environmental
influence
 Sociocultural factor
 Biological influences
Excess dopamine
release
Abnormalities in the
neurotransmitters like
norepinephrine,
serotonin and
acetacholamine
 Cannabis intake

Sign and symptoms
Book picture Patient Pictures
 Logorrhea(excessive
talking)
 Aggressiveness
 Delusion of
grandiosity
 Irritability
 Elation of mood
 Insomnia
 Self neglect

Diagnostic evaluation
Book picture Patient picture
 History collection
 Mental status
examination
 Psychoanalysis
 History collection
 Mental status
examination
 Psychoanalysis

Psychopharmacology
Book picture Patient picture
 Mood stabilizer
 Antipsychotics
 ECT
 Mood stabilizer
 Antipsychotics

Nursing Diagnosis
 Risk for violence related to manic excitement as evidence
by aggression towards his mother.
 Risk for infection related to injury as evidenced by poor
hygiene of the patient.
 Self care deficit related to cognitive deficit as evidenced
by dirty clothes and appearance.
 Impaired verbal communication related to biochemical
changes as evidenced by excessive talking.
 Impaired sleeping pattern related to excitement as
reported by his mother.
 Disturbed family process related to mental disorder of a
family member as evidenced by knowledge deficit
regarding health care support.

Health education
 Advise the patient to take bath daily
 Advise to change clothes daily
 Encourage social interaction.
 Encourage the patient to share his feelings.
 Improve the self care needs (personal hygiene)
independently.
 Sleep hygiene techniques.
 Instruct to use relaxation technique when getting
aggressive.
 Taught about the positive coping methods.
 Advice to do meditation.
 Patient has taught some relaxation techniques
 Advice the patient for regular checks up and follows

Bipolar manic episode

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Bipolar manic episode