Bipolar manic episode
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Bipolar manic episode
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Bipolar manic episode
- 2. 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
- 3. 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.
- 4. 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.
- 5. According to observer Logorrhea(excessive talking) Aggressiveness Delusion of grandiosity Irritability Elation of mood Insomnia Self neglect
- 6. 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.
- 7. 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.
- 9. 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.
- 10. 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.
- 11. 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
- 12. 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.
- 13. 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
- 14. 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.
- 15. 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
- 16. Sign and symptoms Book picture Patient Pictures Logorrhea(excessive talking) Aggressiveness Delusion of grandiosity Irritability Elation of mood Insomnia Self neglect
- 17. Diagnostic evaluation Book picture Patient picture History collection Mental status examination Psychoanalysis History collection Mental status examination Psychoanalysis
- 18. Psychopharmacology Book picture Patient picture Mood stabilizer Antipsychotics ECT Mood stabilizer Antipsychotics
- 19. 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.
- 20. 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