Mental Health Case Study: Bipolar 1 disorder Madick1

Bipolar Disorder Case Study - Mental Health Clinical Fall 2020

Justyn Madick

Youngstown State University

Abstract

Bipolar disorder is a condition that is characterized by mood swings that consist of

profound depression to extreme euphoria or mania with periods of normalcy. Although that is

how it is characterized, there are many different types of bipolar syndrome. Bipolar 1, bipolar 2,

rapid cycling, mixed states, and a condition named cyclothymic disorder are all categorized as

bipolar syndrome types. In this scenario, D. T was diagnosed with bipolar 1 disorder current

episode depressed. In most cases, bipolar 1 is categorized by episodes of mania and there may

not be much depression. This case study will describe, the patient’s history, events leading up

to the admission, an in-depth explanation of the patient’s diagnosis, patient goals (short and

long term), the patient’s current stressors, and a list of pertinent nursing diagnoses with the

evaluation of the patient’s outcomes.

Objective data

Patient arrived at the emergency department on October 19, where he stated he was

there to “get counseling”. In the emergency department, the patient stated that he was sad

but did not have suicidal ideation. He has a past medical history of bipolar 1 disorder. On

October 14th, he was released from jail where he started taking Depakote. Upon discharge, he

stopped taking it due to lack of access. He stated that he thought that the Depakote was

helping him. In the ED, his urine drug screen was positive for amphetamines and marijuana. He

has a history of meth amphetamine and marijuana use. He stated that he believes the drugs

have worsened his mental condition, and that he should have known better to start using drugs

again. During the assessment, the patient stated that he was feeling confused and having

trouble concentrating. Patient stated that he is homeless. He also stated that his stress is “off

the wall” and also relates this to his drug use. He states that he is having slight paranoia, and

believes that people are after him. He denied any hallucinations in the ED on his assessment. He

denies being depressed but sadness was revealed upon further assessment. Patient has not had

attempts of suicide in the past. He does not have access to weapons. He stated he uses meth

regularly due to the fact that “it is cheap and affordable.” Patient stated that he has episodes of

mania that can last for a week. During these episodes, he states he experiences flight of ideas,

racing thoughts, and states he feels that he does not need to sleep during this manic episode.

During the date of care, the patient was relaxed and had a normal appearance. Upon

initial assessment, the patient had animated facial expression, with a relaxed posture. His dress

was neat and appropriate for the situation, and did not have any abnormal physical

characteristics. During our conversation and my assessment, he had no inappropriate motor

activity including akathisia, akinesia, tardive dyskinesia, or acute dystonic reaction. D.T has no

history of self-harming behaviors or suicidal ideation, no history of assault, but has a legal

history. Weeks before admission to the hospital, he was arrested on burglary charges and spent

time in jail. He is currently on house arrest during the time of admission. At first, he was

hesitant to talk with a student, but after completing group activities he became comfortable

with me. Sitting in on group allowed me to form a rapport with this patient before I started my

assessment. I believe this was beneficial, because it allowed him to develop a trust in me and

become more comfortable with sharing personal stories with me. As our conversation

progressed, he opened up and shared stories with me about his past, family relationships,

previous hospitalizations and more. I learned he has a history of mental illness, a history of drug

abuse, a poor relationship with his mother, that his father passed away, and his current

stressors he is dealing with. Upon admission per hospital policy, labs were drawn and the

results are as follows.

The most important lab value is his Valproic acid. This is drawn to check the level of the

drug in his system. This was checked because when he was in jail, he was placed on Depakote

to stabilize his mood. His level was at 28 on 10/22 which is low and reveals he was not taking

his medication when he got released from jail. The normal range should be 50-100. Another lab

value that is important is his Urine drug screen. He tested positive for amphetamines and

cannabis. This is important because if a person is on drugs, it make mimic or display as a mental

illness. It may also worsen signs and symptoms of a preexisting mental illness. Lastly, His

hemoglobin A1C was a 5.9%. This is elevated and may be considered prediabetes. It is
Mental Health Case Study: Bipolar 1 disorder Madick5

important to monitor his blood glucose during admission and provide education on his blood

glucose.

D.T is currently on a variety of medications for many reasons. First, he is on Depakote.

This is an anticonvulsant which is used in bipolar patients as a mood stabilizer. He is on 250 mg

two times a day. During the day of care, his dose was changed from 250 mg BID to 500mg BID.

He is also on olanzapine or Zyprexa which is an antipsychotic. He takes 10mg QHS for his bipolar

disorder. He also takes hydroxyzine or Atarax which is an anxiolytic for anxiety. He takes 25mg

Q 6 hours PRN. Lastly, he takes Trazadone which is also a PRN medication to aid in sleep. He

takes 50mg QHS. Since admission, he has been compliant with his medication regimen and

wishes to continue taking them upon discharge. Access to medication is a problem for him, but

he wishes to talk to someone to have access. He stated that the medications are helping his

mood and making him feel much better.

Summarize the Psychiatric Diagnosis

D.T has a diagnosis of bipolar 1 disorder with current episode of depression. Bipolar

disorder is defined as “Bipolar disorder is diagnosed when a person’s mood fluctuates to

extremes of mania and/or depression. Mania is a distinct period during which mood is

abnormally and persistently elevated, expansive, or irritable. Typically, this period lasts about 1

week but it may be longer for some individuals.” (Videbeck, S. L., & Miller, C. J. pg.286).

More specifically, bipolar 1 disorder is one or more manic or mixed episodes usually

accompanied by major depressive episodes. There are behaviors that are common in patients

diagnosed with bipolar disorder. When a patient is experiencing mania, they express inflated

self-esteem, decreased sleep, pressured speech, flight of ideas, risky behavior, and they may
Mental Health Case Study: Bipolar 1 disorder Madick6

experience agitation. In contrast, when a patient is experiencing a depressed phase they may

display a depressed mood, feelings of worthlessness, lack of pleasure, and thoughts of death.

The most important aspect of care for a patient who is diagnosed with bipolar disorder is

safety. For a manic patient, they participate in risky activities which can cause injury or death.

They also may disregard self-care whether it be sleep, showering, or eating. All of which being

important for survival. As for the other extreme, episodes of depression can cause the patient

to have suicidal ideation. “Clients with psychiatric disorders, especially depression, bipolar

disorder, schizophrenia, substance abuse, posttraumatic stress disorder, and borderline

personality disorder, are at increased risk for suicide.” (Videbeck et al. pg. 316).

Identify The stressors and Behaviors

D.T admitted himself to the emergency department to receive counseling. He stated he

experiences a lot of stress, but the biggest stressor is his learning disability. He stated multiple

times “I get too ahead of myself and it frustrates me.” He wanted to learn coping techniques to

help calm his nerves and anger when he starts to feel overwhelmed. Another large stressor in his

life is his living situation. He is currently homeless due to his mother kicking him out of the

house due to his drug addiction. He stated, “living on the streets suck, and I need to stop using

drugs to get a better relationship with my mom.” That leads me to the next stressor which is his

relationship with his parents. His father passed away when he was 18 years old from a

complication form surgery. He stated that he had a good relationship with his father. As I stated

above, his current relationship is not as strong with his mother as it once was. Lastly, he also

experienced a great amount of bullying in high school which led him to dropping out in the 10th

grade. He stated, “one of my goals if to get my GED when I get out of the hospital.” It was said

that this will make him feel better about himself and relieve the stress of dropping out.
Mental Health Case Study: Bipolar 1 disorder Madick7

Discuss patient and family history of mental illness

D.T does not have a history of psychiatric hospitalizations, but was previously diagnosed

with bipolar 1 disorder by his primary care provider. The patient has not taken any medications

for his psychiatric disorder until he was in jail soon before hospitalization where he started

taking Depakote. His mother has a history of depression. There is no history of suicide or

suicidal ideation in the family history.

Describe the psychiatric evidence based nursing care provided

Upon evaluation in the emergency department, the patient was admitted to the

psychiatric unit for an estimated 5-7 days. This will allow the patient to stop drug use, start

medication for his mental illness, and to keep him safe. Per hospital policy, he was checked for

anything that could harm himself or others. The patient was also ordered to start medication to

help with his dipolar disorder. D.T was informed on group therapy and the benefits of it. He

attended group and stated he was benefiting from it greatly. This provided the patient a way to

work on his desired goals and gave him an environment to talk with other people. Milieu

therapy is beneficial for many reasons. This provided the patient with a structured schedule and

routine which will keep him safe, reduce isolation, suicidal ideation, and improve functioning

for a patient with a mental illness.

Evaluate patient outcomes related to care

The patient responded well to the treatment provided during his hospitalization. A

combination of medications with therapy greatly impacted his prognosis. One of the most

important aspects is abstaining from drug use. The patient would like to check himself into

rehab to stop using drugs. Community resources and follow up care for both substance abuse
Mental Health Case Study: Bipolar 1 disorder Madick8

and mental illness are necessary. D.T expressed his satisfaction with the progress he has made

since admission. He plans to continue to take his medication and do what is necessary to avoid

an episode again. Being taught coping techniques has proven beneficial to the patient. He sated

they have helped him when he starts getting frustrated with himself in group. He plans to

continue improving and comply with what is suggested to him to get better.

Summarize the discharge plans

D.T has many plans for discharge. He stated that he would like to go to rehab to stop

using drugs. He believes that it will strengthen his relationship with his mother. He also stated

that he feels so much better when he is not doing meth. He attributed his hospitalization and

worsening mental illness to his drug use. He also stated he plans to move in with his friend. This

would get him living off of the streets and provide a sober friend to be around. As I previously

sated, he plans to comply with his medication regimen and outpatient therapy. Lastly, he would

like to get his GED and find a job where he can. He aspires to complete school in order to get a

job so he can make enough money to support himself.

Prioritized list of all actual nursing diagnoses

 Ineffective individual coping related to ineffective problem-solving skills as evidenced by

destructive behavior toward self.

 Interrupted family processes related to situational crisis as evidenced by family in a crisis

 Risk for injury related to neurologic imbalances as evidenced by impaired judgement

List of potential nursing diagnoses

 Risk for violence related to manic excitement

 Risk for injury related to extreme hyperactivity

 Risk for suicide related to current episode of depression

Conclusion

In conclusion, D.T is doing the right things in order to have a good prognosis. He

admitted himself in order to get counseling and to better himself. One thing he continued to

stress was the important to stop using drugs. He plans on using community resources in order to

do so. The patient is currently going through treatment on the psychiatric unit. The treatment

consists of counseling, group therapy, psychopharmacology, and milieu therapy. All of said

treatments are proven to be beneficial for the patient. The patient must follow through with his

goals and comply with the goals set for treatment. If he does so it will lead to a good prognosis

for him. Lastly, continuing to use coping techniques is important to keep his anger and

frustration under control. This will help him reason through problems and stressful situations he

encounters.
Mental Health Case Study: Bipolar 1 disorder Madick10

References

Authors, A., & Roger S. McIntyre & Joseph R. Calabrese. (n.d.). Bipolar depression: The clinical

characteristics and unmet needs of a complex disorder. Retrieved November 30, 2020,

from [Link]

McCormick, U., Murray, B., & McNew, B. (2015, September). Diagnosis and treatment of

patients with bipolar disorder: A review for advanced practice nurses. Retrieved

November 30, 2020, from [Link]

PMC, E. (n.d.). Differences between bipolar I and bipolar II disorders in clinical features,

comorbidity, and family history. Retrieved November 30, 2020, from

[Link]

Videbeck, S. L., & Miller, C. J. (2020). Chapter 17/Mood Disorders and Suicide. In 

Psychiatric-mental health nursing (pp. 284-326). Philadelphia: Wolters Kluwer.