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The term “insane” derived from the Latin word “insanus” has been used for centuries to describe individuals who exhibited classic manic behaviors. Before mental health was recognized and understood, many of these people were labeled as outcasts, lunatics, or simply mad. These lunatics were unwanted in society, resulting in them being placed in insane asylums, religious facilities, or even killed.
My mother was diagnosed in 2018 as bipolar manic depressive. According to the National Institute of Mental Health, “Bipolar disorder is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.” Bipolar disorder can be broken down into two categories: type 1 or type 2. The main difference between the two is the presence of manic high episodes.
Type 1 has severe manic and depressive episodes that can last days to months at a time. Type 2 does not have manic high episodes but experience manic depressive episodes.
Manic episodes are periods were patients can go back and forth from feeling good and full of energy (manic high), to feeling really low, sad, and suicidal (manic depressive) (Harvard 2019).
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“ She followed all my directions. It was really easy to contact her and respond very fast as well. ”
The back and forth between the two is called “rapid cycling”. How quickly one can “cycle” between states depends on the individual.
My mother experiences frequent mood cycling, and it can be exhausting. She can go from being perfectly fine one moment, to hysterically crying over spilled milk for hours. When my mom goes into a hypomanic episode, she becomes severely depressed for weeks to months.
She has lost many jobs because she cannot find the motivation to get out of bed, or even call her employer to let them know. When she isn’t having an episode, she is an excellent employee, shows up on time, is dependable, hard-working, and pleasant to be around. She becomes a completely different person during a hypomanic episode and has to be constantly watched by someone because she has attempted suicide on multiple occasions in the past.
There is no single cause of bipolar disorder but there are many contributing factors. Factors such as genetics, brain structure, and hormones play a role in an individual developing the disorder. According to the National Institute of Mental Health, “the disease is highly heritable, so having a family member with the condition increases the risk greatly.” Environmental factors, stress, and substance abuse can also be triggers for manic episodes.
Bipolar disorder can present itself in many different ways. Most commonly it is experienced through periods of intense emotions, erratic behaviors, and inability to control one’s actions. Depending on the type of episode a person is having, will determine the symptoms they display. During a manic episode, a person will experience an abnormally elevated mental status, increased energy, feelings of euphoria, racing thoughts, and lack of self-control. It is very easy to misdiagnose a manic episode for someone high on stimulants or drugs because the behaviors are very similar. The person can function on little to no sleep and go days without sleeping. Hospitalization may be required to control severe symptoms and psychotic hallucinations. Many factors can trigger a manic episode such as a change in routine, a stressful event, or an SSRI medication.
During a manic episode, my mom can be either a delight to be around or a complete monster. Sometimes she will have increased energy, elevated moods, goes on reckless shopping sprees, deep cleans the house, and does other out of character things. On the other end, she can become aggressive, demanding, and violent. She will start screaming and start fights over the littlest things, she will throw things, and break things. She has absolutely no self-control during a manic episode and it is the most terrifying thing to witness in the world.
On the opposite end of the spectrum, a patient can go through hypomania or a severe depressive episode. Those are characterized by the opposite symptoms such as sleeping for days, no motivation to get out of bed, go to work, and withdrawal from family and friends. The patient can feel severely hopeless and depressed and contemplate suicide. Patient’s may also relapse on drugs and alcohol during these episodes as well.
There are two types of Bipolar disorder, type 1 and type 2. Each one is categorized depending on frequency and severity of episodes. Type 1 is the most severe of the two. It is defined as “one or more manic episodes leading to serious problems, inability to function or complete daily tasks, hospitalization, suicide attempts, and psychotic features such as hallucinations.” (NIMH 2009). Type 2 is milder to moderate in severity. It is defined as: “1 or more hypomanic episode lasting 4 days or longer, no mania or hyper-mania episodes, 1 or more major depressive episode lasting 2 weeks or more with disruption to daily life.” (NIMH 2009). Any of these diagnoses are life changing but being able to distinguish between the two helps providers better treat patient’s and help prevent severe reoccurring episodes.
Unfortunately, there are no medical tests to confirm a bipolar diagnosis. A patient is diagnosed based on history of symptoms, family history, and problems that have occurred in a person’s life. To be diagnosed, a patient must have had at least one manic or hypomanic episode. Most patients seek help with they are depressed or hypomanic, making it easy for a health care provider to misdiagnosis bipolar disorder. If a doctor prescribes an SSRI, the usual treatment for depression, it can send a bipolar patient into a manic episode. A psychiatrist and primary care physician work together to diagnose and treat patients with this disorder. Mental health professionals use a Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) to diagnose which type of Bipolar a person is. (NAMI 2019). It assesses the patterns and severity of manic and depressive episodes, to help gain a better understanding of how the disease is affecting an individual. A suicidal risk assessment might be obtained as well to see if safety implementations are needed.
My mother was not diagnosed bipolar until her 3rd suicide attempt. She is an alcoholic as well which intensifies her disorder. When she decided she wanted to get sober, it triggered a mixed manic and depressive episode. During her detox, she began having tremors, auditory and visual hallucinations, and suicidal thoughts. These traits are commonly seen in someone who is actively detoxing, and in someone who is experiencing a bipolar episode. Unfortunately for my mom she was experiencing both, which heightening these manifestations. After being admitted to the hospital and reviewing her history, a doctor finally caught it. He realized she was recently prescribed citalopram for depression from her pcp (which contributed to the exacerbation of the episode) and connected the dots. I finally felt some relief to finally have answers to my mother’s erratic behaviors and inability to control her emotions and impulses.
The usual treatment for Bipolar Disorder involves medications, therapy, and lifestyle changes. Mood stabilizers, anticonvulsants, anti-anxiety, and antipsychotics are some of the usual medications prescribed to manage symptoms associated with the disease. A typical person can be on up to 5-6 different medications at the time that all work on different areas of the brain to help reduce severity of mood swings and mania. Lithium and Valium are most commonly used in combination with Zyprexa and Risperdal to treat agitation. Benzodiazepines such as clonazepam and lorazepam are useful in reducing anxiety and used for acute mania episodes. They also help with reducing insomnia and panic. Valproate and Carbamazepine are used to help patients with excessive mood cycling. They also help patients who are also experiencing alcohol withdrawal and prolonged manic episodes lasting longer than 3 weeks.
Regular therapy appointments with a mental health professional are needed to constantly evaluate the patient. Frequent changes in well-being, state of mind, and suicidal ideation are assessments that need to be made constantly, as well as compliance with medications and effectiveness of treatment. Support groups are also very helpful for those suffering from manic depression. It helps them feel less alone, better understood, and that they are capable of living a normal life despite their condition.
Lifestyle changes are a necessity when it comes to managing this disease. Developing a regular sleep schedule, taking frequent rest periods during the day, and reducing stress are key factors in reducing manic and mania episodes. Creating a regular daily routine and sticking to it also helps a patient better manage their symptoms. Having a stable home and work environment is also essential. Sudden changes in routine, sleep habits, or life events are triggers for an episode, so avoiding these things are critical in the overall well-being of a patient.
My mother is prescribed 6 different medications for her disorder, has a co-visit with her psychiatrist and primary care doctor at the same time once a week, and also attends AA twice a week. My mother has trouble with taking all her medications when she is supposed to, refilling them, and understanding why she can’t stop taking them when she is feeling better. Recently, she had been doing very well, had a new job, a new boyfriend, and had not had an episode in over 2 months. She was also 2 months sober which she was very proud of herself. She ran out of some of her medications and waited over a week to refill them because she didn’t feel it was urgent to because she was feeling better and did not see the point in taking her medications. Well she ended up going into a manic episode, relapsed on alcohol, and decided to take 20 of her lithium pills to kill herself. I had spoken on the phone with her earlier that day and I could tell she was in a “great mood”. She says she cleaned her house, got her hair done, and wanted to come visit me. She was upbeat and rambling on about all the great things going in her life and how great she felt. Well around midnight I got a phone call from my aunt stating my mother was in the hospital and had to get her stomach pumped because she tried to kill herself that evening. According to her boyfriend, he had gotten home from work and asked my mom where the tv remote was, and that she started screaming at him, throwing things, and became very verbally aggressive. The trigger for my mom was her not taking her medications as she was supposed to. We have her back on her medications, we are showing her love and understanding, and explaining to her this was a setback not a failure, and again explained to her why she has to take her medications. It will take my mom months before she can snap out of the manic and mania cycling and feel better again. She tends to start drinking after she has a setback and gives up trying, so showing my mom support (even though it has happened more times than I can count) is the most important thing we can do for her right now.
The nursing diagnoses chosen where altered thought processes, impaired social interaction, and risk for injury. My mother’s thought process is very altered during her manic and mania states. She experiences hallucinations, she is very disorganized, becomes agitated very easily, and has trouble focusing. As a nurse it is very important to use a firm and calm approach when talking to patients during an episode to avoid increasing agitation and aggression. Using simple, short and concise statements and explanations helps patients better understand situation and what is being asked of them. With my mother, we have to help redirect her attention and energy constantly to avoid her obsessing over one thing that is making her angry or upset. After my mother comes out of an episode, she usually avoids all contact with everyone due to her embarrassment and shame of her actions during her episode. She won’t go to work, go to her doctor’s appointment, or answer her phone. It is important to communicate with my mom during this time by leaving her voicemails, text messages, and showing up unexpectedly to spend time with her. I have found taking my mom out to eat and then to see a movie usually helps her feel better and more motivated to interact with others. I will also go with her to her doctor’s appointments (mostly to make sure she actually goes), go to AA meetings with her, and call her at least twice a day. Preventing social isolation is so important because it helps prevent relapse or self-harm. Some other interventions to help reduce risk for injury are to remove all knives and guns from patient’s possession, monitor medications, remove alcohol from the home, and supervise patient as much as possible.
Prior to discharge from a hospital or psychiatric in-patient facility, it is super important to know who will be assisting patient at home and monitoring well-being. If there is no family or friends available/willing to do this, a case manager may refer the patient to home health to assist with these needs. It is also important that patient follow up with doctor’s appointments and mental health care to continue treatment. Information about social support groups, AA, and crisis walk-in centers should be given to both patient and family to assist with managing symptoms and care. Reinforcement about strict medication compliance, when to take medications, not to take with alcohol, and to refill them before they run out is essential. If that patient is taking Lithium, it is important to stress the need to monitor blood lithium levels to avoid toxicity. Educate patient that high sodium intake can lower lithium levels, reduced sodium intake can increase lithium levels, so it is crucial to maintain a constant sodium intake. Education about signs and symptoms to watch for upcoming manic or mania episode, when to call the doctor, and when to go to the emergency room should be given both verbally and on paper. It is also important to develop a plan of action in what to do during an episode, how to avoid triggers, and how to make necessary life changes.
A patient with a mental health disorder places extreme stress on family members, and strains family relationships. An assessment should be done when the family is present with the patient. The nurse should focus on determine the strengths and problem areas that involve the patient’s illness and the ability of the family to support the patient. My mother’s constant mood swings and behaviors have caused my youngest sister to no longer speak to her, my brother emotionally distances himself from her, and the rest of my family has given up on my mother and wants nothing to do with her. This effects my mother greatly, it causes her to drink, want to kill herself, and gives her an excuse for her poor behavior. Before understanding her diagnosis and causes behind her actions, I thought she was just a careless drunk who cared about nothing and nobody but herself. But after learning more about the disease and how it alters behavior, I have found myself more patient and understanding of my mother. It has also helped me emotionally not be affected with her outlandish behaviors. My siblings refuse to go to family therapy and are unwilling to meet with my mother’s psychiatrist to have help with coping with this unfortunate situation. I have explained to them many times why our mom is the way she is, and she will never return to the amazing mother we had in our childhood, but with the right treatment her symptoms can be managed, and she can be tolerable to be around. My brother and sister will text and call my mom when she is sober and not in an episode, but it hurts to get there hopes up that she is finally doing better, then relapses again. It is a vicious never-ending cycle. It is the nurse’s job to assess these things and provide education on how to cope, manage, and deal with all the factors surrounding the disease. Providing encouragement and resources to family members will help them better understand and help the patient and themselves navigate the difficult waters of mental health disorders.
Bipolar disorder is a chronic, long-term condition that cannot be cured, but can be managed with proper treatment. It is important for the patient and family to understand what bipolar disorder is, what to expect, what to do during an episode, and what resources are available to them. Informing the family that this disorder is hereditary and that they are at risk for developing this disease, what symptoms they should watch for, and when to be seen. Education on how alcohol, drugs, and caffeine can cause relapse and why it is important to avoid these substances. Teaching coping strategies for dealing with work, stress, family problems, and the dynamics of life can improve quality of relationships and over all well-being of the patient and loved ones. Teach about treatment and medications, side effects, toxic effects, what to avoid, and how to take them is extremely important since patient will be on multiple medications for the rest of their lives. It is also important to reinforce compliance with medical appointments, follow-ups, and compliance with plan of treatment. There is a lot of information to process and understand, so it is the nurse’s responsibility to teach patient and family throughout patient stay to avoid bombarding them with information right before discharge. It is critical to provide hand-outs, hotline numbers, agency referrals, and other visual aid’s so that they can be reviewed at a later time to fully comprehend information.
The stigma surrounding mental health is slowing fading, with more resources becoming available each year. In Grand Junction there are mental health resources for those in need. Mind Springs Health and West Springs Hospital located at 515 28 ¾ road in Grand Junction, is a medical facility specializing in mental health. They offer walk-in mental health and addiction services seven days a week, 23 hours a day. Additional assistance and information are available on their website mindspringshealth.org or by phone 970-201-4299. Another program called “The Women’s Recovery Center”, is a 90-day intensive drug and alcohol rehabilitation program that is exclusively for women focusing on holistic recovery including mental health. A new building is currently under construction and is scheduled for completion in 2021.
About 60 miles away in Montrose, Colorado, there is a walk-in clinic called “Western Slope Crisis Center” located at 300 N. Cascade Avenue. They provide immediate access to mental health care, emergency services, and withdrawal management. They offer short-term (3-5 days) in-patient beds to patients 12 years and over who are experiencing a manic or hypomanic episode, or any other mental health episode that requires 24-hour medical support.
There is also a national helpline called SAMHSA (1-800-487-4889) for substance abuse, mental health, and suicide help. They also have a website with an abundance of information at www.samhsa.gov. It is confidential, free, available 24 hours a day, 7 days a week, 365 days a year. They are able to provide information, resources, and someone to talk to in your local area.
There are numerous other resources available to patients and family regarding bipolar disorder. There is no shame in asking for help when it is needed.
Understanding Bipolar Disorder: Providing Support to Those in Need. (2024, Jan 24). Retrieved from https://studymoose.com/understanding-bipolar-disorder-providing-support-to-those-in-need-essay
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