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BIPOLAR DISORDER WITH

MANIA: CASE STUDY

Nicole Redmond
10/04/18
YSU Nursing
Mental Health
Bipolar Disorder with Mania: Case Study

Abstract

Bipolar disorder is a relatively common and also misunderstood disorder in our society. On the

date of care, the patient had a diagnosis of bipolar disorder with mania. This case study will

define bipolar disorder using the DSMV, and explore this particular patient’s experience with

the illness. This incudes the patient’s treatment plan and goals including discharge plan.

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Bipolar Disorder with Mania: Case Study

Objective Data:

J.C. is a 51-year-old male involuntarily admitted on 9/09/18 with a diagnosis of bipolar

disorder with mania. On the date of admission, J.C. drove himself to the emergency department

due to having homicidal ideations towards his brother for “messing things up with his parents.”

Upon his psychiatric evaluation and many times afterwards, J.C. also threatened to kill the

psychiatrist for holding him in the behavioral health unit. The patient has a history of assault,

homicidal ideation, hallucinations, and delusions. J.C. also has medical diagnoses of

hypertension and hyperglycemia. All labs and toxicity screening are negative. The only

abnormal labs are elevated glucose and white blood cells. The patient is on a couple of

medications and claims to be compliant: amlodipine (Norvasc) for hypertension; haloperidol

lactate (Haldol) 10mg intramuscular every 6 hours prn as an antipsychotic; risperidone

(Risperidone) 2mg po daily as an antipsychotic. J.C. was also recently admitted from 8/25/18-

9/05/18 and has a history of psychosis.

Bipolar Disorder:

According to the DSMV, Bipolar disorder is characterized by primary symptom

presentation of manic, or rapid (daily) cycling episodes of mania and depression. The DSM V

defines depression as: Depressed mood and/or loss of interest or pleasure in life activities for at

least 2 weeks and at least five of the following symptoms that cause clinically significant

impairment in social, work, or other important areas of functioning almost every day

 Depressed mood most of the day.

 Diminished interest or pleasure in all or most activities.

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Bipolar Disorder with Mania: Case Study

 Significant unintentional weight loss or gain.

 Insomnia or sleeping too much.

 Agitation or psychomotor retardation noticed by others.

 Fatigue or loss of energy.

 Feelings of worthlessness or excessive guilt.

 Diminished ability to think or concentrate, or indecisiveness.

 Recurrent thoughts of death.

In addition, the DSM V also defines mania. Manic episodes are characterized by:

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood,

lasting at least 1 week (or any duration if hospitalization is necessary)

B. During the period of mood disturbance, three (or more) of the following symptoms have

persisted (4 if the mood is only irritable) and have been present to a significant degree:

 increased self-esteem or grandiosity

 decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

 more talkative than usual or pressure to keep talking

 flight of ideas or subjective experience that thoughts are racing

 distractibility (i.e., attention too easily drawn to unimportant or irrelevant external

stimuli)

 increase in goal-directed activity (either socially, at work or school, or sexually) or

psychomotor agitation

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Bipolar Disorder with Mania: Case Study

 excessive involvement in pleasurable activities that have a high potential for painful

consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or

foolish business investments)

Events Prior to Admission:

The date of my therapeutic communication with J.C. was 9/13/18. Upon talking with J.C, I

was able to gather some subjective information from the patient. He stated that he is

originally from Youngstown but has not been in the area for years. The patient stated that

he lived in Los Angeles, and that he was friends with many famous people including warren

buffet, Michael Jackson, and Jeff Dunham. He said that he was in the entertainment

industry. When asked why he returned to Youngstown, the patient stated that his family

called him and said that his father was sick. He states that he came home and was staying

with his family, however he said that his family did not like how much energy he had so they

kicked him out of his home. This is where the homicidal ideations are believed to originate,

because the patient verbalized and made it clear that his brother “messed things up with his

dad.” He then stated that is when he drove himself to the emergency room, because he

stated that he knew he should not want to hurt his brother. He also stated at a different

point in our conversation that he came to the Emergency Room because he “needed a place

to stay.” When asked why he thinks his family did not want him to stay with them, the

patient had an interesting story. He stated that everybody in his life is after him and his

famous son’s money. In fact, the patient stated that when he was 16 years old, he received

electric convulsive therapy at St. Elizabeth Hospital in Youngstown. He believes that while

he was unconscious, the doctors and nurses took a sperm sample from him, and he believes

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Bipolar Disorder with Mania: Case Study

that he now has many children (or as he called them “seeds”) that he does not even now

about. He believes that one of his children is Lebron James, and that everybody in his life

including his family and brother, are after Lebron’s money. The patient demonstrated a

flight of ideas throughout our communication. He appeared restless, suspicious, and manic

at times. Throughout our conversation, I would get confused at his story, and when I would

ask him for clarification he would get very agitated.

Patient and Family History

J.C. has a clear history of bipolar disorder, mania, and psychosis. J.C. also has a history of

assault and homicidal ideation. His most recent hospitalization prior to the one on the date

of care was from 8/25/18 – 9/05/18. He was only discharged for four days before returning

to the behavioral health unit on 9/09/18. No family history of mental illness was reported.

Care Provided

On the date of care, communication between myself and the patient was difficult at times.

The patient had many things to say about himself and his situation. I listened without

judgement. When appropriate, I intervened and asked questions. I also tried to encourage

positive coping and expression of feelings. The patient seemed skeptical of what I had to say

or ask him. J.C. claimed to be compliant on his medications. The patient stated his daily goal

was to “find my money.” Patient occasionally attends group therapy. Described as a

monopolizer at group therapy. J.C. was sent back to his room during therapy one day for

yelling and being violent towards other patients, and left the hallway stating that he has a

hit out for the psychiatrist on the unit. Patient demonstrates ineffective coping strategies.

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Bipolar Disorder with Mania: Case Study

Ethnic, Cultural, Spiritual Influences:

J.C. is a Youngstown native, and he has loyalty for where he came from. Patient stated that

he desired to give back to the community. J.C. openly expresses feelings positive feelings

towards his “bros,” especially those who he grew up with.

Patient Outcomes:

Before a plan of care is even planned, the patient must understand that he is experiencing

symptoms of bipolar and mania. So, I believe that the first step should be the patient

coming to terms with his mental illness. For example, the patient experiences certain

symptoms such as an onset of symptoms during adolescence, frequent relapses, periods of

increased energy and little need for sleep, and impulsivity. The patient must understand

that these are abnormal symptoms in order to understand his illness. Another priority

outcome for J.C. is that he will learn appropriate coping skills. The patient is very hostile

towards those who disagree with him or interfere with his plans. Often, he results to

violence to solve these problems. Positive coping will provide him a way to handle his

negative feelings without resorting to violence. Another outcome is for the patient to learn

effective communication and how to verbalize feelings to others. This will help him think

about his feelings more before acting out. The patient also needs to be educated on

medications and the importance of being compliant with his medications.

Discharge Plan:

Upon discharge, the patient should utilize the teaching and therapeutic skills he learned on

the behavioral health unit that are listed above. These include positive coping strategies,

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Bipolar Disorder with Mania: Case Study

effective communication skills, and medication compliance. In addition, this patient will

need to be provided with resources and help to try to help the relationship between him

and his family. A strong support system will help this patient immensely. It is also

imperative that J.C. follows up with a psychiatrist and seeks counseling regularly. In an

outpatient setting, the patient will receive more education and information, support and

counseling, development of plans, and additional medication monitoring. Using all these

resources and following up in an outpatient setting has been proven to decrease chance of

rehospitalization. In following a plan of care in an outpatient setting, this will hopefully

decrease the chance that he will end up back on the behavioral health unit in the near

future.

Nursing Diagnoses:

1. Risk for Homicidal Ideation as evidenced by homicidal statements.

 Patient will learn appropriate coping skills (deep breathing, exercise)

 Patient will demonstrate knowledge of therapeutic effects of medications

 Patient will establish a better network of support with family

2. Ineffective thought process as evidenced by homicidal ideations.

 Patient will take medications as directed.

 Patient will reorient and be able to display appropriate behaviors.

 Patient will continue to seek counseling.

3. Ineffective display of appropriate communication and problem-solving skills.

 Patient will attend group therapy and display appropriate behavior.

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Bipolar Disorder with Mania: Case Study

 Patient will verbalize emotions and problems before acting out.

Potential Nursing Diagnoses:

 Risk for Injury

 Risk for violence: Self-directed or other directed

 Impaired Social interaction

 Ineffective individual coping

 Interrupted Family process

 Total self-care deficit

Conclusion:

J.C. is a complicated patient. He stated how he wakes up in the morning with energy and that

people including his family do not understand him. He was very energetic during my whole

interaction with him. If he follows the above patient outcomes he has potential to live a normal

life. For this to happen he must establish a support system, learn positive coping strategies,

learn therapeutic communication skills, and follow medication compliance.

Sources:

https://www.ncbi.nlm.nih.gov/books/NBK64063/

https://nurseslabs.com/bipolar-disorders-nursing-care-plans/

https://www.medscape.org/viewarticle/718206

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Bipolar Disorder with Mania: Case Study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1076446/