ACKNOWLEDGEMENT

The members of this case presentation wish to express their heartfelt

gratitude and appreciation to the people who have helped them, in one way or
another in making this case presentation possible.

First of all. To Our God, Almighty Father, for always guiding the members
throughout this case presentation.

To the Mental Hospital Ward of Pototan Mental Health Unit, for allowing
the group to have one of their patients to be the subject as the basis of this case
presentation, which could enhance the knowledge and confidence of the nursing
students in delivering effective care to the mentally-ill patients they handle.
To Mrs. J.B. (aunt) for allowing the group to interview and assess the
patient.
To Manus Redimentes Dei 2017, for helping and guiding the group in
preparing for case presentation, and;
To the Level III Clinical Instructors, especially to Mrs. Ma. Lourdes Alvarez,
our case presentation Adviser, for helping the group in choosing the best case in
PHMU and for sparing some of the RLE time to be used in making their case
presentation and for helping the group to look for a patient.

INTRODUCTION

According to the World Health Organization (2007), "Mental health is not

just the absence of mental disorder. It is defined as a state of well-being in which
every individual realizes his or her own potential, can cope with the normal
stresses of life, can work productively and fruitfully, and is able to make a
contribution to her or his community.

Bipolar disorder is the name used to describe a set of 'mood swing'

conditions, the most severe form of which used to be called 'manic depression'.
DSM-IV-TR defines two types of bipolar major depressive disorders: Bipolar I and
II and describes cyclothymic patterns (Frisch, L. & Frisch, N., 2002).
It is also said that one of the cause for having bipolar disorder is through
genetic. It can be inherited from the parents or identical twins. Bipolar disorder is
a disease that typically begins in early adulthood between the ages of 15 and 25.
Men tend to get develop bipolar disorder slightly earlier than women; whereas
most males become ill between 16 and 25 years old, most females develop
symptoms between ages 25 and 30. The average age of onset is 18 in men and
25 in women. Bipolar disorder onset is very rare for people under 10 years of
age, or over 40 years of age.
According to DOH National Center for Mental Health as of 2015, Bipolar
disorder has ranked top 2 mental disorders with 2,025 numbers of cases in the
Philippines. According to the Senate Office of the Secretary (2013), Depression
has been the number one cause of suicide, accounting for about 90 percent of
the total cases. Other causes may include alcoholism, substance abuse and
untreated mental illnesses including bipolar disorder, schizophrenia, and others.
Among the negative life experiences that may cause depression leading to
suicide are: Death of loved one. Separation or breaking up from a relationship,
losing custody of children, or feeling that a child custody decision is not fair,
serious loss such as job

or house or money or business, serious illness like terminal illnesses, serious

accident, chronic physical pain, loss of hope, being victimized (domestic
violence, rape, assault, etc), physical or verbal abuse, serious legal problems,
etc.

LEARNING OUTCOMES
At the end of the case presentation, students will be able to:
1.

Define bipolar disorder and understand the cause of bipolar disorder of their
patient.

2.

Identify the potential risk factors for the development of bipolar disorder
3. Evaluate the developmental stage of the client according to the theories of
Erikson, Freud and Piaget.
4. Demonstrate the appropriate approach used in dealing with psychiatric
patients with bipolar disorder
5. Discuss the pathological abnormalities in the neurophysiology of the brain.
6. Learn the categories of drugs, mechanism of actions, side effects and special
nursing considerations used to treat specific symptoms of mental illness.
7. Identify different treatment modalities that could alleviate emotional distress
and can change maladaptive behaviors.
8. Explain the psychological and social interventions designed for people with
bipolar disorder.

TEXTBOOK DISUCSSION

The combination of mania and depression is typically referred to as

Bipolar Disorder. Although clients may be depressed and manic at the same
time, the two conditions most commonly occur sequentially: most often the mania
comes first, followed by depression. Psychiatrist refers to the mood change from
mania to depression or depression to mania as the switch process. Some of the
best data on the inheritance of manic-depressive illness come from studies of
twins (Goodwin & Jamison, 1990). If one of two identical twins is manicdepressive, the other is most certain to develop the disease. Even when identical
twins are separated early in life and brought up in completely different adoptive
families, when one has manic-depressive disorder, the risk for the second twin
seems to be at least 70% (Frisch, L. & Frisch, N., 2002).

LATEST UPDATES
Study finds strong link between childhood adversity and bipolar disorder
diagnosis
People with bipolar disorder more than twice as likely to have suffered
childhood adversity. The researchers compared the likelihood of people with and
without bipolar disorder having adverse childhood experiences, such as physical,
emotional and sexual abuse. The findings revealed a strong link between these
events and subsequent diagnosis.
Bipolar disorder is characterized by extreme depressive and manic states
that impair quality of life and increase suicide risk. An urgent need in this field is
better understanding of risk factors that can be used to improve detection and
treatment. The authors defined childhood adversity as experiencing neglect,
abuse, bullying or the loss of a parent before the age of 19. There was a
particularly strong link between emotional abuse with this four times more likely
to have happened to people with bipolar.
The findings have implications for those providing treatment, as they can
factor in these childhood experiences when developing personalized therapy
plans.

DEFINITION OF TERMS

Bipolar I Disorder. It is a classic manic-depressive disease, with the

combination of depression and at least one episode of mania (Frisch, L. & Frisch,
N., 2002).

Bipolar II Disorder. It is diagnosed when one hypomanic episode has

accompanied major depression but there has been no mania (Frisch, L. & Frisch,
N., 2002).

Cyclothymic Disorder. It is an individuals cycle between hypomanic and

melancholic states but do not qualify for a diagnosis of major depressive disorder
(Frisch, L. & Frisch, N., 2002).

Denial. It is a condition in which someone will not admit that something sad,
painful, etc.., is true of real (Merriam-Webster, 1828).

Histrionic Personality Disorder. Constantly seek attention through excesses of

emotional expression (Frisch, L. & Frisch, N., 2002).

Narcissistic Personality Disorder. It is a self-centeredness and inflated selfesteem, both beginning by early adulthood (Frisch, L. & Frisch, N., 2002).

SCOPES AND LIMITATIONS

This psychiatric case presentation is focused on a patient who was
diagnosed with Bipolar Disorder. The Custodes Sanantes Dei 2017 of Saint Paul
University Iloilo, Academic Year 2016-2017, conducted this case presentation.
Patient was received by student nurse, Mr. K.B. during his 1 week and 4 th
day of his admission in Pototan Mental Health Unit (PMHU). The dates wherein
student nurse handled the patient were October 3 and October 17-18, 2016.
There is a difficulty in gathering the primary information due to patients
unavailability during the exposure at PMHU. Part of the groups limitation is
limited knowledge of patient's family regarding his health history because he
stayed in his apartment and his aunt does not know what happened to him
exactly and the absence of laboratory results in the chart.
Scope includes the personal data gathered during interaction with patient
and folks in the area and data gathered during the exposure at PHMU. It also
includes data gathered from the patient's chart. The names used and mentioned
in all parts of the case presentation especially in the Nursing History were all in
initials to preserve confidentiality.