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Exploring Bipolar Disorder: Pathology, Characteristics and Care Strategies
Abstract
This paper includes the comparison and contrast of schizophrenia disorder pathology from multiple resources, as well as data obtained from clinical sites at Harris Health Psychiatric Center. The paper will discuss pertinent lab tests and diagnostic studies upon availability and the significance of each; a care plan with three nursing diagnoses, a short-term goal with interventions for each, and a long-term goal with one discharge teaching plan for each are included in this paper. Information retrieved from 2 journal articles on schizoaffective disease formulated in content. This paper exemplifies schizoaffective disorder and the major components of the disorder.
Disease Pathology Compare/Contrast
According to Videbeck (2014), “Schizoaffective disorder is diagnosed when the client is severely ill and has a mixture of psychotic and mood. The symptoms may occur simultaneously or may alternate between psychotic episodes (p. 266). While observing and interviewing a patient at Harris County Psychiatric Center (HCPC) diagnosed with schizoaffective disorder, multiple symptoms related to the disorder were demonstrated. The patient was admitted to the hospital for depression and having bizarre behavior thoughts. The patient thought people were talking about him when there was no one around him. The patient states that when he does not take his medicine, he “starts getting out of control.” This patient started yelling out and disturbing his family until his family felt the need to bring him to the hospital. His primary diagnosis at the time of admission was schizoaffective disorder.
Characteristics
- Depression
- Bipolar disorder
- Social isolation
- Bizarre behavior/thoughts
- Poor hygiene
- Suicidal thoughts
- Paranoia
- Difficulty sleeping at night
- Language and thought process
This patient at HCPC states, “do not like acting out only occurs when out of medication.” (HCPC, personal communication, September 2018).
Procedures
Schizoaffective disorder is a chronic mental health condition characterized by symptoms of schizophrenia, such as hallucinations or delusions. As a result, there are no large-scale epidemiological data worldwide. Prevalence or incident of schizoaffective disorder is estimated to be less common than schizophrenia. This disorder affects between 2 and 5 people out of every 1,000 people and is more common in women (Videbeck, 2014).
Course
The course of schizoaffective disorder usually features a cycle of severe symptoms followed by improvement with fewer symptoms. The disorder is usually lifelong. There is hope for individuals with schizoaffective disorder. Symptoms will improve over a present lifetime. The patient at Harris County Psychiatric Center (HCPC) stated that when properly medicated, the symptoms related to the disease are less severe (Videbeck, 2014).
Etiology
Most studies cluster schizoaffective disorder together with schizophrenia or bipolar disease. The symptoms may alternate psychotic and mood disorder symptoms. “Some studies report that long-term outcomes for the bipolar type of schizoaffective disorder are like those for bipolar” (Videbeck, 2014, p . 268). This is an organic disease with underlying physical brain pathology. “Some therapist still believes this type of disorder results from dysfunctional parenting or family dynamics. Newer scientific studies began to demonstrate a form of brain dysfunction. These neurochemical/neurologic theories are supported by the effects of antipsychotic medication, which help control psychotic symptoms” (Videbeck, 2014, p. 68).
The patient has no job and no medical insurance, which often makes it difficult to schedule appropriate doctor appointments and maintain a medication regimen (HCPC, personal communication, September 2018).
Treatment
It is very important that the patient carry out and respond to treatment as ordered. It is a combination of medications and counseling. When necessary, some therapy and psychotherapy, psychoeducation, family therapy, group therapy, life skills training, and hospitalization at times. Medication used for treatment includes antipsychotic medication for delusion and hallucination episodes and mood stabilators for antidepressant disorder. Proper education is ongoing. Most importantly, it promotes safety and knows about their disorder and the many side effects that can occur. Maintenance therapy is also beneficial to the well-being of individuals with schizoaffective disorder (Skelton et al., 2015).
Prognosis
Individuals with schizoaffective disorder, as stated by a patient at Harris County Psychiatric Hospital (HCPC), function better when following a medication regimen properly as prescribed by a physician. Medication and therapies work best when used together for better response. Schizoaffective patients have a more positive outcome when prescribed neuroleptic and anticholinergic. They will demonstrate less severe depressive symptoms than mood disorder patients (Evans, 1999).
Pertinent Lab Data and Diagnostic
Lab results and diagnostics studies are relevant to indicate an underlying cause, such as any abnormalities in lab results and diagnostic testing. For example, certain drugs and comorbidities may interact and trigger unexpected onset and negative behaviors. The patient at HCPC did not have any labs or diagnostics available in the chart.
Physician Order and Teaching
- Sertraline 200 mg PO daily for depression. Before taking sertraline liquid concentrate, tell your doctor if you are allergic to latex.
- Risperidone 2 mg PO twice daily for schizophrenia / bipolar disorder. Advise the patient to report suicidal thoughts.
- Metformin 500 mg po daily to treat type 2 diabetes/overweight. It is important to take metformin with food to reduce stomach-related side effects.
- Benztropine 1 mg op daily for acute dystonic reaction. Teach patients and family that it may cause drowsiness or dizziness, and frequent mouth care may cause dry mouth.
- Teach the patient and family to notify the health care team of any signs and symptoms of suicidal thoughts or ideations.
Care Plan
- Disturbed personal identity related to bizarre behavior as evidenced by the patient stating, “yelling out I get paranoid thinking someone is talking to me when no one is there” (HCPC, personal communication, September 2018).Short-term goal: The patient will control bizarre behavior.
Subjective: The patient states he feels much better when he takes his medication.
Objective: The patient talks to me himself when sitting alone.
Assessment: The patient wants to continue his medication.
Plan: The patient is planning to apply for financial assistance to help pay for medication.
Long-term goal: The patient will get the financial help he needs to maintain the medication regimen as prescribed.
Teaching: Re-educate patients on how important it is to take medication and schedule routine doctor appointments.
Interventions: Promote safety at all times. Explain the major side effects of medication and notify the healthcare team of any suicidal thoughts (Schultz, 2013).
2. Social Isolation related to delusional thinking as evidenced by sitting in a room alone.
Short-term goal: The patient will verbalize what he is thinking during the open-ended conversation.
Subject: Patient states, “I hear voices at night sometimes when I’m sleeping” (HCPC, personal communication, September 2018).
Objective: The patient sits in his room alone, not interacting with others.
Assessment: The patient states that he will attend group therapy at the next meeting.
Plan: The patient will allow the therapist to interview him briefly and go outside with others
Long-term goal: The patient will interact more with others. Taking it one day at a time.
Discharge Teaching: Teach the patient to verbalize concerns, participate, and ask questions within the group. Notify the healthcare team of any concerns (Schultz, 2013).
Interventions: Encourage the patient to enjoy life. Support the patient, redirect them to develop a positive attitude, and present the patient with resources that will guide them to maintain positive thoughts (Schultz, 2013).
3. Insomnia related to delusional thinking, as evidenced by the client not being able to sleep at night.
Short-term goal: Patient will rest well at night while hospitalized.
Subjective: The patient states, “Sometimes I can’t sleep because I hear voices” (HCPC, personal communication, September 2018).
Assessment: The patient knows with proper rest, he will feel better.
Plan: The patient is willing to take medication as prescribed so he can remain calm and rest better at night.
Long-term goal: The patient will take his medication as prescribed and get at least 8 hours of sleep every night.
Teaching: The nurse will educate the patient that proper rest is important.
Conclusion
The nurse will set standards for why proper rest is important for the mind and body. The nurse will provide in-service and keynotes on proper rest methods and relaxation therapy. The patient will verbalize concerns and be willing to obtain proper sleep to decrease stress levels and maintain a productive life.
References
- Skelton, M., Khokwar, A., & Thacker, D. (2015). Schizoaffective disorder. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482450/
- Evans, J. D. (1999). Course and outcome of schizophrenia. Psychiatry (Edgmont), 20(10), 1-6.
- Schultz, S. (2013). Psychiatric nursing care plans (5th ed.). Elsevier Health Sciences.
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