A case of bipolar disorder avi

A CASE OF BIPOLAR DISORDER

I.AVINASH

611171602010

PATIENT PROFILE FORM

NAME - K. Ganga UNIT - Psychiatry Ward

AGE - 35 years IP no.-968761

SEX - Female Adm. Date - 24/1/2014

WEIGHT-55 Kgs DOD – 13/22014

REASONS FOR ADMISSION Appearance of excessive irrelevant talking, reduced sleep, indecent behavior observed since 2 months. history of roaming outside.

History of visual hallucinations.

PAST MEDICAL HISTORY:Similar complaints are observed in past 2 years.no history of delusions and hallucinations.

PAST MEDICATION HISTORY:Given ECT and drugs tab. Haloperidol, Tab. Chlorpromazine, Tab. Trihexyphendyl for one and half month 1year ago.

FAMILY HISTORY

NIL IN PARTICULAR

SOCIAL HISTORY:o Not known alcoholic or smoker

PHARMACEUTICAL CARE PLAN1.SUBJECTIVE EVIDENCE:

Excessive talking and indecent behavior existing from 2 months. Reduced sleep from 1 month, visual hallucinations, roaming out side.

2.OBJECTIVE EVIDENCE:

No specific lab investigations are available for bipolar disorder. Manic episodes were observed with mood fluctuations frequently for significant period for 2 years. Diagnostic and Statistical Manual of Mental Disorders (DSM).

3.ASSESMENT:

Based on subjective and objective evidence the patient was diagnose with MAINAC EPISODES.

FINAL DIAGNOSIS IS BIPOLAR DISORDER.

DIAGNOSIS:

BIPOLAR DISORDER

GOAL TO BE ACHIVED Reduce the symptoms so that she no longer have any negative

effect on her life.

To provide better sleep to the patient.

Prevent or reduce the needs to visit or to stay in hospital.

Encourage the patient to establish regular daily rhythms for sleep, exercise, and eating activities.

Avoid or reduce undesirable side effects that may induced by medication

To improve patients psychological and social development.

Plans to reduce visual hallusinations

TREATMENT OPTIONS: Bipolar disorder cannot be cured, but it can be treated effectively over

the long-term. Proper treatment helps many people with bipolar disorder even those with the most severe forms of the illness gain better control of their mood swings and related symptoms. But because it is a lifelong illness, long-term, continuous treatment is needed to control symptoms.

Combined Use of Psychotherapy and Pharmacotherapy for Management of Bipolar Disorder.

DRUG TREATMENT: Mood stabilizers: Lithium

Anticonvulsants: Valproic acid or divalproex sodium

Lamotrigine

Gabapentin

Topiramate

Oxcarbazepine

Symbyax(combines the antidepressant fluoxetine and the antipsychotic olanzapine)

Typical antipsychotics:

Chlorpromazine

Haloperidol

Flupentixo

Clopentixol

Atypical antipsychotics: Olanzapine

Aripiprazole

Quetiapine

Benzodiazepines:   Clonazepam

Lorazepam

Diazepam

Chlordiazepoxide

Alprazolam

Antidepressants: Fluoxetine

Paroxetine

Sertraline

Bupropion

PSYCHOTHERAPY: Cognitive behavioral therapy (CBT) Family-focused therapy Interpersonal and social rhythm therapy Psychoeducation

OTHER TREATMENTS: Electroconvulsive Therapy (ECT) Sleep Medications Herbal Supplements

PHYSICAL EXAMINATIONS:

Physical examinations were done regularly.

BP – 120/90 mm Hg

Pulse – 72/min

Temp – 98.7 F

Abdomen-soft

patient is conscious and coherent

• DAY BY DAY OBSERVATION CHART: On 24th ECT is given.

On day-1 drug therapy is started,

evidence of reduced sleep

excessive irrelevant talking were observed

symptoms were continued day-2 & 3

On day-4 i.e. 29/1 she slept well but irrelevant talking was observed.

Similar symptoms were continued on day-5,6,7,8 & 9

On day-10th she was better having relevant talking and slept well.

On day-11th symptoms of cold & fever were observed. Treatment was given to reduce cold and fever. better relevant talking and slept well. Cont. for day-12,13,14.

On day-14th cold was reduced and body temperature came to normal.

On day-15th symptoms of disorder were reduced. Better relevant talking, having good sleep, able to be normal with other people cont. till 14/2 i.e. day-20 of her admission.

She was discharged from the hospital on 14/2 on request of her parents with her discharge medication.

ECT given on.

24/1/14

25/1 not given

28/1

30/1

1/2/14

Drug regimen for 20 days is mentioned in the following drug charts

DRUG CHART: 25/1/14 – 5/2/14DRUGS DOSE ROA FRQ D1 D2 D3 D4 D5 D6 D7 D8 D9 D1

0

1.Tab. Lithium cabamate

300mg Oral 1-0-1

2.Tab. Na.valproate

500mg Oral 1-0-1

3.T.Haloperidol 5mg Oral 1-0-1

4.T. CPZ 100mg Oral 1-0-1

5.T. THP 2mg Oral 1-1-0

6.T.Diazepam 5mg Oral 0-0-1

7.Inj.Haloperidol +Inj.promethazine

1amp

1amp

IM 1-0-1

8.T.Quetiapine 50mg Oral 1-0-0

9.T. Alprazolam 0.25mg Oral 1-0-0

• DRUG CHART: 6/2/14 – 14/2/14DRUGS DOSE ROA FRQ D11 D1

2D13

D14

D15

D16

D17

D18

D19

D20

1.Tab. Lithium cabamate

300mg Oral 1-0-1

2.Tab. Na. valproate

500mg Oral 1-0-1

3.T.Haloperidol 5mg Oral 1-0-1

4.T. CPZ 100mg Oral 1-0-1

5.T. THP 2mg Oral 1-1-0

6.Inj.Haloperidol +Inj.promethazine

1amp

1amp

IM 1-0-1

7.T.Quetiapine 50mg Oral 1-0-0

8.T. Alprazolam 0.25mg Oral 1-0-0

9.T.Paracetamol 250mg Oral 1-0-1

10.T.Chlorpheniramine

Oral 1-0-1

• GOALS ACHIVED: Patient is having better sleep than previous.

Reduced irrelevant talking and visual hallucinations

Reduced tendency of negative behavior and indecent behavior.

MONITORING PARAMETERS:

Cardiovascular monitoring.

Tardive dyskinesia for antipsychotic drugs.

Neuroleptic malignant syndrome checks.

Pulmonary tests for bronchopneumonia.

Blood tests for leukopenia, neutropenia & agranulocytotoxicty etc.

Goniscope evaluation and close monitoring of intraocular pressure an regular intervals.

Lithium dosing should be accurate.

Hepatic and renal function tests should be done.

• CONTRAINDICATIONS: Drugs should not be used in patients hypersensitive to these drugs.

combination use of Haloperidol and Lithium:

An encephalopathic syndrome (characterized by weakness, letheargy,tremulousness & confusion, EPS, leukocytosis, elevated serum enzymes, BUN & FBS)followed by irreversible brain damage may occur in a few patients treated with lithium plus haloperidol.

Diazepam is contraindicated in glaucoma patients.

PATIENT COUNSELLING:

ABOUT DISORDER: making the patient knowing about her disorder is necessary for her co-operation.it should be done in a peaceful manner.

o This helps for a better controlling of the condition.

o Patients guardians should be acknowledged about the disorder and letting them know how important the medication is.

o Counselling programs are conducted regularly.

o Patient should be kept in observation.

• ABOUT LIFE STYLE MODIFICATIONS:

Healthy diet should provided.

Meal should contain food which she likes.

Protein rich diet I s maintained for better maintenance of body.

Patient should be kept totally away from the strainers.

Harmful things should be kept out of reach

Patient should be never left alone.

Healthy and hygiene surroundings should be maintained.

THANK YOU have a nice week