Bipolar Disorder affects approximately 2.3 million American adults age 18 years and
older in a given year. Men and women are equally likely to develop bipolar disorder. The age of
onset is in the early twenties (Shives, 2008).
Bipolar disorder used to be known as manic-depressive disorder or manic depression. It
is a serious mental illness, one that can lead to risky behavior, damaged relationships and careers,
and even suicidal tendencies if it is not treated (Shives, 2008).
Bipolar disorder is characterized by extreme changes in moods, from mania to
depression. Between these mood swings, a person may experience normal moods. Terms used to
describe the labile affects or mood changes of clients with bipolar disorder are: euphoria, elation,
hypomania, mania, depression, and rapid cycling. These changes range from mild to severe, the
same of those with depressive behaviors (Shives, 2008).
Shives states that clients with mania exhibit hyperactivity, agitation, irritability, and
accelerated thinking and speaking. Behaviors may include pathological gambling, a tendency
to disrobe in public places, wearing excessive attire and jewelry of bright colors in unusual
combinations, and inattention to detail. The client may also be preoccupied with religious,
sexual, financial, political, or persecutory thoughts that can develop into complex delusional
symptoms. Flight of ideas, as well as other psychotic symptoms may persist.
Bipolar disorder is generally undiagnosed, as stated by Shives, because of under
recognition of manic and hypomanic episodes. The mortality rate for untreated bipolar disorder
is higher than for most types of heart disease and some types of cancer. Many clients present
to health care provider with one year of symptom onset, there is usually a five to ten year delay
from symptom onset to formal diagnosis.
Schizoaffective disorder is a subtype of schizophrenia. It is characterized by an
uninterrupted period of illness during which, at some time, the client experiences a major
depressive, manic, or mixed episode along with the negative symptoms of schizophrenia. During
that same period of illness, in the absence of prominent mood symptoms, the individual exhibits
delusions or hallucinations for at least two weeks (Shives, 2008).
Axis I Schizoaffective disorder, current manic
Axis II Deferred
Axis III Her EKG shows evidence of sinus tachycardia.
Axis IV Severe psychosocial stressors.
Axis V Her GAF is 20.
Patient arrived to St. Catherine’s emergency department on March 27, 2010. Patient
is a forty-seven year old Puerto Rican female. Patient arrived via wheel chair to BHS from
emergency department. Upon arrival patient was hyperactive with rapid pressured speech,
but was compliant with the admission process. Patient stated, “She and her daughter had been
engaged in verbal altercations.” Her daughter called the ambulance and the patient was brought
to emergency room. Patient is manic with loose associations and tangential thoughts. Patient was
also somewhat confused, and after the interview she stated she, “Been here for days.” Patient
denies any suicidal ideations. Patient also has a past history of schizoaffective disorder.
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