Mental Health Nursing.

Identify and Describe the signs and symptoms of the mental distress experienced by adults with Bipolar Disorder II

Bipolar disorder is a common and serious mental disorder which is synonymous with the older term manic depressive psychosis. It is a comparatively serious and recurrent  condition which is characterised by periods of complete normality and indispersed with episodes of either mania (disinhibited and overactive behaviour associated with elation) or depression (lethargy and low mood) (Lam D et al 1997)

The rate of relapse is comparatively high with some studies showing 50 % at one year and as much as 70% at five years (Keller MB et al 1993)

If we consider studies such as that by Perry (et al 1999), we find evidence that this high relapse rate can be positively affected by appropriate and timely  intervention.  It is these aspects that are particularly appropriate to nursing intervention and will be the subject of this essay.

Describe the nursing interventions to be used to relieve the mental distress

In any field of medical practice, it is essential to have a firm evidence base (Green & Britten. 1998) as this underpins all rational treatment. The Perry study is well constructed and clearly presented and the findings are backed up with other work in the field. (Gitlin MJ et al 1995). In essence, the authors found that in bipolar disorder, each patient would characteristically present with constant, identifiable and manageable prodromal symptoms of relapse, in some cases as much as two weeks before an episode of mania or depression. These prodromal symptoms were very idiosyncratic to  not only the patient but also to which type of relapse they were having.

It follows from this finding that if early signs can be reliably identified then there may be a possibility that early therapeutic intervention may have a beneficial effect. (Rihmer, Z et al 1999). The Perry study examined and evaluated this possibility and found that prompt recognition and intervention by nursing staff could significantly reduce the number of relapses over time and also increase the amount of “well time” before the next relapse.

The most significant factor in this reduction was the training of the patient to recognise the prodromal symptoms and this was achieved by a painstaking nurse interview when the common features of the prodrome were discussed and evaluated and then presented back to the patient.

It was found that this intervention significantly decreased the number of manic episodes but had little impact on the depressive episodes. The authors suggest that this is primarily because of a number of different factors namely that the manic prodromes are more distinct and longer than the depressive ones and also that acute mania can be treated both more effectively and also more quickly than the depressive equivalent. (Ferrier, N 1999).

An incidental finding was that this intervention improved overall measures of social functioning because of the increased confidence in the ability to cope with the relapse. Other studies show that this accumulative improvement was likely to be a result of the regime rather than purely an effect of the attentions of an empathetic therapist. (Hlastala SA et al 1997)

Give rationale for these nursing interventions

The rationale for the intervention above is clearly supported by the evidence of the study. If we consider other, equally dispassionate reviews such as those undertaken by the Sainsbury centre.(SCMH 1998), we can see evidence that there is considerable scope for other nursing based interventions which have proven therapeutic benefit.

This particular study showed that in their particular cohort of depressed patients with bipolar disorder 30% did not have the opportunity to take part in any therapeutic or socially integrated activity and 40% did not take part in any recreational  or other social activity, both of which are shown to have a positive impact on speed and extent of recovery (Sotsky, S. M et al 1999)

Again, on a purely practical note, 50% of patients in this particular study stated that they did not receive enough information about their illness which is a matter that many nurses would regard as being well within their professional remit. (Yura & Walsh M 1998).

There is considerable evidence that patient empowerment and education is a vital therapeutic tool in dealing with bipolar disorder (Stuart, S et al 1997), (Thase, M. E et al 1999)