Disorder Analysis Project:

Bipolar Disorder
by
Julie Allen and Johanna Sotelo
GNRS 584
Professor Anderson
April 10, 2017
 Research Question and Significance.

Which therapies will reduce or alleviate bipolar disorder symptoms of mania

and depression, while also reducing substance abuse disorder in patients

within the span of a year?

This is significant because many patients with a mental illness have a dual diagnosis and use

substances such as marijuana, alcohol or other recreational drugs to deal with their mental issues.

Understanding what interventions can help reduce the episodes and symptoms would be helpful for

medication compliance and preventing use of substance abuse in bipolar disorder patients.
 Introducing John Doe

Client: Single Caucasian , 35 year old male.

Assessment:
Our client was dressed inappropriately, however he had adequate hygiene. He was
cooperative, but not appropriate. He was fidgety and agitated at times depending on the
topic we were discussing. He had a flight of ideas and had a full affect. The patient was
also having grandeur thoughts of being able to end world hunger by selling marijuana.
Background:
Patient was resisting arrest for indecent exposure and was taken to jail. In jail he
assaulted an officer and became a 5150. He had not been compliant with the
medications he was prescribed for his history of bipolar disorder.
Psychiatric Diagnosis:
Bipolar Disorder NOS
Substance Abuse Disorder: Marijuana
 Our Findings
Integrated Group Therapy: Cognitive
Behavioral therapy. Built rapport with the
clients. Client contact was maintained via in
person, and phone conversations on a
daily basis. Significant reduction in the use
of substance use when compared to the
Enhanced Assessment and Monitoring
Program and the Group Drug Counseling.
Demonstrated a decline in manic and
depressive symptoms.
Group Drug Counseling: Demonstrated a
reduced use of substance abuse but was
not as effective as the integrated Group
therapy
(Weiss, et.al., 2009) (Stanton et. al., 2013) (Weiss, et.al., 2007) (Wenze et.al., 2015),
Enhanced Assessment and Monitoring
Program: The standard of care after
discharge. clients are monitored at different
times, but little change is seen in the
substance use and recurrence of episodes
of mania and depression are common in
this type of care.
Exercise Programs: Helps patients who
experience depression and anxiety in
bipolar disorder, significantly lowering
scores on the Depression Anxiety Stress
Scale. This finding would not benefit this
patient because he experiences more
manic episodes than depression.
 Medication Table
Medication Classification Action Dosage Side Effects Rationale for
and Route use in this client

Eskalith Mood Stabilizer Alters cation 300 mg PO Routine: Frequent Client has bipolar
(Lithium) transport in T.I.D urination, rash, bloated disorder and
nerves and feeling, slight muscle manic episodes.
muscles. twitching, edema, weight This is used to
May influence gain. treat his episodes
reuptake of Life Threatening: Nausea, and prevent them
neurotransmitters. diarrhea, tremor, LOC, from occurring.
nystagmus, ataxia, ringing
in ears.

(Lippincott, 2017) (Vallerand, 2017)

 Medication Table cont.

Medication Classification Action Dosage and Side Effects Rationale for use
Route in this client

Seroquel Atypical Blocks dopamine 200 mg HS Tremor, muscle stiffness, This is used to
(Quetiapine) Antipsychotic and serotonin 5- muscle rigidity, tardive treat the patients
HT2 receptors. Its dyskinesia, fever and bipolar manic
action may be muscle damage, episodes. It is
mediated through drowsiness, weight gain, used to prevent
this antagonism. hypertension, increased the manic
blood glucose, dizziness. episodes.

(Lippincott, 2017) (Vallerand, 2017)

 Nursing Diagnoses

1. Ineffective individual coping related to disturbance in tension release and

ineffective problem solving strategies as evidenced by slight agitation, taking
shirt off, substance use, and attacking an officer secondary to bipolar disorder.
2. Impaired social interactions related to impulsive behavior and disturbances in
thought processes as evidenced by irritability, poor judgement, inappropriate
comments, racing thoughts, and inappropriate interactions with females
around him.
3. Ineffective health maintenance related to lack of ability to make good
judgement regarding ways to obtain help as evidenced by noncompliance to
medications, parents enabling behaviors, selling house and leaving money on
doorstep and substance use secondary to bipolar disorder.
(Ackley, 2017)
 Interventions:

1. Assist the client to set realistic goals and identify personal skills and
knowledge (Ackley, 2017).
Evaluation: Intervention was implemented during clinical visit to
Arrowhead Behavioral Health. Client stated he was skilled in
construction, and was good at building. Client stated that he believed
realistic goals were to open a medical marijuana dispensary. We
redirected his goals to be geared towards his recovery and eliminate
any future episodes of mania through the participation of the group
therapy session. Group therapy is beneficial for patients in expressing
stress factor and developing improved coping skills (Weiss et. al.,
2009).
 Intervention
2. Refer patient to appropriate social agency for assistance (Ackley,
2017).
Evaluation: This intervention was not implemented. We hope that
the client and his family will get the support needed in order to
reduce another episode. Becoming part of an integrated group
therapy or drug group counseling will significantly lower the
client's substance use. Participants of Integrated treatment
adherence programs have been proven to recover faster from
episodes of mania or depression and adhere to treatment
regimen (Wenze. et.al, 2015).
 Intervention

3. Assess the clients feelings, values, and reasons for not following the prescribed plan
of care (Ackley, 2017). Intervention was implemented during our clinical day.
Evaluation: The client feels like he cannot trust anyone, including his family.
When we talked to him they were considering discharge and he was taking his
medications. In implementing our intervention, we found out he discontinues his
medications because he feels marijuana is all he needs. He stated he hopes to
open a dispensary and give away all of the proceeds to end world hunger. He
did not understand the need to take the medications, because he feels fine
without them. For patients with substance use disorder in addition to Bipolar
disorder, an integrated group therapy treatment option is the best choice. In
reducing the substance use, the patient will likely reduce the episodes of mania
and depression experienced (Weiss et. al., 2009)
 CONCLUSION: SUMMARIZE

Research presented that integrated group therapy is the best intervention for patients with a
dual diagnosis of a mental illness with substance abuse disorder.

Although it is not a definitive method in reducing or eliminating substance use in the Bipolar
population, evidence shows Integrated Group Therapy to be most successful at reducing
Substance Use Disorder. The reduction of substance use can increase adherence to
medication and thus lower episodes of mania and depression.

Exercise was an intervention that did not show beneficial effects on the bipolar disorder
patient with manic episodes and in substance abuse.

Further research is needed in this area, as all sample sizes were small and may not
represent the entire bipolar population.
 References:
Ackley, B.J., Ladwig, G.B., & Makic, M.B.F. (2017). Nursing Diagnosis Handbook (11th
Ed). St Louis, MO: Elsevier.
Halter, M.J., (2014). Varcarolis Foundations of psychiatric mental health nursing: A clinical
approach (7th ed.). St. Louis, Missouri: Saunders Elsevier.
Lilley, L., Rainforth Collins, S. & Snyder, J. (2017). Pharmacology and the Nursing
Process (8th ed.). St Louis, MO: Elsevier.
Lippincott. (2017). Nursing2017 Drug handbook (7th, Ed.). Philadelphia, PA: Lippincott,
Williams & Willcotts.
Vallerand, A.P. & Sanoski, C.A. (2017). Daviss Drug Guide for Nurses (15th ed.).
Philadelphia, PA: F.A. Davis.
Stanton, R., & Happell, B. (2013). Exercise for mental illness: A systematic review of
inpatient studies. International Journal of Mental Health Nursing, 23(3), 232-242.
Doi:10.1111/inm.12045.
Weiss, R.D., Griffin, M.L., Jaffee, W.B., Bender, R.E., Graff, F.S., Gallop, R. J., &
Fitzmaurice, G.M. (2009). A community-friendly version of integrated group
therapy for patients with bipolar disorder and substance dependence: A
randomized controlled trial. Drug and Alcohol Dependence, 104, 212-219.
 References:

Weiss, Roger D;Griffin, Margaret L; Kolodziej, Monika E; Greenfield, Shelly F, Najavits,

L.M, Daley, D.C., Doreau, H.R. Hennen, J.A. (2007). A randomized trial of
integrated group therapy versus drug counseling for patients with bipolar disorder
and substance dependence. The American Journal of Psychiatry, 164(1), 100-
107.
Wenze, S,J., Gaudiano, B.A., Weinstock, L.M., Tezanos, K.M. & Miller, I.W. (2015).
Adjunctive psychosocial interventions following hospital discharge for patients with
bipolar disorder and comorbid substance abuse: A pilot randomized controlled
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