Manic patient education

bigsurgirl · Sep 24, 2009

Psych nurse here!!! This is a great article that has helped me deal with newly diagnosed pts. sorry its long.

The 5 stages of Bipolar grief

•Denial

•Many people when first diagnosed are downright relived to finally have a name for what ails them. However , that relief soon turns to denial once the full implications of the illness are evident. What this means is that they come to understand how much of their core personality is driven by the illness, and once they settle into the routine of drug-taking and doctor’s visits, the realization that life will never be the same as it used to be begins to haunt and torment them into denying some, or all of, reality. This is a dangerous but necessary time for them to pass through. They must accept it for what it is, an essential stage of coming to terms with being bipolar. Just be aware that the next step is the time when clients are most inclined to do something they may regret later on. They may drink heavily, quit taking their medication, quit seeing their psychiatrist and /or therapist and if possible there should be a safety net of some sort of in place in terms of support. If they crash hard, let there be someone who cares and can help them hold on till stability returns.

Anger: They will be furious with life, themselves, the past, missed chances ,screw-ups their friends, their significant others and their physician. No one will escape totally unscathered from the sphere of the bipolar person who has yet to come to terms with his/her circumstances THEY SHOULD BE ALLOWED TO BE ANGRY! They have the reason and right to be. Anger in it's self is not a bad thing so long as it is used to empower rather than disempowering or harm other or self. The crucial point is that the client understand and acknowledge there anger. They must own it, accept it, and make it theirs to the extent necessary to get though it. Does this mean permission to wallow in it indefinitely? No way! Client can not move onward unless they dealt with this critical aspect of learning to survive with a brain chemistry that will betray them at the first opportunity. They may be angry; it’s ok, and they need no ones permissions to be so.

Guilt:

• Of all the many things felted as clients attempt to adjust to being officially bipolar, guilt is perhaps the most burdensome and difficult to get a grip on. There’s guilt over past obnoxious behaviors and over sexual indiscretions, the way they treated family and friends, the lack of attention or care they have given their children, the inability to maintain jobs or relationships and the nagging self-doubt about their own sense of worth. But despite all the foregoing, remember that, and in fact teach clients to make a personnel motto: GUILT IS A WASTED EMOTION! Explain to them it comes from an exaggerated sense of reasonability aimed at the wrong kinds of things and for there wrong reasons. Explain it comes from all the times of do’s and don’ts that have been drilled into them from /by mom, dad school and the church. They need to let go and forget them, unless they are principles they personally chose, after careful thought, they do not matter now and they never did. What matters now is the future they choose to follow. From this point on, the choice and responability is all their’s.That’s a little intimidating, but it’s also a freeing kind of thought as well. Encourage them to try it on for size; they might come to appreciate it. If nothing else, it unities that old guilt knot in one’s stomach.

Resignation:

Probably the most difficult and depressing aspect of this disorder is encountered after passing though the tussle with denial and guilt—it’s the point when mere resignation settles on their shoulders like Poe's black raven quoting its dirge of “nevermore”. Nevermore the euphoric high’s of hypomania. Nevermore the super bursts of creative energy. Nevermore the ability do the work of ten others, stay up at the local club all night, and still write or paint until time for work the next morn .Nevermore the quick running and life-of-the party charisma. Nevermore….yes, for this they must (and will) mourn, for the drugs that stabilize them will exact a price in return and this is part of it. So they should be allowed to morn for the parts of their personality that may be muted or disappear entirely; its ok to lay black roses at the feet of the drugs they must take. But then they must move on by accepting that :1 they will experience a sense of resignation regarding there situation. 2) They will morn and suffer severe depression at feeling forced into resignation. 3) They will occasionally (or often) entertain the notion of dumping there drugs down the toilet (and they may, but ask them to please think it through first). 4. They will expect life to get immediately better and they will be disappointed at the fact that it doesn’t. As a nurses we can only urge, with all our heart to ride out the tough times. This coming to grips with a new you takes a very long time Some things will improve very quickly, but others won’t and new things will pop up to grieve the client. As a nurse we must understand bipolar’s are not usually patient sorts, but for there life and well-being you explain that they must be patient with this process of adaptation.

Reconciliation:

•So they have been very brave and they have made it through the 4 previous stages; now they will think they can breath a bit easier for the worst is definitely over. Hopefully, as they reconciled there past with the rather scary present, they will learn a bit about themselves and discover a well of strength within that will carry them through the ups and downs to most certainly come there way in the future. During this last phase they will continue the process of adjusting their medication, setting in with a good doctor and developing a strong support network. This is also the period during which they will spend a great deal of time thinking about where they end and the drugs begin. Mixed in with these considerations will be an ongoing quest to find the real person underneath and /or cohabiting with the bipolar inside of them. …Sound peculiar? It should, but ask a bipolar of some standing and you will find out that all have spent a good bit of time trying to figure out which of their cherished personality traits are due to their being bipolar and which are due to some unique, core “self. They wonder whether it wasn’t their bipolar self protecting them from a world that was always just a bit too much. All of this questioning is an essential part of the process of acceptance. When they have accepted that there is no magic cure for what they have, and that they will have it forever, they can move on to making their life as fulfilling and stable as it can be. When they reach a point where they are both reconciled to the illness and accepting of the treatment it mandates they will really begin to grow and live a full life. The road is fraught with peril, but the destination is certainly worth the risk.

EarthChild1130 · Sep 29, 2009

I use NAMI (National Alliance on Mental Illness) as a source for some things (http://www.nami.org) because they have some wonderful resources for illness education. You can also check out Mental Health America, at http://www.nmha.org, or the National Institute of Mental Health, https://allnurses.com/patient-education/www.nimh.nih.gov ...they both have great information! If your patient is newly diagnosed, making sure that s/he has good social supports is important too...I don't know about your area, but at our clinic our case managers teach illness management groups and support groups for schizophrenia, bipolar, etc...might also be a good support for your patient...good luck!

drmatt · Oct 13, 2009

Hello all!!
Just wondering if you have any ideas/methods for giving education to a newly diagnosed manic patient??
There is plenty of information out there for general bi-polar education but i havent as of yet been able to find anything specific to mania. All your help is greatly appreciated =)

The usual treatment for bi-polar disorder is a lifelong therapy with mood-stabilizers. The therapy should be with a combination of medications which are prescribed for the condition. The most effective treatment under mania is the combination of medications and psychotherapy. You can also check out this very useful resource online named videomd.com which will provide you some very useful tips related to patient education.