She has also recently experienced a "depressive episode characterized by the presence, while depressed, of two (or more) of the following:" poor appetite, insomnia and hypersomnia, low energy and fatigue, low self-esteem, poor concentration, difficulty making decisions, feelings of hopelessness, and a lack of energy that stood in notable contrast to her agitated, incessant movement and energy during her manic phase.
During her manic phase, Katherine showed clear signs of inflated self-esteem or grandiosity, a decreased need for sleep, was more talkative than usual, had a lack of need for sleep, was agitated in a manner observable to others, had racing thoughts and a flight of ideas accompanied with goal-directed social and academic activity, and also showed features of involvement in pleasurable activities such as binge drinking, shopping, sexual activities, and other types of "excessive involvement in pleasurable activities that have a high potential for painful consequences" as per the DMV-IV.
Review of issues in care and expert opinions
The willingness of Katherine's family to be involved speaks well of the potential of her case to have a good outcome. To confirm the diagnosis, her parents were asked to complete a Mood Disorder Questionnaire (MDQ), through which they confirmed Katherine's rapidly shifting moods throughout her adolescence. Katherine would often be best friends with girls, and then have a falling-out with them. Her school record, though strong, was often characterized by bursts of activity, followed by long periods of 'mental health days.'
Katherine was prescribed a mood stabilizer, to immediately address her condition and to make her a more active part of her treatment. Her parents were referred to therapists in the area that dealt specifically with managing college students and mental disorders. In treating a bipolar adolescent, it is essential that everyone around that individual get 'on board' with their treatment. One of the problems is that mania can feel positive. When confronted with her diagnosis, Katherine said that she enjoyed the increased creativity and goal-directed behavior regarding her school assignments. It was difficult to show the patient that this increased activity was fleeting. "Adherence appears to vary with the age of the patient and duration of illness…Clinical experience suggests that a younger patient in a first episode simply wants to get on with life and has particular difficulty accepting the chronicity of the illness" (Sherman 2007, p.3). Additionally, "patient beliefs about the illness and medication are often critical in determining adherence behavior...Some may have the incorrect idea that lithium or Depakote [divalproex] is addicting, for example" (Sherman 2007, p.1).
Finding a correct treatment and medication regime can be difficult. It would have to be determined between the university, Katherine's professors, and her treatment team, how best to salvage her semester, although with proper treatment, being a full-time undergraduate with managed bipolar disorder is certainly possible.
Recommendations for nursing and own personal growth
Adhering to a schedule to reduce external stimulation that can trigger a manic episode and having understanding treatment staff and a university community is essential in monitoring college students like Katherine with bipolar disorder. Treating the bipolar college student is a joint effort between the community, family, and the student herself. College presents many mood pitfalls that can make things difficult even for a relatively stable adolescent. Having a clear schedule and support system is important for a bipolar teen. Also, managing medication and side effects can be especially tricky, as some can trigger mania, if incorrectly prescribed.
Families should be taught to recognize the signs of an episode in their adolescent. The adolescent him or herself must be capable of self-monitoring and treatment compliance. Finally, the school needs to be aware of the need for accommodation and creating an effective support structure, regarding the student's scheduling, room assignments, and other requirements for attending the university.
DSM-IV Code: Bipolar. Available from psychnet on March 30, 2009 at http://www.psychnet-uk.com/dsm_iv/dysthymic_cyclothymic_episodes.htm#Manic%20Episode:
McDougall, Tim. (2009). Nursing children and adolescents with bipolar disorder: Assessment, diagnosis, treatment, and management. Journal of Child and Adolescent Psychiatric
Nursing, 22(1), 33-9. Retrieved March 30, 2009, from ProQuest Medical
Library database. (Document ID: 1663483211).
Recognizing and understanding bipolar disorder. (2007). Journal of Family Practice.
FindArticles.com. Retrieved March 30, 2009 at http://findarticles.com/p/articles/mi_m0689/is_11_56/ai_n21106670