The mechanism of lithium is not fully understood, but this drug is a mood stabilizer. It helps prevent and treat the manic episodes of bipolar disorder by modulating the effects of neurotransmitters.
Valproic acid is used to treat the manic episodes associated with bipolar disorder, and its mechanism of action is unclear. Side effects of valproic acid include liver disease and hypersensitivity.
Lamotrigine is a drug helpful in treating bipolar disorder, though its exact mechanism of action is not fully understood. It can lead to hypersensitivity, and its use should be cautioned in those with renal and hepatic disease.
Patients in acute or delirious mania may have clouding of consciousness and may have intense symptoms. Forced hospitalization may be necessary as they become a danger to themselves or others, and death may even occur without intervention. With hospitalization, patients can be medicated and monitored as their manic phase passes. This provides a controlled environment with low level stimuli and structured solitary activities. Management of care focuses on redirection of destructive and inappropriate behaviors. Restraint may also be necessary with these patients.
As these patients have impaired functioning, they may not have had proper nutrition during their mania. Because of this, it is encouraged to help the patient consume sufficient finger-foods and between-meal snacks to meet nutritional requirements. High calorie, high carb foods that patients can “eat on the run” are encouraged until they are stabilized on medications. Increase fluids as they often become dehydrated due to excess activity. Consultation with a dietician may be necessary to determine the appropriate amount of calories.
As patients who are manic may neglect personal hygiene, it is important to help reintroduce them to necessary ADLs (activities of daily living). This helps the patient identify positive aspects about self and increase self-esteem.
Monitoring for signs associated with hygiene deficiencies, decreased appetite, changes in sleeping patterns, eating, elimination, and sexual patterns as ‘vegetative signs’. This also includes watching for changes in concentration, activity level, social interaction, and awareness/care of physical appearance.
As depression may lead to suicidal thoughts, additional precautions may be warranted. Patients may need to be hospitalized on a psychiatric unit, and be placed under close watch so that they do not harm themselves. While being monitored, these patients are administered the appropriate psychotherapy to help them recover from their condition. The patient should be placed on suicide precautions until deemed safe.
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