CHAPTER

19

Nursing Care of Clients with Disorders Related to Anxiety and Alterations in Mood

OVERVIEW

A. Primary initial deficit occurs in mood or ability to manage anxiety, although there may be changes in
cognition and behavior
B. Anxiety disorders are the most common of all psychiatric disorders, resulting in distress and functional
impairment; rarely treated in inpatient settings unless anxiety is extreme and functioning is impaired or if
treated concurrently with another mental health disorder
C. Anxiety and depressed mood may find expression in physical symptoms associated with somatoform and
dissociative disorders
D. Acting out occurs because of fear, not antisocial tendencies
E. Anxiety is contagious and can be communicated to others

MAJOR DISORDERS ASSOCIATED WITH ANXIETY

GENERAL NURSING CARE OF CLIENTS WITH ANXIETY DISORDERS
A. Provide an environment that limits demands and permits attention to resolution of conflicts; establish a
trusting relationship
B. Identify precipitating stressors and limit them if possible
C. Intervene to protect from acting out on impulses that may be harmful to self or others
D. Accept symptoms as real to client; do not emphasize or call attention to them
E. Attempt to limit client’s use of negative defenses, but do not try to stop them until ready to give them up
F. Help to develop appropriate ways of managing anxiety-producing situations through problem solving and
cognitive/behavioral therapies; assist to expand supportive network; assist significant others to
understand the client’s situation
G. Plan a routine schedule of activities
H. Manage aggressive behavior progressively (e.g., diversion, limit setting, medication administration,
seclusion, restraints)
I. Collect and document information to assist with determining presence of both an anxiety disorder and
depression (comorbidity)
J. Encourage to develop a balance between work and relaxation

GENERALIZED ANXIETY DISORDER (GAD)

Data Base
A. Etiologic factors
1. Psychologic, behavioral, and neurobiologic theories are postulated; the latter is most promising
2. Functions to permit some measure of social adjustment
3. Commonly begins in early adulthood as a result of environmental factors and pressures of decision
making; early life is rigid and orderly
4. Excessive anxiety and worry involves at least two life situations
5. Unrelated to physiologic effects of substances or a medical condition
B. Behavioral/clinical findings
 1. Persistent anxiety (longer than 6 months) and excessive worry associated with three or more of the
following symptoms: restlessness (akathisia) or feeling on-edge, becomes easily fatigued, difficulty
concentrating, irritability, muscle tension, and sleep disturbance
2. Inability to control the anxiety
3. Impairment in social or occupational relationships
4. Symptoms of autonomic hyperarousal (e.g., tachycardia, tachypnea, dizziness, and dilated pupils);
however, they are less prominent than in other anxiety disorders
C. Therapeutic interventions: same as those listed under Panic Disorders

Nursing Care of Clients with Generalized Anxiety Disorder

See General Nursing Care of Clients with Anxiety Disorders under Major Disorders Associated with
Anxiety and Nursing Care of Client with Panic Disorder under Panic Disorder

PANIC DISORDER
Data Base
A. Etiologic factors
1. Biochemical and genetic theories are most often cited as the underlying cause; no one gene or
biochemical dysfunction has been identified
2. Onset varies, most often noted between late adolescence and mid-30s; infrequently may begin in
childhood or after age 45; early life rigid and orderly
3. Discrete periods of intense discomfort for more than 1 month in duration
437

4. Recurrent attacks of severe anxiety may be associated with a stimulus or can occur spontaneously
5. Pressures of decision making regarding lifestyle that occur in early adult years act as precipitating
factors
6. Functions to permit some measure of social adjustment
B. Behavioral/clinical findings
1. Brief attacks of overwhelming, intense discomfort
2. Attack must be accompanied by four or more of the following symptoms: palpitations or accelerated
heart rate; sweating; trembling or shaking; shortness of breath; feelings of choking, chest pain, or
discomfort; nausea or abdominal distress; depersonalization; fear of losing control; fear of dying;
paresthesias; and chills or hot flashes
C. Therapeutic interventions
1. Complete diagnostic workup to rule out physical illness
2. Psychotherapy, family therapy, group therapy, cognitive/ behavioral therapies
3. Psychotropic medications: sedative/hypnotic and antianxiety agents are used short term when client is
unable to cope or accomplish daily activities and until healthier coping emerges; antidepressants are
used prophylactically in long-term therapy (see Chapter 16, Related Pharmacology, Psychotropic
Medications, Sedative and Hypnotic Agents and Antianxiety/ Anxiolytic Medications)

Nursing Care of Clients with Panic Disorder

Assessment/Analysis
1. Progression of somatic symptoms
2. Interference in activities of daily living (ADLs) and social and occupational functioning
3. Situational triggers that may precipitate the onset of an attack
4. Determination whether panic symptoms are relate to a phobia (e.g., agoraphobia)
Planning/Implementation
1. See General Nursing Care of Clients with Anxiety Disorders
2. Remain with client during an attack; maintain safety
3. Remain calm and in control of the situation
4. Assign to a private room if hospitalized because it decreases environmental stimuli
5. Administer prescribed medications
Evaluation/Outcomes
1. Identifies situations that increase anxiety
2. Demonstrates increased use of anxiety-reducing behaviors
3. Follows prescribed treatment regimen
4. Reports a decreased number of panic attacks

PHOBIC DISORDERS
Data Base
A. Etiologic factors
1. Anxiety unconsciously transferred to an inanimate object or situation, which then symbolically
represents the conflict and can be avoided
2. Anxiety is severe if the object, situation, or activity cannot be avoided

OBSESSIVE-COMPULSIVE DISORDER
(OCD)
Data Base
A. Etiologic factors
1. Chronic anxiety disorder with decreased levels
of serotonin
2. Control of anxiety with obsessions (intrusive
recurring thoughts) or compulsions (repetitive
ritualistic behaviors)
3. Compulsive behavior precedes obsessive
thinking
4. Symptoms worsen with stress
5. OCD symptoms are similar in adults and
children; adults recognize behavior is
excessive and interferes with daily activities
but cannot be controlled; children do not have
this insight
6. Pressures of decision making regarding
lifestyle that occur in the early adult years act
as precipitating factors; some evidence that
early life patterns were rigid and orderly
B. Behavioral/clinical findings
1. Major defensive mechanisms are isolation,
undoing, and reaction formation; intellectual
and verbal defenses are used
2. Thoughts persist and become repetitive and
obsessive
3. Demonstrates indecisiveness and a striving for
perfection and superiority
4. Anxiety and depression present in various
degrees, particularly if rituals are prevented
5. Obsessions or compulsions consume most of
client’s waking hours (at minimum more than
1 hour per day) and interfere with ADLs,
occupation, social activities, or relationships
6. Limiting or interrupting a ritual increases
anxiety
C. Therapeutic interventions
1. Same as those listed under Panic Disorder
2. Behavior modification to attempt to limit
length and/or frequency of ritual
3. Cognitive therapy
4. Psychotropic medications: clomiPRAMINE
(Anafranil) and fluvoxamine (Luvox) to
control symptoms
Nursing Care of Clients with Obsessive-
Compulsive Disorders
Assessment/Analysis
1. Type and use of ritual or obsession
2. Level of anxiety (e.g., mild, moderate, severe,
panic)
3. Level of interference in lifestyle
4. Extent of danger inherent in ritual or obsession
5. Behaviors associated with other anxiety disorders
Planning/Implementation
1. See General Nursing Care of Clients with
Anxiety Disorders
2. Allow performance of the ritual initially unless
ritual causes harm and must be stopped (e.g.,
excessive hand washing causing skin damage);
eventually attempt to limit length and frequency
of the ritual
3. Support attempts to reduce dependency on the
ritual
4. Role model appropriate behavior and discuss
adaptive responses
Evaluation/Outcomes
1. Decreases obsessive thoughts and length and
frequency of ritual
2. Follows prescribed treatment regimen
3. Learns new adaptive coping responses
POSTTRAUMATIC STRESS DISORDER
(PTSD)
Data Base
A. Etiologic factors
1. Follows a devastating event that is outside
the range of usual human experience (e.g.,
rape, assault, military combat, hostage
situations, natural or precipitated disasters)
2. Neurobiology of PTSD does not follow the
usual fight-or-flight stress response; studies
indicate a complex interaction of
neuroendocrinology, neuroanatomy, genetics,
and traumatic stress
3. Adult’s response involves intense fear,
helplessness, or horror; child’s response
involves disorganized or agitated behaviors
4. Traumatic event is persistently
reexperienced as flashbacks, distressing
dreams, sense of reliving the experience, or
exposure to situations (including
anniversaries) that foster recall of the event
B. Behavioral/clinical findings
1. Exposure to a traumatic event resulting in
death, threatened death, or serious injury to
others or self
 2. Responds to traumatic event with intense
fear, confusion, helplessness, horror, or denial
3. Feelings of isolation and detachment;
depression
4. Interrupted concentration; difficulty sleeping
5. Violent outbursts of anger
6. Hypervigilance; hyperarousal; exaggerated
startle reflex; avoidance of associated stimuli
7. Risk taking behaviors; substance abuse in
attempt to control symptoms
C. Therapeutic interventions
1. Same as those listed under Panic Disorder
2. Behavior modification to provide controlled
exposure to recall of event
3. Use of eye movement, desensitization,
reprocessing techniques (EMDR)
4. Imagery, relaxation, and meditation
5. Cognitive restructuring and reframing
Nursing Care of Clients with Posttraumatic
Stress Disorder
Assessment/Analysis
1. History of traumatic experience
2. Sleep-pattern disturbances, outbursts of anger,
and decreased concentration
3. Screening for symptoms of major depression,
phobias, and substance abuse
4. Behaviors associated with other anxiety
disorders
Major Disorders Associated with Anxiety 439
CHAPTER 19 Nursing Care of Clients with
Disorders Related to Anxiety and Alterations in
Mood 440
Planning/Implementation
1. See General Nursing Care of Clients with Anxiety
Disorders
2. Stay with client when memory of event returns to
conscious level
3. Protect from acting out violently with disregard
for safety of self or others
Evaluation/Outcomes
1. Uses positive coping mechanisms to manage
anxiety and reactions to the traumatic event and
its flashbacks
2. Verbalizes a decrease in dreams or flashbacks
regarding the traumatic event
3. Follows prescribed treatment regimen
MAJOR SOMATOFORM DISORDERS
GENERAL NURSING CARE OF CLIENTS
WITH SOMATOFORM DISORDERS
A. Identify when anxiety is translated into physical
illness or bodily complaints (somatization)
B. Establish a trusting relationship
C. Provide an environment that limits demands on
and permits attention to resolution of conflicts
D. Identify pattern of recurring clinically significant
somatic symptoms; accept that symptoms are real
to client
E. Attempt to limit client’s use of negative defenses,
but do not try to stop them until ready to give
them up
F. Help to develop appropriate ways of managing
anxiety-producing situations through problem
solving and cognitive therapies
G. Accept physical symptoms but do not talk about,
emphasize, or call attention to them
H. Minimize sick-role behavior; encourage
independence within abilities; avoid providing
secondary gains
I. Encourage to develop a balance between work and
relaxation
J. Help to identify and label needs met by symptoms
CONVERSION DISORDERS
Data Base
A. Etiologic factors
1. Anxiety unconsciously converted to physical
symptoms that are not under voluntary control;
usually localized to one area of the body;
symptoms permit avoidance of an
unacceptable activity
2. Symptom or deficit is not related to an
underlying medical condition, to substances, or
to a cultural norm; distinguishes conversion
from psychophysiologic disorders associated
with tissue changes
3. Symptoms permit some measure of social
adjustment
4. Onset before 30 years of age; may recur
5. Physical illness frequently used by family as
excuse for problems; early life often rigid and
orderly
6. Pressures of decision making regarding
lifestyle in early adult years act as precipitating
factors
B. Behavioral/clinical findings
1. Symptoms or deficits that affect voluntary
motor or sensory function (e.g., paralysis,
blindness, deafness)
2. Conflicts or stressors (usually dependence
versus independence) precede initiation or
exacerbation of symptoms or deficits
3. Noticeable lack of concern about problem
(“la belle indifference”)
4. Impairment may vary over different
episodes; may not follow anatomic structure
(e.g., paralysis or numbness may circle foot or
arm [stocking-and-glove anesthesia])
C. Therapeutic interventions
1. Complete diagnostic workup to rule out
physical problems
2. Psychotherapy, family therapy, group
therapy as necessary to resolve severe
emotional problems
3. Psychotropic medications: antidepressants
(selective serotonin reuptake inhibitors
[SSRIs]); antianxiety agents rarely helpful (see
Chapter 16, The Practice of Mental
Health/Psychiatric Nursing, Related
Pharmacology: Psychotropic Medications,
Antidepressants)
Nursing Care of Clients with Conversion
Disorders
Assessment/Analysis
1. Presence of physical symptoms with no
pathophysiologic basis
2. Level of concern regarding physical symptoms
3. Degree of impairment
 4. Level of anxiety 2. Onset usually during adolescence but can
Planning/Implementation begin in childhood; may continue for years
See General Nursing Care of Clients with 3. No predisposing factor in early life or family
Somatoform Disorders patterns is identified
Evaluation/Outcomes B. Behavioral/clinical findings
1. Uses problem solving rather than physical 1. History of multiple plastic surgeries to
symptoms to manage anxiety-producing situations correct imagined defects
2. Decreases episodes that use physical symptoms 2. Preoccupation with imagined deficit causes
to manage anxiety avoidance or impairment in social and
occupational relationships
BODY DYSMORPHIC DISORDERS 3. Often exhibits symptoms of depression or
obsessive-compulsive personality traits Major
Data Base Somatoform Disorders 441
A. Etiologic factors
1. Preoccupation (not of a delusional intensity)
with a defect in appearance, either imagined or
exaggerated, even if there is a slight defect
C. Therapeutic interventions
1. Same as those listed under Conversion
Disorder
Nursing Care of Clients with Body Dysmorphic
Disorders
Assessment/Analysis
1. Preoccupation with imagined physical defects
2. History of medical and surgical therapies to
correct imagined defects
3. Ability to manage stressful situations
4. Level of anxiety
Planning/Implementation
See General Nursing Care of Clients with
Somatoform Disorders
Evaluation/Outcomes
1. Uses problem solving rather than physical defect
to manage anxiety-producing situations
2. Verbalizes that emphasis on physical defect is
exaggerated
3. Accepts and is comfortable with self
HYPOCHONDRIASIS
Data Base
A. Etiologic factors
1. Preoccupation with belief that there is a serious
illness because of misinterpretation of physical
symptoms
2. Diagnostic evaluation does not support beliefs
and does not allay client fears
3. Client’s knowledge of symptoms associated
with a disease aids in development of a similar
set of symptoms, leading to a conclusion that
the disease is present
4. Psychosocial stresses influence development of
this disorder
5. Usually begins between 20 and 30 years of
age; can occur across the life span
B. Behavioral/clinical findings
1. Misinterpretation and exaggeration of physical
symptoms
2. Inability to accept reassurance even after
exhaustive testing and therapy; leads to “doctor
shopping”
3. History of repeated absences from work
4. Adoption of sick role and invalid lifestyle
C. Therapeutic interventions
1. Same as those listed under Conversion
Disorder
Nursing Care of Clients with Hypochondriasis
Assessment/Analysis
1. Level of preoccupation with symptoms
2. Duration and degree of impaired functioning
associated with symptoms
3. History of psychosocial precipitant stressors
Planning/Implementation
See General Nursing Care of Clients with
Somatoform Disorders
Evaluation/Outcomes
1. Accepts that there is no physical basis for the
symptoms
2. Uses more effective coping mechanisms to
manage anxiety
3. Continues therapy even after condition has
improved
DISSOCIATIVE DISORDERS
Data Base
A. Characterized by either a sudden or a gradual
disruption in integrated functions of
consciousness, memory, identity, or perception of
the environment
B. May be transient or become a well-established
pattern
C. Etiologic factors: related to increased stress or
traumatic event(s) such as sexual abuse during
childhood
D. Types
1. Dissociative amnesia: inability to recall
important personal information, usually of a
traumatic or stressful nature as distinguished
from ordinary forgetfulness
2. Dissociative fugue: sudden, unexpected
travel accompanied by an inability to recall
one’s past, identity confusion, or assumption
of a new identity
3. Dissociative identity (also known as
multiple personality disorder): coexistence of
two or more distinct personalities within an
individual
4. Depersonalization: persistent or recurrent
feeling of being detached from one’s mental
processes or body that is accompanied by
intact reality testing
E. Behavioral/clinical findings
1. Inability to recall important personal
information usually of a traumatic or stressful
nature
 2. Gaps in recalling aspects of one’s life
history; usually related to traumatic episodes
F. Therapeutic interventions
1. Complete diagnostic workup to rule out
possibility of organic causes (e.g., brain tumor)
2. Psychotherapy (e.g., individual, family)
3. Development of more effective and
satisfying ways to manage anxiety
Evaluation/Outcomes
Nursing Care of Clients with Dissociative
Disorders
Assessment/Analysis
1. Identity; memory; consciousness
2. Physical condition
3. Psychosocial component to discover
fundamental anxiety source
4. History of emotional trauma in childhood
5. Suicidal risk
6. Recent use of alcohol or drugs
Planning/Implementation
1. See General Nursing Care of Clients with
Anxiety Disorders
2. Assist with treatment plan to alleviate
symptoms
3. Reinforce effective coping skills
4. Assist with problem solving
5. Encourage involvement in individual long-term
therapy and family therapy
1. Recalls and identifies past experiences
accurately
2. Verbalizes increased satisfaction with family
and work relationships
3. Ceases incidents of being absent without
explanation
4. Develops more effective coping mechanisms to
manage anxiety CHAPTER 19 Nursing Care of
Clients with Disorders Related to Anxiety and
Alterations in Mood 442

MAJOR DISORDERS RELATED TO
ALTERATIONS IN MOOD
GENERAL NURSING CARE OF CLIENTS
WITH MOOD DISORDERS
C. Neurobiologic perspective
A. Monitor nutritional intake and elimination
B. Keep environment nonchallenging with
decreased stimuli; avoid boredom; focus on
feelings
C. Observe for mood swings, irritability, and
depressive episodes
D. Protect from suicide or violent acting out; keep
under constant observation if necessary; keep
communication open and direct; ask if client has
a specific plan to commit suicide
E. Keep activities simple, uncomplicated, and
repetitive and of short duration requiring little
concentration
F. Base activities on client’s status: psychomotor
retardation in depression and hyperactivity in
mania; initiate one-to-one interactions with client
and eventually expand to one or two other people
G. Observe for adverse effects of drugs; monitor
therapeutic blood levels if appropriate
H. Encourage to continue medications even after
symptoms abate
I. Provide information regarding special dietary
precautions when taking certain medications
(e.g., monoamine oxidase inhibitors [MAOIs])
J. Assist with developing coping strategies; plan for
follow-up support and supervision
BIPOLAR DISORDER
Data Base
A. Characterized by a cyclical disturbance of mood,
encompassing emotional extremes: episodes of
vehement energy of mania, despair and lethargy
of depression, or a mixture of both
B. Presence of one or more manic or hypomanic
episodes with a history of depressive episodes;
predominant mood is elevated or irritable,
accompanied by one or more of these symptoms:
hyperactivity, lack of judgment with no regard
for consequences, pressured speech, flight of
ideas, distractibility, inflated self-esteem, risky
behavior, and hypersexuality
1. Hypomanic: mood elation with higher than
usual activity and social interaction, but not as
expansive as full mania; a distinct period of
elevated or irritable mood that is different from
mania; duration of at least 4 days
2. Mania: elevated, expansive, or irritable mood
accompanied by hyperactivity, grandiosity,
and loss of reality
1. Neurotransmitters, or certain chemicals in the
brain that regulate mood, have been identified
(e.g., serotonin, dopamine, norepinephrine, and
gamma-aminobutyric acid [GABA])
a. Increased levels of norepinephrine,
dopamine, and serotonin in acute mania
b. Decreased levels of norepinephrine,
dopamine, and serotonin in depression
2. Research suggests this disorder results from
complex interactions among chemicals,
including neurotransmitters and hormones
3. Family and twin studies suggest a genetic
component, but no gene has been identified
except in rare, familial forms of the disorder
4. Biologic rhythms and physiology related to
depression show abnormal sleep
electroencephalogram (EEG), sensitivity to
absence of sunlight, and circadian rhythm
disturbance
D. Physiologic theory postulates that mood also
may respond to drugs or a variety of physical
disorders
1. Drugs associated with depressive status:
alcohol, sedative-hypnotics, amphetamine
withdrawal, glucocorticoids, propranolol,
risperidone, and steroid contraceptives
2. Drugs associated with manic status: cocaine,
MAOIs, tricyclic antidepressants, steroids, and
levodopa
3. Physical illness, such as brain attack
(cerebrovascular accident) and some endocrine
disorders (e.g., Cushing disease and
hypothyroidism) can lead to depressive
episodes
4. Obesity is a related factor to depression
E. May be response to loss (dysfunctional
grieving), increased stress, or change in life
events, role, and sleeping and/or eating patterns;
overreaction to stress may lead to suicide
F. Generally occurs between 20 and 40 years of
age; however, reported in clients older than 50
years, and increasingly in children and
adolescents
 G. Resumption of customary activities between
episodes

DEPRESSIVE EPISODE OF A BIPOLAR

DISORDER
Data Base
A. Etiologic factors: see Data Base under Bipolar
Disorder
B. Behavioral/clinical findings
1. Either a depressed mood or loss of interest
or pleasure, occurring during a 2-week period,
with a change in level of functioning, plus five
or more of the following:
a. Change in weight
b. Insomnia (especially early morning
awakening)
c. Psychomotor agitation or retardation
d. Fatigue
e. Worthless feelings or inappropriate guilt
f. Somatic complaints
g. Diminished hygiene
h. Concentration difficulties
i. Inability to make decisions
j. Social withdrawal
k. Pessimism
l. Suicidal behavior progresses from suicidal
ideation, suicide threats, suicide gestures,
suicide attempts, to successful suicides;
presuicidal behaviors include no interest in
the future, giving away personal possessions
Major Disorders Related to Alterations in
Mood 443
 2. Orientation and logic unaffected
3. Sex drive (libido) decreased
4. Constipation and urinary retention
5. Anniversary reaction: depression and suicidal gestures may increase as anniversary of
loss of loved object nears
C. Therapeutic interventions
1. Antidepressant medications that increase the level of norepinephrine and serotonin (see
Chapter 16, The Practice of Mental Health/Psychiatric Nursing, Related Pharmacology:
Psychotropic Medications, Antidepressants)
2. Cognitive and behavioral psychotherapy
3. High-protein, high-carbohydrate diet; dietary supplements if necessary
4. Electroconvulsive therapy (ECT)
a. Brief electrical stimulus applied to brain, resulting in a seizure that alters brain
chemistry and eventually alters mood
b. Used most often for recurrent depressions, delusions, suicidal ideation, and clients
who are resistant to drug therapy
c. A depolarizing muscle relaxant causes paralysis (e.g., succinylcholine [Anectine]),
which reduces intensity of muscle contractions during tonic/clonic stage of seizure;
given after a short-acting barbiturate or other sedative/anesthetic such as propofol
(Diprivan)
d. Side effects: fatigue, muscle soreness, mild temporary confusion, and short-term
memory loss; effects should resolve a few weeks after treatment ends

Nursing Care of Clients during a Depressive Episode of Bipolar Disorder

Assessment/Analysis
(Table 19-1: Bipolar Disorder: Symptoms of Depression)
1. Feelings of worthlessness, guilt; often fearful of feelings
2. Suicidal ideation or acting out; presence of a plan increases the danger of suicide; may be
ambivalent about suicide
3. Depressed mood, loss of interest or pleasure, and slowing of psychomotor activity
4. Weight for recent changes and to establish a baseline
5. Changes in sleep patterns
6. Changes in ability to concentrate
Planning/Implementation
1. See General Nursing Care of Clients with Mood Disorders
2. Accept inability to carry out daily routines; assist with ADLs
3. Set expectations that can be achieved
4. Provide realistic praise whenever possible
5. Involve in simple repetitious tasks and activities
6. Accept feelings of worthlessness as real; do not deny, condone, or approve feelings
7. Spend time with client to demonstrate recognition of client’s worth
8. Protect from acting on suicidal thoughts, especially when depression begins to lift;
suicide is a real and ever-present danger throughout entire illness
9. Teach about ECT procedure
a. Informed consent required
b. Never left alone during and after the procedure; remain in recovery for 1 to 3 hours
after procedure; criteria for return to unit includes stable vital signs, alert, oriented, and
able to ambulate without assistance
c. Eliminate food and fluids for 6 to 8 hours before procedure
 d. Asleep at beginning of procedure; short-acting sedative administered
e. Oxygen administered before and after the procedure
f. Full-body muscle response is minimized by medication; muscle-paralyzing agent
administered
g. Brief electrical stimulus (no more than 2 seconds) precipitates seizure that eventually
causes an elevation in mood
h. May experience disorientation, headache, and muscle aches for about 1 hour after
procedure; analgesic given to treat headache
i. May experience temporary memory loss during and for several weeks after
completion of therapy
10. Refer for grief counseling, assertiveness training, and anger management
Evaluation/Outcomes
1. Remains free from injury
2. Verbalizes feelings
3. Verbalizes increased feelings of self-worth
4. Continues prescribed treatment regimen
5. Returns to preillness level of functioning

MANIC EPISODE OF A BIPOLAR DISORDER

Data Base
A. Etiologic factors: see Data Base under Bipolar Disorder
B. Behavioral/clinical findings
1. Persistently elevated, expansive, or irritable mood for a duration of 1 week, plus three
or more of the following:
a. Grandiosity
b. Insomnia
c. Verbosity (pressured speech)
d. Flight of ideas
e. Hypersexuality
Table 19-1 Bipolar Disorder: Symptoms of Depression
Affect Cognition Physiolog Behavior
y
Apathy Pessimism Anorexia Decreased
Anhedonia Worry Insomnia ADLs
Anxiety Poor Early- Irritability
Anger concentrat morning Agitation
Guilt ion awakening Psychomot
Helplessne Slowed Fatigue or
ss thinking Constipatio retardation
Loneliness Indecisiven n Social
Low self- ess Impotence withdrawa
esteem Hypochond Decreased l
Sadness riasis libido Crying
Emptiness Suicidal Hypersomn Self-
Flat ideation ia and abusive
expression Negative compulsiv acts
self- e eating Substance
appraisal initially in abuse
Psychosis some
clients;
this
changes to
anorexia
and
insomnia
as
depression
worsens