Understanding Bipolar Disorder: Assessment, Intervention, and Collaborative Decision Making

This essay talks about people with bipolar disorder I (PWBD). It is important to have a good understanding of bipolar disorder and its signs and symptoms so that the best clinical interventions can be initiated. The essay talks about an outline of the service user from the presented scenario that may include any information about the illness. The essay also explores any appropriate theoretical concepts that are useful in the assessment and delivery of intervention that could help the service user. Additionally, the essay talks about the role of the nurse in the assessment, planning, and delivery and evaluation of care. The essay further talks about the significance of collaborative decision-making in preventing patient deterioration and enhancing recovery. Finally, the essay critically analyzes the concepts around risk assessment, risk stratification, and risk management in addition to the local services and interventions that may be available.

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MENTAL HEALTH
by [NAME]
Course
Professor’s Name
Institution
Location of Institution
Date

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Bi-Polar Disorder
Introduction
A bipolar disorder may also be referred to as a manic-depressive illness. It is a disorder of
the brain that causes strange variations activity levels, mood, energy, and the ability to carry out
normal daily activities. The mood swings may include hypomania and depression. Individuals
with this disorder may, therefore, experience periods during when they feel excessively
energized and happy while other periods they experience extreme sadness (Carr et al., 2016).
There are four types of bipolar disorders that include Bipolar I Disorder, Bipolar II disorder,
cyclothymia, and other types that may be specified or unspecified (Craddock and Sklar, 2013, p.
1658). In this essay, we will talk about people with bipolar disorder I (PWBD). It is important to
have a good understanding of bipolar disorder and its signs and symptoms so that the best
clinical interventions can be initiated.
The essay talks about an outline of the service user from the presented scenario that may
include any information about the illness. The essay also explores any appropriate theoretical
concepts that are useful in the assessment and delivery of intervention that could help the service
user. Additionally, the essay talks about the role of the nurse in the assessment, planning, and
delivery and evaluation of care. The essay further talks about the significance of collaborative
decision-making in preventing patient deterioration and enhancing recovery. Finally, the essay
critically analyzes the concepts around risk assessment, risk stratification, and risk management
in addition to the local services and interventions that may be available.
This topic is of special importance to the patients, their families, and health practitioners.
Understanding the concept around bipolar disorder may help an individual in recognizing the

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symptoms depending on their mood swings and seek medication before these symptoms become
severe. Therefore, one can call their doctor and work with the doctor in collaboration to manage
the disorder (Ghaemi et al., 2014, p. 102). It is additionally worth noting that having enough
knowledge regarding this topic helps an individual in understanding the medication that may be
administered to them and all the potential side effects (Hodgkin et al., 2018). This topic also
helps individuals to learn about the lifestyle changes that they may make to help in reducing
mood swings.
Background
The patient in the provided scenario is a 28-year-old man who has also been diagnosed
with Bipolar Affective Disorder. This condition is otherwise known as bipolar disorder. He has a
bipolar I disorder that dates back to 8 years ago. Having bipolar disorder makes the patient’s
mood alternate between mania and depression with periods of normal mood in between. An
individual feels more productive at work and is confident of accomplishing anything they set
their mind to. Then all of a sudden, they start experiencing extreme depression, and they feel
unworthy. There is a feeling of excitement that suddenly changes to a feeling of sadness that
never goes away. An individual changes from being full of energy to being extremely tired.
The life journey of people with bipolar disorder I is always a tricky one that demands a
lot of care to help the individuals with this disorder. They have to experience a battle between
their emotions and intellect on a daily basis. They have to remind themselves of all the things
they must do to survive, and sometimes the only way to do this is by reminding themselves that
they have a purpose in this life (Duffy et al., 2014, p. 123). The service users will hear a lot of
voices in their minds telling them a lot of negative things that can make them engage in harmful

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activities. The most important way to tackle this problem is by learning from yesterday, living
for today, and hoping for tomorrow.
Bipolar disorder is ranked as the fourth most common mental health illness. The first
three include depression, anxiety, and schizophrenia. In the UK, around 2% of the population
experiences a lifetime prevalence of bipolar disorder. Women between the age of 16-24
experience the highest rate of bipolar disorders (Laursen, 2011, p. 102). Men, on the other hand,
averaged around 3% positive outcomes on bipolar at several age groups. Additionally, younger
people are at higher risk of having a bipolar disorder when compared to the adults (Dols et al.,
2014, p. 115).
Patients with bipolar disorder die from some causes that may include heart diseases and
flu. Death rates are reportedly high among individuals with bipolar disorder with a reduction of
around 10-20 years in life expectancy (Laursen, 2011, p. 103). The most elevated cause of death
among people with bipolar disorder is suicide (Malhi et al., 2013, p. 566). According to WHO
reports, over 90% of individuals recovering from bipolar disorder experience relapses in
different episodes of their lives. The reports further indicate that within 2 to 5 years,
approximately 60-75% of patients experience relapses.
The treatment of this disorder is very challenging for the primary care service providers
and diagnosing it is even more difficult. This difficulty is in most cases caused by the negative
attitudes of the patients towards the available services . They live in denial due to the fear of
stigmatization that comes from having this disorder. There is also limited education regarding
this disorder leading to a confusing presentation of bipolar disorder that has caused several cases
of misdiagnosis. The education is also important to help patients with drug adherence. The

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service user from the presented scenario has a history of drug non-adherence despite being under
the care of CMHT for the past three years.
Discussion
Theoretical Concepts
The assessment, planning, and delivery of interventions in mental health are important
yet quite challenging. The main goal of a mental health service is the provision of significant
health outcomes for service users. It can also be a challenge because, the choice of methods,
outcome measures, and outcome domains involve a balance between clinical, ethical and
conceptual considerations. This assessment, planning, and delivery of the interventions
encompass a critical review of the medical model, recovery model, and bio-psychosocial
approach within the field of mental health (Grunze, 2015, p. 660).
The biopsychosocial approach argues that we have biological, social, and psychological
factors that determine the condition of mental health of an individual. This approach further
provides evidence that a mentally sound individual may still experience a bipolar disorder at
some point in life. It is additionally important to note that this approach gives room for an
extensive evaluation of the patient and this is quite necessary for achieving successes in the
treatment of mental health conditions such as a bipolar disorder. It involves the general medical
history, substances and medications, and the family history of the service user. Like in the
provided scenario, the service user has a medical history of bipolar disorder and uses lithium
600mg medication. It also involves childhood experiences and personality disorders. This model,
however, has a drawback in that it may reinforce the stigma that is normally associated with

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mental illness because it may suggest that bipolar conditions are simply volitional rather than
medical conditions.
The Role of a Nurse
Bipolar disorder in most cases is misdiagnosed, and its prevalence is often
underestimated. This is because it rarely appears to respond to the normal treatment procedures
of depression thus leading to an increase in mortality and morbidity (Ghaemi and Dalley, 2014,
p. 317). The nurses, therefore, can impact significant care for these service users by recognizing
and assessing the bipolar disorder (Culpepper, 2014.). They also manage to treat the patients
with the most appropriate stabilizers and therapies.
A nurse applies a dynamic and systematic approach in the collection and analysis of data
to perform a systematic assessment of the patient and come up with a care plan and the necessary
interventions for patients with bipolar disorder (Carvalho and Vieta, 2017). The assessment is
done to establish a database regarding how the client responds to illness and their ability to
handle health care needs. The nurse uses physical care, relapse prevention, and psycho-education
to make a positive development to this condition of bipolar disorder.
The management of bipolar disorder can be done at both the community setting and
inpatient setting. The nurses set aside treatment goals for both short-term and long-term bipolar
disorders. The short-term goals differ from the long-term goals in that the short-term goals focus
on stabilization and safety whereas the long-term goals focus on relapse prevention and the
reduction of the severity of depressive episodes (Geddes and Miklowitz, 2013, p. 1675). The
nurse must ensure that safety is the number one priority since bipolar patients are at high risk of
self-harm. The service users admitted to hospitals with the condition of bipolar disorder like in

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the presented scenario may show signs of delusions, anger, impulsivity, and irritability and they
may thus risk harming themselves (Mondimore, 2014). The nurses, therefore, may administer to
help in stabilizing the patient thus allowing a quick recovery.
The nurses also need to educate the service users regarding bipolar disorder and
emphasizing the necessity for adhering to medication with the aim of improving patient outcome.
The education also helps the families of the patients in understanding bipolar disorder and the
best care plan for the patients.
Changes in Focus in the Role of a Nurse
The importance of nurses in the delivery of efficient and high-quality care cannot be
underestimated. There are occasions when the needs of the service user may change thus calling
for an escalation of care. This is when the focus of the role of the nurse might change to
accommodate the change in the needs of the service user. Extremely depressed patients are at a
higher risk of self-harm and may, therefore, require urgent care to prevent them from harming
themselves (Goodrich et al., 2013, p.383). There other presentations may include insomnia,
fatigue, indecisiveness, and restlessness among others. The change in nursing roles is important
in addressing the condition of the service user and ensuring quality health outcomes while at the
same time preventing patient deterioration.
The change may include the application of Mental Health Laws to help the service user in
handling their bipolar disorder condition. The mental health law specifically provides for an
assessment of mental health, detention, and compulsory treatment for any patient with a serious
mental illness that may involve bipolar disorder (Planner et al., 2014, p. 458). According to the

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Mental Health Act 2014, the compulsory treatment is most suitable in preventing the service user
from harming him/herself.
Once the nurse diagnoses an individual with a particular mental health condition such as
a bipolar disorder that escalates and may pose a danger to the service user the nurse may then
force the service user to be referred for a different type of treatment according to section 5 of the
Mental Health Act 2014. This forceful treatment may be important in preventing patient
deterioration which may cause further psychological or physical harm. However, consent is very
important in health care, and a patient must agree to a certain clinical procedure or have a close
family member consent to the treatment procedure on their behalf. Therefore, this compulsory
treatment may violate the patient’s right to consent. This is the reason why a compulsory patient
must be issued with a written statement of their rights as patients as soon as they become
compulsory patients.
Collaborative Decision Making
Collaborative decision making is when health practitioners and the patients work together
to come up with the perfect decision that may help in care provision. The nurse brings their
knowledge of understanding the clinical condition, the potential interventions, and the likely
risks and benefits of alternative interventions (Fisher et al., 2016, p. 1108). The service user, on
the other hand, comes with the knowledge of a good understanding of their values, preferences,
and goals. It can, therefore, be argued that a collaborative decision making involves all the
parties involved coming up with their respective views and negotiating a plan that both agree is
consistent, ethical, and congruent with the preferences of the patient.

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Several studies have revealed that the shared decision making in the healthcare setting
increases the quality of life of the service users, improves the quality of communication with the
health practitioners which consequently leads to greater therapeutic alliance and improved drug
adherence (Morant et al., 2016, p. 1005). It is also important to note that collaborative decision
making improves patient satisfaction and lowers the decision conflicts that may arise from being
poorly informed or not informed at all regarding the clinical decision. Collaborative decision
making also enhances a better follow-through regarding the treatment recommendations thus
leading to improved health outcomes.
It is, however, important to note that the implementation of collaborative decision making
has a lot of challenges. For example, from the provided scenario, we notice that the service user
is paranoid about the clinical procedures recommended by the nurse. He even claims that the
doctors are colluding with the police. This is an implication that he does not trust anyone and
thus convincing him to participate in a collaborative decision making is a huge challenge. He
becomes increasingly irritable and frustrated to be engaged in making an informed decision
regarding the best care plan for his condition.
In most cases, patients want to be heard and have their desires made part of the decision
making process. This, however, may not be easy especially in mental health conditions because a
patient with a bipolar disorder may not be in the right state of mind to make an informed
decision. We can take an example from the chosen scenario where the service user was insisting
that his only problem is a persistent headache he has been experiencing for months. It is,
however, clear that a headache is not his only problem and therefore listening to him and
ignoring the assessment results may cause serious health deterioration. It is thus important that

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the nurse uses their clinical assessment in addition to the patient desires to come up with the best
care intervention that suits the patient thus ensuring quality health outcomes.
Risk Stratification, Risk Assessment, and Risk Management
Risk stratification uses a particular process to identify individuals that have a higher
likelihood of suffering an unplanned hospitalization or health deterioration and thus provide an
appropriate care plan. Risk stratification is important in providing the trigger that is required to
plan, communicate, and monitor the available care plans. The best setting for this service is
found in hospitals, emergency departments, and ambulances among others (Jones et al., 2016).
Care strategies that are coordinated and evidence-based are thus planned according to the need
that has been identified. From the provided scenario, the service user could have been helped at
an earlier stage through risk stratification and thus prevent deterioration as was witnessed from
the patient assessment.
It is also important that the nurse clarifies the nature of the presenting problem and after
that determine the current form of the bipolar disorder whether it is mania, depression, or a
combination of the two. This is possible through risk assessment during which the practitioner
may also assess whether the service user is psychotic and identify if these psychotic symptoms
may be an indication of high risk (Phillips and Kupfer, 2013, p.1669). The patient may also be
assessed with the aim of determining their ability to make informed decisions and sound
judgments. Risk assessment may be done by seeking information from other sources such as
family members, close friends, colleagues, or in rare occasions, unrelated observers. In the
chosen case scenario, the police receive calls from unrelated observers that this particular service
user is upsetting children using the paddling pool (Rosa et al., 2014). On arrival, the police assess

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him and determine that his condition requires further assessment and is thus placed in section
136 and transported to a health facility.
At the hospital, the nurses perform risk management on him to prevent him from harming
himself. The key intervention in managing risks is through communication. The health
practitioner should advise the service user of the nature of the problem and emphasize their level
of concern. Specific interventions that include medications are important in managing risks
associated with bipolar disorder (Videbeck and Videbeck, 2013). From the presented scenario,
the service user is administered with lithium 600mg to help in controlling the bipolar disorder.
Local Services and Interventions
People with bipolar disorder need medical attention to put their symptoms under control.
Continuing the medication on a long-term basis helps in reducing the severity and frequency of
occurrence of bipolar mood episodes. It is important that as a patient, one works with their doctor
to come up with the right combination of drugs that can help in ensuring a quick recovery. Some
of the most important and readily available therapeutic interventions for service users include
cognitive behavioral therapy, family-focused therapy, and social rhythm and interpersonal
therapy.
In cognitive behavioral therapy, the service user examines how their thoughts affect their
emotions. This is also the time when they learn how to change their negative thinking behaviors
into more positive behaviors. This therapy helps in avoiding relapses, managing symptoms and
solving problems (Young and Grunze, 2013, p. 6). Interpersonal therapy reduces stress by
addressing and solving interpersonal problems. It is a relationship-oriented approach that helps in
improving health outcomes. The family-focused therapy aims to restore a supportive home

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environment (Vallarino et al., 2015, p. 556). This is possible by educating the family member
regarding bipolar disorder and the best way to respond to the disease. Other interventions that are
readily available in local services include medication, psychotherapy, education, and lifestyle
management among others.
Conclusion
A bipolar disorder causes strange variations activity levels, mood, energy, and the ability
to carry out normal daily activities. There are four types of bipolar disorders that include Bipolar
I Disorder, Bipolar II disorder, cyclothymia, and other types that may be specified or
unspecified. Several theoretical concepts support the assessment, planning, and delivery of
interventions to help the patients with bipolar disorders. The assessment, planning, and delivery
of the interventions encompass a critical review of the medical model, recovery model, and bio-
psychosocial approach within the field of mental health.
There are instances when bipolar disorder can be misdiagnosed, and its prevalence
underestimated. The nurses, therefore, can impact significant care for these service users by
recognizing and assessing the bipolar disorder. The nurses also need to educate the service users
regarding bipolar disorder and emphasizing the necessity for adhering to medication with the aim
of improving patient outcome.
Collaborative decision making is also important in realizing quality health outcomes. The
nurse brings their knowledge of understanding the clinical condition, the potential interventions,
and the likely risks and benefits of alternative interventions. The service user, on the other hand,
comes with the knowledge of a good understanding of their values, preferences, and goals. It is,
however, important to note that the implementation of collaborative decision making has a lot of

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challenges. For example, from the provided scenario, we notice that the service user is paranoid
about the clinical procedures recommended by the nurse.
Recommendations
 Management of bipolar disorder should focus on a strong therapeutic relationship.
 Prompt action should be taken once a bipolar disorder has been detected to initiate an
appropriate assessment thus aiding in providing quality care.
 The management of this disorder should rely on the integration of clinical experiences
and evidence-based data.

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