2. PATIENT PROFILE FORM
NAME - K. Ganga UNIT - Psychiatry Ward
AGE - 35 years IP no.-968761
SEX - Female Adm. Date - 24/1/2014
WEIGHT-55 Kgs DOD – 13/22014
3. REASONS FOR ADMISSION
Appearance of excessive irrelevant talking, reduced
sleep, indecent behavior observed since 2 months. history of
roaming outside.
History of visual hallucinations.
PAST MEDICAL HISTORY:
Similar complaints are observed in past 2 years.no history of
delusions and hallucinations.
PAST MEDICATION HISTORY:
Given ECT and drugs tab. Haloperidol, Tab. Chlorpromazine, Tab.
Trihexyphendyl for one and half month 1year ago.
4. FAMILY HISTORY
NIL IN PARTICULAR
SOCIAL HISTORY:
o Not known alcoholic or smoker
5. PHARMACEUTICAL CARE PLAN
1.SUBJECTIVE EVIDENCE:
Excessive talking and indecent behavior existing from 2 months.
Reduced sleep from 1 month, visual hallucinations, roaming out side.
2.OBJECTIVE EVIDENCE:
No specific lab investigations are available for bipolar disorder. Manic
episodes were observed with mood fluctuations frequently for significant
period for 2 years. Diagnostic and Statistical Manual of Mental
Disorders (DSM).
3.ASSESMENT:
Based on subjective and objective evidence the patient was diagnose
with MAINAC EPISODES.
FINAL DIAGNOSIS IS BIPOLAR DISORDER.
7. GOAL TO BE ACHIVED
Reduce the symptoms so that she no longer have any negative
effect on her life.
To provide better sleep to the patient.
Prevent or reduce the needs to visit or to stay in hospital.
Encourage the patient to establish regular daily rhythms for
sleep, exercise, and eating activities.
Avoid or reduce undesirable side effects that may induced by
medication
To improve patients psychological and social development.
Plans to reduce visual hallusinations
8. TREATMENT OPTIONS:
Bipolar disorder cannot be cured, but it can be treated effectively over
the long-term. Proper treatment helps many people with bipolar disorder
even those with the most severe forms of the illness gain better control of
their mood swings and related symptoms. But because it is a lifelong
illness, long-term, continuous treatment is needed to control symptoms.
Combined Use of Psychotherapy and Pharmacotherapy for
Management of Bipolar Disorder.
9. DRUG TREATMENT:
Mood stabilizers:
Lithium
Anticonvulsants:
Valproic acid or divalproex sodium
Lamotrigine
Gabapentin
Topiramate
Oxcarbazepine
Symbyax(combines the antidepressant fluoxetine and the antipsychotic
olanzapine)
12. PSYCHOTHERAPY:
Cognitive behavioral therapy (CBT)
Family-focused therapy
Interpersonal and social rhythm therapy
Psychoeducation
OTHER TREATMENTS:
Electroconvulsive Therapy (ECT)
Sleep Medications
Herbal Supplements
13. PHYSICAL EXAMINATIONS:
Physical examinations were done
regularly.
BP – 120/90 mm Hg
Pulse – 72/min
Temp – 98.7 F
Abdomen-soft
patient is conscious and coherent
14. • DAY BY DAY OBSERVATION CHART:
On 24th ECT is given.
On day-1 drug therapy is started,
evidence of reduced sleep
excessive irrelevant talking were observed
symptoms were continued day-2 & 3
On day-4 i.e. 29/1 she slept well but irrelevant talking was observed.
Similar symptoms were continued on day-5,6,7,8 & 9
On day-10th she was better having relevant talking and slept well.
On day-11th symptoms of cold & fever were observed. Treatment was given to
reduce cold and fever. better relevant talking and slept well. Cont. for day-12,13,14.
On day-14th cold was reduced and body temperature came to normal.
15. On day-15th symptoms of disorder were reduced. Better relevant talking,
having good sleep, able to be normal with other people cont. till 14/2 i.e. day-
20 of her admission.
She was discharged from the hospital on 14/2 on request of her parents with
her discharge medication.
ECT given on.
24/1/14
25/1 not given
28/1
30/1
1/2/14
Drug regimen for 20 days is mentioned in the following drug charts
18. • GOALS ACHIVED:
Patient is having better sleep than previous.
Reduced irrelevant talking and visual hallucinations
Reduced tendency of negative behavior and indecent behavior.
19. MONITORING PARAMETERS:
Cardiovascular monitoring.
Tardive dyskinesia for antipsychotic drugs.
Neuroleptic malignant syndrome checks.
Pulmonary tests for bronchopneumonia.
Blood tests for leukopenia, neutropenia & agranulocytotoxicty etc.
Goniscope evaluation and close monitoring of intraocular pressure an regular
intervals.
Lithium dosing should be accurate.
Hepatic and renal function tests should be done.
20. • CONTRAINDICATIONS:
Drugs should not be used in patients hypersensitive to these drugs.
combination use of Haloperidol and Lithium:
An encephalopathic syndrome (characterized by
weakness, letheargy,tremulousness &
confusion, EPS, leukocytosis, elevated serum enzymes, BUN &
FBS)followed by irreversible brain damage may occur in a few patients
treated with lithium plus haloperidol.
Diazepam is contraindicated in glaucoma patients.
21. PATIENT COUNSELLING:
ABOUT DISORDER:
making the patient knowing about her disorder is necessary for her
co-operation.it should be done in a peaceful manner.
o This helps for a better controlling of the condition.
o Patients guardians should be acknowledged about the disorder and letting
them know how important the medication is.
o Counselling programs are conducted regularly.
o Patient should be kept in observation.
22. • ABOUT LIFE STYLE MODIFICATIONS:
Healthy diet should provided.
Meal should contain food which she likes.
Protein rich diet I s maintained for better maintenance of body.
Patient should be kept totally away from the strainers.
Harmful things should be kept out of reach
Patient should be never left alone.
Healthy and hygiene surroundings should be maintained.
