Nursing Considerations for the Oncology Patient with Bipolar Disorder (Guest Blogger Nathan Braden)
Bipolar Disorder (BPD) is a unique psychological pathology that has been shown to have an impact on about 5% of the general population within the United States. While the percentage in the oncology patient population can be even smaller, it is important to be prepared. It is imperative that nurses are equipped with the knowledge to recognize, assess, and intervene for cancer survivors with BPD.
Generally speaking, BPD is a lifelong illness. It is defined by characteristic episodes of fluctuating mood that include mania, hypomania, and depression. These episodes vary in length. The management of BPD or one of its subtypes is already complicated. In caring for oncology patients there are additional factors to consider:
- Foster an interdisciplinary team effort. Working together (psychiatry, oncology service, nurse, pharmacy) can reduce drug side effects and interactions.
- Assess for interactions between chemotherapeutic drugs and psychotherapeutic drugs Mood stabilizers, antipsychotics, and antidepressants maybe used in the treatment of BPD.
- Monitor clinical trial drugs for creating or exacerbating BPD-like symptoms. (hyperactivity or depression)
- Monitor the body’s ability to metabolize and excrete psychotherapeutic drugs (impaired liver or kidney function)
- Assess previous medical, psychiatric, and personal history—paying attention to substance use
- Assess past compliance with psychiatric treatment recommendations.
- Ensure safety of the environment. Especially with a patient who is experiencing an acute manic or depressive episode
- Proper identification and recognition of support systems; friends, family, and community.
Sometimes, when cancer is identified, comorbid conditions such as BPD take a back seat. However, it is the duty of the nurse to assess for and report mood disturbances. These issues may not be a reaction to the stress and sadness of a cancer diagnosis, but the symptoms of an undiagnosed or unmanaged psychological disorder.
http://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm03
http://onlinelibrary.wiley.com/doi/10.3322/caac.21285/full
https://link.springer.com/chapter/10.1007/978-3-642-40134-3_11
https://www.medscape.com/viewarticle/540883
GUEST BLOGGER: Nathan Braden is a graduate student at The Ohio State University College of Nursing. He is studying Psych-Mental Health nursing. He will graduate in May 2018 and sit for certification as a PMHNP. Nathan has been a Registered Nurse for 8 years and been with the James for all of them. He received his ADN from Marion Technical College and his BSN from The Ohio State University.