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Admitted: Disclosing your mental illness in an unrelated emergency


Admitted: Why you should disclose your mental illness in an unrelated emergency
Cathy J. Rubel, PMHNP-BC
Certified Nurse Practitioner

Mental illness causes more disability in developed countries than any other group of illnesses. In 2004, almost 25% of Americans reported having some type of mental illness (Reeves et al., 2011).  Bipolar disorder, or manic depression, has a high rate of co-morbidity with other problems including, but not limited to, thyroid malfunction, migraines, diabetes, cardiovascular disease, obesity, substance abuse, and other mental illnesses (NIHM, 09-3679). Meaning you have a significant risk of being in the hospital for other reasons. While your nurses do very well with those illnesses, they probably haven’t had much training in psychiatric nursing.

So, what do your nurses need to know to take the best care of you? Bipolar Disorder (BPD) is a medical illness, just as diabetes is. BPD is a recurrent mood disorder featuring episodes of mania or hypomania and depression and sometimes both polarities at the same time, called mixed episode (Antai-Otong, 2008). Between episodes, most people have relatively normal moods and activity. These periods may last years (NAMI, 2009). Disruptive behaviors are common in the manic phase of BPD and must be managed quickly and appropriately with a predictable plan for both the patient and the staff. As you know, when you are stressed, your mood may shift rapidly between elation and anger. Aggressive behaviors can quickly escalate. Few situations are more stressful than being in the hospital. Your aggressive behaviors can be directed toward yourself or toward others (Antai-Otong, 2008). Your nurses want, above all, to keep you safe.

Teach your nurses what to look for to help prevent you from becoming manic.  Some common symptoms are an elated happy mood or irritable angry mood, increased energy and activity, racing thoughts, increased talkativeness and “pressured” speech, grandiose ideas, poor judgment, decreased sleep or need for sleep, and increased sexual interest and activity (NAMI, 2007). What are your particular symptoms? Tell your nurses what best helps you to reduce your anxiety and stress.

Let your nurses and doctors know what medications you use to control your illness.  These medications can affect and be affected by the medications you are prescribed for your current illness, as well as by the illness itself. Some medications, such as lithium, can affect your thyroid function, which can enhance mood changes. Thyroid levels should therefore be monitored (Antai-Otong, 2008). Kidney function, liver function, fluid intake, and sodium balance can affect certain of your medications as well, so levels need to be monitored. (NAMI, 2007). These levels can also be affected by your current medical need.

Make sure your nurses know what time you usually take your medications. If your medication makes you very sleepy and you need to take it at night, make sure your nurse knows that. Most medications for bipolar disorder do not have withdrawal symptoms, but stopping them suddenly can increase the risk for mood relapse, particularly of mania, in the next few months, so this should be avoided  (Huyse et al., 2006). Many of the medications used in the treatment of Bipolar Disorder don’t have forms that can be given by a shot.  If you are not allowed to eat or drink, ask first if your normal medications can still be allowed with a sip of water.  If they cannot be given, make sure your nurse/doctor consults with your Psychiatrist or Psych/Mental Health Nurse Practitioner and with the hospital pharmacist for alternatives. Remember that your nurse is likely not as familiar as you are with the special concerns of the medications you take to manage your Bipolar Disorder.

Medications given for breathing problems, such as steroids, can raise your feelings of anxiety and give you the “shakes” so that you feel your usual medications are not working properly. Other medications can make your usual medications less effective for you.

So let’s pull it all together. Part of the admission assessment is asking if the patient has ever been diagnosed with a mental illness. Please be honest.  They can’t help you if they don’t know. Tell your nurse how you manage it at home.  You are always the best person to ask.  Let your nurses know what they can do to help when you feel you are losing control. Help them work with you. Make sure they know not just what medications you take, but when and how, so that they can try to maintain your normal schedule. Make sure they have the correct information for your Psychiatrist or Psych/Mental Health Nurse Practitioner. And sign a release of information so they can be contacted.

Your nurses are not trying to cause you a problem, they are usually just not familiar with your disorder. Remind them, you are a person first. You have Bipolar Disorder.  You are not Bipolar Disorder, any more than the other patient is cancer. And both of you need to keep in mind:

“Anger comes from having an episode and being unable to control it.  It is physiological, not emotional.”---Cory Dobbelaere

“In any crisis, never respond to the symptom, respond to the heart---they are scared!”  -Cory Dobbelaere, author, speaker, and person with Bipolar Disorder.



Reeves, W.C., Strine, T.W., Pratt, L.A., Thompson, W., Ahluwalia, I.,…Safran, M.A. (2011) Mental illness surveillance among adults in the United States.  Morbidity and mortality weekly report. 60(03); 1-32. Atlanta, GA 30333: Centers for Disease Control and Prevention.

Stang, P., Frank, C., Yood, M.U., Wells, K., and Burch, S. (2007). Impact of bipolar disorder: results from a screening study. Primary Care Companion Journal of Clinical Psychiatry 2007; 9(1): 42-47.

Bipolar Disorder (Publication No. 09-03679) U.S. Department of Health and Human Services.  National Institute of Mental Health, 2009.

Antai-Otong, D. (2008). Psychiatric nursing: Biological and behavioral concepts. Clifton Park, NY: Thompson Delmar.

Understanding bipolar disorder: what you need to know about this medical illness. (2007) National Alliance on Mental Health (NAMI): Arlington, VA.           


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