Bipolar Mania and Insomnia

Thanks, ask me anything if you believe i missed something important for you.
She is not good at explaning certain things, the most important things i know from observation.

1. Age,sex,weight,body and face appearance, country, occupation.
54
Female
60kg
1,70m
small frame
Caucasian, white skin but not too white, dark hair, brown eyes, good looking but have a weak jawline and

maxilla a bit retracted.
youthful looking for the age, looks 15 years younger
Brazil
Housewife


2. Main complaints and other associated troubles.
a)Where is the trouble; The exact locality of the complaint like hands,legs etc; duration of trouble.
Bursitis in the hips, being feeling with ups and downs for 5 years.

b)What exactly do you feel, Sensation as pain, how pain feels or burn etc.
Large area with pain.

c)What are the factors that causes this trouble according to you.
Nervous system, Arthritis, Osteoporosis (maybe because she was born with 7 months and had problems with

her legs turn inwards, the doctor told to bury her legs in the sand to correct when she was a kid and it

worked)

d)Condition under which the complaint is reduced or you feel better like,cold or hot application,cold or

hot weather,position as standing,walking,rest etc.
Hot weather, rest.

e)Condition under which the complaint is increased like,cold or hot application,cold or hot

weather,position as standing,walking,rest etc.
Cold, going uptairs because causes inflamtion in the trocanter joint.

f)Any other complaint any where in the body.
Hands have some arthritis but not much pain, back pain sometimes, had more back pain a few years ago.

Sometimes she have restless leg. Fibromyalgia most pain in the hips. Bursitis in the shoulder and a bit

in the knee.
Gastritis
Uterine fibroid (looks pregnant), menopause did not started.
Bruxism (gone now)

g)Onset time of troubles in detail, i.e which came first, after that what problem and so on.
A lot of Back pain 6 years ago. Hips 4 years ago. Fibromyalgia came togheter with the hips and also

connected with the bursitis.
Gastritis started with clonazepam.
Uterine fibroid 15 years ago.
Bruxism 6 years ago.

h)Treatment method adopted and its result.
Anti-inflamatory, pain relief medications and mostly results from physiotherapy and cymbalta for

fibromyalgia.

3. History of diseases in family.
Mother with depression. Depression is strong in the family.
Mother with parkinson and memory loss, doesn't barely recognize the family.

4. Personal History.
a)About childhood.
Would get angry easily, stuborn didn't like studying, would get very frustrated if she didn't get exactly

what she wanted.

b)Academic performance.
Not good in early childhood, got better with time.

c)Any major incidents in life and the effect of it on life.
No

d)How you are satisfied with your sex life, friends, family members, company etc.
No friends, complains about the family, even though family is very supportive.

5. Habits/Addiction.
a)Smoking, Alcohol,Sleeping pills, Laxative etc.
Sleeping pills and compulsive buyer, didn't hated staying home until this year, now she isn't buying more

stuff, but is very attached to what she have.
Laxative is using everyday for about 2 months.

b)Masturbation and frequency.
ANS.

6. How is your Appetite and Thirst.
Gets thirst fast. Din't have much appetite until Seroquel.

7. Likes and Dislikes.
a)Alcohol Bread Butter Bitter Salt Sweet Sour Fats Milk Mud Chalk Egg Spicy food Meat Fish Fruits Fried

Food
Warm food-drink Cold food-drink Ice Ice cream Chocolates Tea Coffee.

Likes chocolate, capuccino and cream cheese.

Dislikes
Drinking cold liquids, never puts ice and doesn't drink directly after getting out of the fridge.
Spicy food
Red meat

b)Anything else about like and dislike of any activity with you or surrounding.
ANS.

8. Bowel movements.
a)Nature of stool, frequency, satisfactory or not.
Hard, small, every 3days. Not satisfactory. Now is taking laxative everyday.

b)Any discomforts associated with stool.
Sometimes can hurt.

9. Urine.
a)Frequency, nature, volume.
Many times, she mostly drinks water so is more white, she can't control much holding since giving birth.

b)Any discomfort before, during or after urination/odour
No

10. For men.
a)Any difference in erection/want of erection/weak erection/Ejaculation early/late.
ANS.
b)Any other trouble in sex.
ANS.

11. For Females.
a)Menses, Regular, Irregular,Early, Late.
ANS.
b)Duration of menses.
ANS.
c)Nature of flow, Scanty, Blood colour, Consistency, Odour, Staining, itching/ when and what makes it

worse/better.
ANS.

12. Sleep.
a)The quality of sleep, the quietness or restlessness of sleep,
position of sleep, times of waking and reasons for waking,
need for cover over various parts of the body,
whether the window must be open or closed etc.
common dreams, peculiar sounds or gestures during sleep, etc.

Poor quality, very light sleep, wakes up tired.
Doesn't make sounds.
Wakes up to go to the bathroom.
Go to bed at 4am. Wakes up at 9am but stays on the bed until 1pm.
Window closed.
9am~1pm light sleep, wakes up multiple times, most of the time is awake just with closed eyes.

She claims that doesn't like to sleep early. Maybe she just says that because she can't do it.


13. Sweat
a)How much, what parts, staining, Odour.
Little, no for the others.

14. Weather
a)Tolerance to heat and cold, dryness, humidity, weather changes, sun,
foggy weather, wind drafts, closed rooms, etc.
Only closes Venetian blind before going to bed.
Hates cold. complains about too hot.
Hates rain.

15. Mental Status
a)The quality of the patient's life in relationship to loved ones, family, friends and colleagues.

Overall quality of energy available to function in daily life, and under various circumstances.
Bad~moderate relationship with family, goes from good to bad with the sons.
Have no friends and colleagues.
Feels marriage wasn't good, complain about it everyday, even with my father being travelling most of the

time for a couple of years.
Isn't divorced, is distant from the husband emotionally. Yet complains about him everyday.

Victim mentally, blames everyone and everything but her. Doesn't take responsability.

Only have energy to go shopping, can stay 6 hours in a mall going many days of the week, stay in the same

store for over an hour. Doesn't mean she buys a lot in one day.

b)Any mental/emotional shocks occurring in the patient's life-grief, major financial losses separation

from loved ones, death, identity crisis and other stress in life.
Loss of father before marriage. Father was was gave her safety.
Worries that doesn't have enough money and won't have money in the future.

c)Memory,ability to concentrate/comprehend.
Poor memory after started with clonazepam.

d)Are you fearful of anything eg: Animals, people, being alone, darkness, death, disease, robbers,

thunder, storm, high places.
Being alone, she always feel alone, even tough she isn't.
Fear of diseases is strong.
Fear os storm.

e)Are you anxious about anything: if yes, give details.
Worries about the future, uncertain of the future.

f)Are you impatient.
Yes

g)Are you doubtful or suspicious.
Yes

h)Are you hurt easily (emotionally)how do you react. Does it cause hatred/revenge.
Yes, gets anger. Yes.

i)Does your pride get hurt easily.
Not sure.

j)Are you depressed, if so, reason/circumstances.
She says soo but she have more mania now.

k)Do you like to share your problems.
Repeat the same problems everyday. Now with Seroquel a bit less.

l)Effect of consolation.
Buying clothes in the mall makes her feel good in the momment.

m)Do you ever become suicidal when? How.
No

n)Memory- quality if poor, for what ( eg. Names, places, people, what you read).
Poor after clonazepam, doesn't remember if take the medicine, what she ate,etc.
Normal for people and places.

o)Do you weep easily, effect of weeping, ie, does it make you worse or better.
Yes, better because she have less mania doing it.

p)Are you easily irritated. What makes you angry, how do you express it.
Yes. Anything that she doesn't agree with, face changes, voice gets louder.

q)Are you destructive.
Sometimes.

r)How good are you in making decisions.
Bad at making and regrets.

s)Do you like company or like to remain alone.
Like company.

t)How seriously are you affected by disorder and uncleanness in your surroundings.
She says she is, but her room is a total mess. The first day of seroquel she "woke up" and couldn't stay

in the room, that effect went away after a few days. A similar result with homeopathy would be good.

u)How does failure appear to you?
Everything is a failure, only thing she did right was taking care of the sons, which she did very well.

v)Are there any matters that you deeply dislike?
Can't think of it now.

w)What activities you deeply like? How does it affect your mood?
Likes to go out in places that look nice. Feels good.

x)Are you affectionate? How does others sorrow affect you?
No. Only with her sons.

y)Any present fears in your life or future.
Fear the future, fear getting old, being alone, having no money.

z)Any present life or future life desires.
Wants to feel safe and travel.

Ok, thanks