Lithium Mania: Play and Learn

Shalon Kearney, RN, BSN, and Julie Meadows, RN, BSN

The authors describe an instructional game,

Lithium Mania, which they developed to assist

in teaching psychiatric clients who were taking

lithium about their medication. This game can

be used in a formal or recreational setting. The

goal of learning made fun was to increase

compliance and decrease recidivism.

N e a r l y 0.5%-1% of the adult population will ex- perience an episode of a bipolar disorder at some point in their lives (Bruno, 1989). The majority of these individuals will experience a high degree of re- cidivism due, in part, to low compliance with their medical regimens. Creative, new nursing strategies for teaching these clients need to be incorporated into medical treatment for a more holistic approach.

The medication of choice for treating bipolar dis- orders is lithium. In 1949 John F. Cade discovered the psychoactive effects of lithium, a drug previously used to treat gout and to prevent epileptic attacks. It has been well-established that 85% of manic clients on lithium show distinct improvement within two weeks (Wolman, 1977). In addition, the frequency and severity of manic episodes decrease when the lithium regimen is followed.

Despite the positive effects of lithium, there are some disadvantages involved in its use. Lithium must be taken consistently and monitored frequently to maintain therapeutic levels. Various precautions need to be instituted to promote efficacy and safety while using this drug. Salt intake must be monitored to maintain appropriate levels because lithium is also a salt, which is soluble within body fluids. Also, lith- ium may produce unpredictable side effects when mixed with other medications (Baer & Williams, 1988).

Side effects of lithium impact many major systems of the body. For example, cardiovascular effects in- clude pulse irregularities, a fall in blood pressure, and ECG changes. Skin anesthesia, blurred vision, and slurred speech are a few of the central nervous sys- tem effects. Neuromuscular and gastrointestinal side effects tend to occur when lithium blood levels range from 1.5 to 2.0 milliequivalents per liter. If blood lith- ium levels become too high (over 2.0 meqlliter), toxic effects such as tremors, seizures, circulatory collapse, and cardiac arrest may occur (Haber, Hoskins, Leach, & Sideleau, 1987). No antidote for lithium poisoning exists; rather, treatment is primarily supportive.

Given these various factors, the authors designed

29 Perspectives in Psychiatric Care Vol. 29, No. 3, July-September, 1993

Lithium Mania: Play and Learn

an innovative game, Lithium Mania, to enhance the education of individuals taking lithium. The primary purpose of this game is to impart knowledge about the benefits, administration, and side effects of the drug in order to increase compliance and decrease recidivism in clients. Secondary benefits of Lithium Mania include increased social contact and increased self-esteem, as clients become more active in caring for themselves.

Lithium Mania is a simple board game that may be used in a variety of settings. The design of the game allows it to be used by an individual or by groups of two to six players. A spinner, tokens, and medication questions of varying difficulty are used to challenge the players. After the leader determines the order of play, the first player spins and answers a question of the corresponding color. Point tokens of the same color are awarded for correct answers. The next player spins and the game continues until the final play. At the end of the game the points on the tokens are added and the player with the most points wins.

The time allotted to playing Lithium Mania can be

Table 1. Sample Questions

1. Lithium should be taken with food to reduce stomach irritation.

false *true

2. The best wav to treat lithium toxicitv is to: a. reduce ihe dosage b. stop taking it c. inciease tKe dosage

determined by the attention spans of the players. The psychiatric nurse in charge may stop the game at any point without leaving the game unfinished. Also, the game can be played several times to reinforce the learning process. Learning is encouraged in a simple, yet nonthreatening and fun manner.

By playing Lithium Mania, clients learn about the crucial facts concerning this drug and their own ther- apy. Lithium Mania may be used in initial teaching or to reinforce previous learning as a part of discharge planning. As clients with bipolar disorders learn about their disease and its treatment, outcomes such as decreased recidivism, increased compliance with the medication, and fewer incidents of lithium toxic- ity are likely to result. Bipolar episodes will decrease in number and severity, allowing the individual the opportunity to live a productive life and contribute to society.

Lithium Mania

References

Baer, C., & Williams, B. (1988). Clinical phnrmacology and nursing. Springhouse, PA: Springhouse.

Bruno, F. (1989). The famil?/ mental health encyclopedia. New York Wiley.

Haber, J., Hoskins, P., Leach, A., & Sideleau, B. (1987). Compre- hensive psychiatric nursing (3rd ed.). New York: McGraw-Hill.

Wolman, B. (1977). Internatioiinl encyclopedia of psychiatry, psychol- ogy, psychonnalysis, and neurology. New York: Aesculapius Pub- lishers.

30 Perspectives in Psychiatric Care Vol. 29, No. 3, July-September, 1993