caseBipolarw
caseBipolarw
caseBipolarw
management plan.The client was giving small answers of the questions. Answer of general
knowledge question and abstract reasoning was not so good. During answering she took long
pauses and started thinking randomly. The client was very attentive during whole interview, as
she concentrated and answered almost every question during the interview.The client’s memory
Formal Assessment
It is a process through which clinicians use well validated test in order to construct a
working image of client. This shows the different aspect of the client's personality. Formal
Mental status examination provides the data base for psychiatric assessment and differential
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Her attitude towards me was good.
She showed some resistance to some of the questions as she was not fully willing to
Sometimes she become sad and started crying at the next she started laughing loudly.
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She sometimes showed blocking as she was not willing to express her real inner feelings.
She was very much preoccupied with the thought of the event.
Cognition
She had a very good memory as she was very easily telling all the events.
Her orientation about herself and about others was good as she had a clear understanding
HTP stands for House-Tree-Person, which is a projective psychological test used to assess a
person's personality and emotional functioning. In this test, individuals are asked to draw a house,
a tree, and a person. The drawings are then analyzed for various psychological indicators, such as
the individual's self-image, relationships, and coping mechanisms. The HTP test is often used in
clinical settings to gain insight into a person's thoughts and feelings that may not be easily
expressed in word
Test Administration
The client was given proper instructions and then asked to draw the pictures of a house, tree
Behavioral Observation
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The client was attentive throughout during the interview.
Time Taken
The time taken by the client was approximately 20 to 25 minutes to complete the test.
Qualitative Analysis
House
Double story house with many doors and without any decoration show her hopelessness and
domestic problems. Stairs in house and close distance between doors show her problems with
family members . Close door show that her family members don't want to intrect with her and she
is facing cristism from her family members . Small structure of house with many rooms show her
Tree
Tree without branches show her inner conflict and cognitive distortions . A simple drawing
of tree show her hopelessness and sadness. A falling of leaves from tree show her disopintment
from her family and criticism . Deep roots of tree show her love and emotions for her daughter
Person
Client draw the picture of lady .Her drawing of person show her depress mood . Many lines
on hair and body show her more talkative, involvement in painful activities. Drawing of her
simple women with low mood show her social withdrawal from neighbors and other members.
Her drawing of lady show her own feelings and emotions and her domestic
problems.Overemphasis or unusual attachment (e.g., nose connected to the eye) might reflect
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sensitivity to emotions, struggles with self-image, or interpersonal concerns.Distorted or
unusually shaped torsos may indicate a distorted body image or internal conflict about one’s
emotional or physical self. Small and unequal fingers of both hands may symbolize insecurity,
The Beck Depression Inventory (BDI) is a widely used self-report questionnaire designed to
representing a specific symptom or attitude related to depression. Respondents indicate how they
have been feeling over the past two weeks, and their scores can help determine the presence and
Interpretation
The interpretation of BDI is categorized into the range that indicate the severity of
depression. The client show moderate depression score 25 on BDI.A score of 25 on the Beck
Depression Inventory (BDI) indicates moderate depression. This suggests that the individual is
experiencing significant depressive symptoms that may be affecting their daily life and
functioning. Symptoms at this level can include feelings of sadness, hopelessness, and a lack of
The Altman Self-Rating Mania Scale (ASRM) is a tool developed by Dr. Edward Altman to
help assess the severity of manic symptoms in individuals, particularly those diagnosed with
bipolar disorder. The scale consists of five items that the patient rates based on their experiences
over the past week. A score of 6 or higher may indicate a need for treatment and/or further
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diagnostic workup to confirm a diagnosis of mania or hypomania.
Interpretation
& client show 6 score on Altman self rating mania scale that indicate hypomanic condition of
patient.
CASE FORMULATION
episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of
Bipolar I disorder. These episodes are similar to manic episodes but are less severe. Hypomanic
symptoms can include elevated mood, increased energy, decreased need for sleep, and
heightened creativity or productivity, but they are less intense than those in mania. The
According to Seligman (1974), feelings of hopelessness plays role in bipolar II. The person
develops the sense of being unable to act and control his/her own life and environment and all
these things bring on sense of helplessness which leads to depressive and hypomanic episodes
(Comer, 2006). In present case, the client feel hopeless as she had no son which caused her low
mood. To avoid this hopelessness, she started talking much and involved herself in extra
household tasks which were not required or useless activities such as washing already washed
clothes etc.
According to the Hopelessness Theory individuals become depressed when they experience
negative life events and make depressiogenic interferences about the cause, consequences, and
self-worth implications of these events. In a logical extension of this theory people might become
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manic when they attribute positive life events unrealistically positive, or when they attribute
negative life events on external, specific, and instable causes. In support of these two theories it
was found that bipolar patients regardless of their current symptoms exhibited specific bipolar-
appraisals for hypomania-relevant experiences (Beck, 1967). In my case, the client was facing
domestic problems which causes her elevated mood. She started talking excessively so that no
other thoughts came to mind and busy herself in activities in order to avoid negative recurrent
thoughts.
Marital dissatisfaction and Bipolar disorders are strongly related. According to Davila,
Stroud & Starr (2009) if bipolar disorder continues, it often leads to substantial deteriorations in
marital relationships. In present case, the client hasd usual fights with her family members. And
also she got disturbed and sad after thinking that she had no son. The recent event which led her
to present condition was also her family angry attitude which led her to present condition of
hypomania.
Goodwin and Jamison, (2007) postulated that, people who experience traumatic events are
at higher risk for developing bipolar disorder. Childhood factors such as sexual or physical abuse,
neglect, the death of a parent, or other traumatic events can increase the risk of bipolar disorder
later in life. Highly stressful events such as losing a job, moving to a new place, or experiencing a
death in the family can also trigger manic or depressive episodes. Lack of sleep can also increase
risk of a manic episode. In my case, the client first got upset due to her mother’s death . The
recent traumatic event was the death of her mother to whom the client was very much attached.
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Theraptic Suggestions
This type of therapy helps in recognizing and changing negative thought patterns and
behaviors. It can assist in identifying triggers for mood swings and developing effective coping
strategies to manage them better.Cognitive behavior therapy (CBT) has been shown to be
efficacious in the management of bipolar depression and during the maintenance phase of
treatment. The basic goals of CBT is to educate the patient about the illness, teaching them
cognitive behavioral skills for coping with their illness and psychosocial stressors and problems
arising out of the same, enhance medication and treatment compliance, monitor the symptoms to
maintaining a consistent schedule and enhancing social connections, it can help regulate mood
and reduce the risk of mood episodes.It emphasizes on regularizing the social rhythms or routine
of the patient and improving the interpersonal relationships of the patients so that they can derive
more satisfaction in their social roles. The basic aim is to teach the patient as to how they can
prevent the development of a new episode. Patients are informed that new episodes can be
precipitated by poor medication adherence, stressful life events and disruption of social rhythms.
Patients are provided with skills as to how they can address interpersonal problems and issues in
the social roles. They are also advised to maintain a regular daily routine and pay attention to the
day to day stresses which can influence their daily routine and how they can minimize the impact
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Dialectical Behavior Therapy (DBT)
developed to help individuals manage intense emotions and improve their interpersonal
relationships. It was originally created for people with borderline personality disorder, but it's
now used for various mental health issues, including bipolar disorder, depression, and anxiety.
intense emotions and improve interpersonal skills. It can be beneficial in addressing emotional
Family Therapy
and support within the family. It can also help address any conflicts or stressors that may be
contributing to the individual's symptoms.This can also be beneficial for those with bipolar
disorder, according to the American Psychological Association. Family members are taught to
recognize the warning signs of either a manic or a depressive episode, Dr. Roane say, and both
family members and patients are taught better communication skills. “A family member can help
to identify when a person with bipolar disorder is about to go into a new episode before it
happens,” he says, “The family members can tell when a patient is not taking medication, so it’s
critical for the family to be involved.” Family-focused therapy is important because it can often
Psychoeducation
Psycho-education may be considered both for the patient and family members. The aim is to
be to educate the patient and family about the illness. They may be provided simple explanations
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about the nature of the illness, treatment options, possible side effects of medications and likely
length of treatment et. Caregivers may also be provided with an opportunity to vent out their
feelings and distress. Psycho-education may also address the important issue of treatment
adherence and identifying early signs of new episode. It is important to remember that psycho-
education is not a onetime event and prior to every session, feedback of the previous sessions
may be taken and psycho-education need to be tailored to the needs of the patient and the
caregivers. Learning more about bipolar disorder and its management can empower the
individual and their family to recognize warning signs, adhere to treatment plans, and work
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