caseBipolarw

Download as pdf or txt
Download as pdf or txt
You are on page 1of 10

precipitating, maintaining, motivating and risk factors were analyzed.

It all helped in making a

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

about the past and present was normal.

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

assessment done through to administration of following four evaluation techniques;

1. Mental Status Examination

2. House Tree Person (HTP)

3. Beck Depression Inventory (BDI)

4. Altman Self-Rating Mania Scale (ASRM)

1. Mental Status Examination

Mental status examination provides the data base for psychiatric assessment and differential

diagnosis. It comprises the observed and objective portion of the evaluation.

Appearance, Attitude, Apparent age

 The client was a good looking 46 years old women.

 She was well dressed and neatly combed.

16
 Her attitude towards me was good.

 The client was sitting on the bed while interview.

 She was cooperative throughout the session.

 She showed some resistance to some of the questions as she was not fully willing to

reveal hir problems and worries.

Mood and Affect

 She was more talkative and volume of speech was high.

 Her voice tone was high.

 Sometimes she become sad and started crying at the next she started laughing loudly.

 She show elevated mood

 Her range of affect was labile

Speech and language

 She was fluent in her speech.

 Her quality of speech remained high mostly.

 Her language was understandable

Thought Processes, Thought Content, and Perception

 Her talk was not very much good.

 She easily related the events as her memory was good.

17
 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

of what was going around her.

Insight and Judgment

 Her insight about herself was normal.

 She was aware of what is going around her.

2. House Tree Person ( HTP )

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

and a person and interpretations were done later on.

Behavioral Observation
18
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

depression and irritated mood .

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

and mother. Her drwaing also show loss of pleasure.

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

19
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,

feelings of weakness, or a sense of being overwhelmed.

3. Beck Depression inventory ( BDI )

The Beck Depression Inventory (BDI) is a widely used self-report questionnaire designed to

assess the severity of depression in individuals. It consists of 21 multiple-choice items, each

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

severity of depressive symptoms.

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

interest or pleasure in activities, among others.

4. Altman Self-Rating Mania Scale (ASRM)

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

20
diagnostic workup to confirm a diagnosis of mania or hypomania.

Interpretation

A cutoff score of 6 or higher indicates a high probability of a manic or hypomanic condition

& client show 6 score on Altman self rating mania scale that indicate hypomanic condition of

patient.

CASE FORMULATION

Bipolar II disorder is a mental health condition characterized by a pattern of depressive

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

hypomanic episode must last at least four consecutive days.

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

21
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-

related dysfunctional attitudes such as “high goal attainment”, positive self-dispositional

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.

22
Theraptic Suggestions

Cognitive Behavioral Therapy (CBT)

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

prevent relapse(Leahy, 2008).

Interpersonal and Social Rhythm Therapy (IPSRT)

IPSRT focuses on stabilizing daily routines and improving interpersonal relationships. By

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

of these day to day stressors on their daily routine.

23
Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy that was

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.

DBT combines cognitive-behavioral techniques with mindfulness practices to help manage

intense emotions and improve interpersonal skills. It can be beneficial in addressing emotional

dysregulation and risky behaviors.

Family Therapy

Involving family members in therapy sessions can improve communication, understanding,

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

help a patient get back on track with their family.

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

24
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

towards better mental health outcomes.

25

You might also like