Introduction
The client is in an unstable mood and requires medication to be “normal.” The mother reports that the adolescent needs to learn to control her emotions. The client does not take responsibility for her choices and actions and justifies her behavior. The client bases her opinion of herself on what her mother, other doctors, and current counselor have told her in the past.
Description of the Client
- Age: 17
- Sex: Female
- Cultural background: American
- Languages spoken: English, German
- Means of support: student, 10th grade
Sexual orientation and religious views are unknown; the client does not have epilepsy.
The girl grows up with one parent in the family: an overbearing mother who strongly influences her daughter. According to the client, the father was missing; according to the mother: he died when the patient was 5 years old. Currently, neither the mother nor the patient is in any relationship. The mother wants to help her daughter with the problem and supports her in her treatment. The patient has a lower MOCA and higher MMSE score.
A girl of short stature and thin build, not athletic. She has a positive attitude towards the people around her, including caregivers. However, the patient gets lost and withdraws into herself or completely loses the conversation thread if she answers “wrong” or does not know the answer to the question. According to past entries in the client’s hospital record, this behavior was not typical for the beginning of treatment: the girl reacted significantly negatively and refused to talk to the medical staff.
Brief Pertinent History
The patient is the only child in the family; Both parents raised her until age 5. From a young age, the girl showed much activity and a desire for learning. Therefore, in addition to school, she attended several additional courses, such as learning languages and playing the violin. As a child, the patient was a very sociable child, but in adolescence, it became more difficult for her to make friends and communicate with people. The impetus for the manifestation of bipolar disorder was severe stress, which became a catalyst. The aggravation and the first noticeable symptoms for others occurred not so long ago, at the age of 15, when the girl experienced severe emotional overstrain and fatigue caused by her studies. At the same age, she and her mother went to the doctor, who assigned her to work with a psychotherapist.
Psychiatric and Substance Abuse History
For the first time, the patient asked for help at the age of 15, when her mother began to observe frequently incomprehensible speech in the child, a lot of sudden movements associated with sleep disturbance, which led to a decrease in its need and duration. For two years, the patient went to a psychotherapist, but it did not show any progressive outcomes. Recently the patient began to show more risky behavior towards her surroundings. At the same time, the patient behaves shyly with strangers, including a consultant.
DSM-5 Diagnosis
The patient has a severe bipolar disorder caused by severe shock and excessive exercise. Secondary diagnoses include ADHD and anxiety disorder. A thyroid function test and urinalysis were performed at the start of treatment, and some thyroid abnormalities were shown. Symptoms of manic development of the disease prevail over depressive ones:
- Decreased need for sleep
- Increased talkativeness
- Racing Thoughts
- Easily distracted
- Reduced ability to remember or concentrate or indecision
Case Conceptualization
Bipolar disorder is a set of mood disorders characterized by marked fluctuations in mood, thinking, behavior, energy, and ability to perform daily activities (Robin et al., 2019). The patient exhibits most of the symptoms identified by the theory, such as fluctuations in behavior and mood, changes in memory, and lack of energy. The information obtained will help choose the proper treatment method for the patient. Usually, bipolar disorder is treated with both specialist help and medication. For a diagnosis to be made, the patient must have a history of both manic and depressive episodes, which is what the patient is experiencing.
Treatment Planning
With bipolar disorder, it is necessary to prescribe a comprehensive treatment, which consists of the appointment of psychotherapy and drug treatment. Psychotherapy aims to identify and treat acute symptoms, identify the causes of episodes of emotional disorders, and develop methods that lead to remission (Robin et al., 2019). The purpose of the type of medication depends on what phase the person is currently in. Working with a psychotherapist did not bring visible results, so additional medication support is needed.
Brief Summary of Course of Treatment
Cognitive-behavioral therapy, family-focused therapy, and psychoeducation have proven to be the most effective in preventing relapses. The most successful medical treatment is lithium salt, which is effective in manic episodes and prevents recurrence (Robin et al., 2019). Valproic acid (Depakote) is a mood stabilizer that is useful in treating manic or mixed phases of bipolar disorder (Robin et al., 2019). Treatment can reduce the number of episodes, their severity, and intensity, prevent adverse life events, and help prevent relationship breakups, job loss, and even suicidal attempts. Therapy will help the patient establish the ability to build relationships with people. In addition, repeated rule-outs can be done to ensure the treatment works.
Current Clinical Concerns
At the initial stage of treatment of a problem, strong isolation of the client can cause, especially during psychotherapy. The patient may not make contact, lie, or react aggressively to people new to her, which may lead to a slowdown in the healing process. The issue of transference may arise if the patient refuses to make contact since, otherwise, she does not pose a threat to society.
Conclusion
While symptoms can change over time, bipolar disorder usually requires lifelong treatment. The attending physician can adjust the drug dosage depending on the disease’s stage. Throughout life, from the start of treatment, an individual plan must be followed to cope with the disease by reducing symptoms.
Reference
Robin, A., Sauvaget, A., Deschamps, T., Bulteau, S., & Thomas-Ollivier, V. (2019). Combined measures of psychomotor and cognitive alterations as a potential hallmark for bipolar depression. Psychiatry Investigation, 16(12), 954–957. Web.