Black Swan: a Psychiatric Diagnosis - Essay Example

BLACK SWAN Black Swan: A Psychiatric Diagnosis Word Count 250 (5 pages) I. Psychiatric history 
 a. Identifying data—Identifying data about this patient includes that the subject (or patient) is a female Caucasian ballet dancer in her early 20s. She has come to the clinic seeking help because she feels that she has been having some difficulties. However, we are going to sort all these problems out together. b. Chief complaint—The chief complaint of the dancer Nina (played by Natalie Portman) is that she has either some kind of mood or personality disorder as well as some type of eating disorder possibly. This is what informs her problematic nature as we are evaluating her issues. She will be summarily evaluated. c. History of Present Illness (Including Onset and Precipitating Factors)—The history of the present illness goes back quite awhile. The onset began a bit before the dancer joined her current ballet company. Precipitating factors include the fact that the patient’s mother was also a former ballet dancer who had similar issues which largely went untreated in the past. d. Past Illnesses—Although no past illnesses are known or have been identified, the patient has a history of psychiatric issues stemming from an eating disorder diagnosed when the patient was young, but was not subsequently treated for it. The patient has no known history or background regarding alcohol or substance abuse problems. e. Family History—The patient has a family history of psychiatric problems. The patient’s mother had significant problems with an eating disorder as well when she was going through her pubescent years as an adolescent and on through her years in college—which significantly impacted her career as a dancer. She also had some kind of aggression issues. f. Personal History—The patient’s personal history is that she had a difficult time with her ballet instructors because they were constantly wanting to check her weight. She would be weighed before every practice session and before any kind of performance. Another dancer, Beth, was quote ‘put out to pasture’ for her poor performance. g. Pertinent Early, Middle, Late Childhood and Adulthood History—Pertinent early history includes the fact that Nina was bullied in childhood. In early childhood is when she started dancing, and her eating disorder started when she was young, carrying over into middle and late childhood and later into adulthood. Thus, she has struggled with the eating disorder for a long time. II. Mental Status Exam 

 For the mental status exam, choose a point in time in the film. Do not try to represent the entire film as one mental status exam, particularly if the character changes throughout the film. The mental status exam should include: 
 a. Appearance (Including Behavior and Attitude)—Nina appears to be gaunt and frail within one scene of the movie. She is not looking very well at all. This is typical of how Nina looks throughout the entirety of the film, so this scene was chosen. Nina’s appearance looks very slight, and it is obvious she has not been feeling well. Her attitude is bad and she is cranky.
 b. Speech—Nina’s thoughts are racing and her speech is unusually fast. This “rapid speech” with an “increase in volume” is common in people who have bipolar disorder when in manic phase, according to Kinsella et al. (2006, pp. 24). Usually, bipolars also get animated in the manic phase. There is also a flurry of “heightened…activity[, which] may indicate the manic phase of a bipolar disorder,” according to Assessment (2004, pp. 51). 
 c. Mood and affect—Nina’s mood and overall affect have been severely impaired. d. Thinking (Including Process and Content)—Bipolar disorder can significantly impair thinking. According to Fast (2009), “[M]any people with bipolar disorder develop a milder form of paranoid thinking” (pp. 38). If Nina were taking medications, this could affect the swiftness of her actions and her motor functions. According to Goodwin and Jamison (2007), “[P]rocesses determining the speed of information processing and the speed and organization of motor behavior [can be affected]” (pp. 282). e. Perceptions—The perceptions that Nina was having at the time seemed a little bit odd. Her thinking patterns were skewed, and she was having a difficult time communicating without seeming a bit “mentally” unbalanced. f. Sensorium/Cognition—The cognition level of Nina is high, but she has been having difficulty making clear connections; she is a little bit paranoid; she has certain delusions of grandeur; and she does not have realistic expectations for certain future events. She needs to improve her overall cognitive capacities and critical thinking. g. Insight—The patient has some insight into her condition, but in general is rather naïve about what she needs to do to change her life for the better. The patient, Nina, sees opportunities to change, but first she has to grasp internally what is wrong about her condition. This can only come with recognition and acceptance of her medical conditions. h. Judgment 
(According to Diagnostic Evaluation Assignment NRS 563 3)—Judgment of the patient, Nina, is not that good. She needs to gain more perspective on her situation. She needs to feel, to the depths of her soul, how these disorders or personality problems can negatively affect her life. Nina desperately needs to figure out how she is going to deal with these problems.

 III. Further Diagnostic Studies 
 a. Conclusions—Further diagnostic studies would have to be done by a dietician as well as a practicing clinical psychiatrist. The dietician will probably be able to help Nina with her eating disorder in terms of helping her with meal planning, while seeing the psychiatrist will allow her to get some psychotropic medications to help her deal with her disorder. IV. Summary of Findings a. Conclusion—The summary of findings is that Nina has acute anorexia with the possibility of having bipolar disorder as another diagnosis—and these issues will be discussed further in the next section. V. Diagnosis 
 Indicate the primary diagnosis on all axes (Axis I-V). Indicate the evidence from the film that you are using to support your conclusions. 
Specifically indicate how each of the diagnostic criteria is met. 
Include differential diagnoses that you might rule out. Indicate additional information required to rule in or rule out the alternative diagnoses. 
 a. Explain why you’ve determined these to be differential diagnoses—Due to the fact that Nina was grossly underweight, this led to a diagnosis of anorexia nervosa. Due to Nina’s flitting thoughts and unstable speech patterns and paranoid behaviors—along with an incident that could be considered a manic episode—she will be diagnosed with having bipolar II disorder. VI. Prognosis 
 a. Assessment of Risk of Harm to Self and Others—Nina might have a possibility of causing harm to her fellow dancers Beth or Lily due to her unusual attitude and behaviors. Since she has behaviors which are highly erratic—and she isn’t eating right—it is concluded that Nina needs immediate intervention, which will be discussed more in the recommendations section. b. Overall Prognosis—Nina’s overall prognosis is good, provided that she sticks to a healthy diet and also takes her prescribed psychotropic medications. She has to maintain good medication management in order to effectively recover significantly and start to lead a more normal existence. c. Evidence to Support Prognostic Future—Evidence which supports Nina’s prognostic for the future shows that, should she eat a normal diet as recommended by her dietician—as well as maintains compliance with the medication regimen prescribed by her psychiatrist—she should be absolutely fine. VII. Comprehensive Treatment Recommendations 
 a. Biological Intervention—The biological intervention for Nina should include her having to take some type of health class at a local college in order to ensure that she has a good grasp of what constitutes healthy eating behaviors as well as exercising, plus an important focus on maintaining good medication management. b. Psychosocial Intervention--In addition to seeing the psychiatrist, Nina should also see a social worker and/or a counselor on a regular basis who can provide her with directive counseling in order to help her balance her work life with her studying and then have some time left for leisure. c. Initial Disposition—The initial disposition was that this treatment needed to be received by the patient as soon as possible or else she was in danger of dying, simply due to the fact that her physical condition was so radically deteriorated and definitely needing immediate attention by medical professionals. d. Give the Rationale for Your Initial Disposition—The rationale for the initial disposition was that the patient (Nina) needed immediate medical attention for her diagnoses of both anorexia nervosa and manic-depression, bipolar II. Nina needs to receive medication from her psychiatrist and comply with the medication regimen that he or she might prescribe in order to stabilize her immediately. REFERENCES Assessment: a 2-in-1 reference for nurses. (2004). US: Lippincott Williams & Wilkins. Avnet, J. (Executive Producer), & Aronofsky, D. (Director). (2010). Black Swan [Motion picture]. United States: Fox Searchlight Pictures. Fast, J.A. (2009). Loving someone with bipolar disorder. US: Accessible Publishing Systems PTY, Ltd. Goodwin, F.K. & Jamison, K.R. (2007). Manic-depressive illness: bipolar disorders and recurrent depression, vol. 1. UK: Oxford University Press. Kinsella, C., Kinsella, C., & Patel, V. (2006). Introducing mental health: a practical guide. US: Jessica Kingsley Publishers. Read More