Psych Formulation on Bipolar patient - Case Study Example

? Psych Case Formulation on Bipolar patient due: Introduction Bipolar disorder refers to a brain disorder that leads to unusual set of “mood swing” conditions; this is an alternating appearance of two emotional extremes. This condition; also known as manic depression, describes exaggerated mood swings, energy, activity levels, delusions of having extraordinary talents, and cognition from one extreme emotion to the other. Bipolar patients experience recurrent episodes of high or elevated moods; characteristics of mania and depression states. Bipolar disorder symptoms can lead to broken relations, and even suicide. Individuals who experience the combination of major depressive episodes and mania are diagnosed with bipolar I disorder, and individuals who experience the combination of major depressive episodes and hypomania are diagnosed with bipolar II disorder. Bipolar illness is a long term condition that can be managed throughout the lifetime of a patient; enabling the patient to lead a healthy life. This paper will deal with sequences of thought, feelings, and deeds that are maladaptive, disruptive, either for the bipolar patient; treatment options will also be discussed in this paper. Clinical data of bipolar disorders Clinical data regarding to bipolar disorders is used by most researchers, who follow the bio-psychosocial approach. Bipolar disorder is a psychological disorder, analyzing it requires the combination and interaction of biological factors, psychological process, and socio-cultural contexts. According to a survey performed by Kessler et al (2005), bipolar disorder develops in an individual’s late teens or early adult life, before the 25 years (p. 593-602). A small percentage of bipolar patients experience their initial symptoms during childhood while a larger percentage develops symptoms later on in life. It is very hard to make a diagnosis of bipolar disorder during its onset. This can be better explained by the neurobiological model which focuses on genetic influences and biological disturbances in the brain. Most individuals go through so much anguish for years before they are correctly diagnosed and treated. This study also proved that this mood disorder may be due to problems in the frontal lobes, hippocampus, and other brain parts associated with moods. Imbalanced of neurotransmitters such as norepinephrine, dopamine, and serotonin according to research is one of the causes of late onset of bipolar disorders. Current completed epidemiological research has approximated the lifetime occurrence of bipolar I and II disorders in the general population to be 3.7%–3.9% (Hirschfeld et al, 2003; Kessler et al, 2005). The frequency in samples of patients displaying depression is much higher, ranging from 21% (Hirschfeld et al, 2005) to 26% (Manning et al, 1997) in primary care settings, and from 28% (Hantouche et al, 1998) to 49% (Benazzi, 1997) in psychiatric clinics. A study conducted by Hirschfeld et all (2000) on the development and validation of a screening instrument for bipolar spectrum disorder recommended the mood disorder questionnaire. Results from this study proved that the use of screening equipment, such as the Mood Disorder Questionnaire, can significantly improve recognition of individuals with bipolar illness, particularly among depressed patients. These results aid in the displaying of bio-psychosocial elucidations, which emphasize the impact of anxiety, negative thoughts, and other psychosocial and emotional responses. From the questioner, the way the participants thought about their stressors indicated the likelihood of a mood disorder. A study funded by the national institute of mental health, conducted by Frank et al (2005) revealed the likelihood of relapse due to psychosocial intervention. Careful attention is paid to the social and cultural factors that form the context, or background of abnormal behavior. From the data obtained, psychosocial intervention centered on the interpersonal issues and social rhythms regulation during acute treatment in bipolar I patients extended the duration to a new episode and reduced the chances of a relapse. Salient features of bipolar disorders Symptoms of bipolar disorder involve extreme moods, especially if the extremes are conflicting with the events around a person. They exhibit abnormal behaviors, which are statistically infrequent from what most average people do. They are different from the usual moods experienced by other people from time to time. Bipolar patients break current social rules and cultural norms on how to behave. Bipolar patients flaunt impaired functioning; they have difficulty in fulfilling appropriate and expected roles in the family and social lives. People with this condition experience intense emotional states that occur in separate times. These mood episodes can be an elevated overexcitement, or and joy resulting to a manic episode; an extremely sad and or depressed state leads to a depressive episode. In some cases, a mood episode is inclusive of both the depressive and manic. Episodes of mania and depression typically come back over time. The prominent feature of bipolar disorder is the explosive and irritable behaviors during a mood episode; expressed by patients who have this condition. Important issues that provide insight into the intraindividual and inter-individual aspects of bipolar condition Thoughts and ideas of a bipolar patient are incoherent and lack rationality. Bipolar patients are unaware of the illness. The lack of consensual perspective brings about a feeling of frustration among the family of the concerned patient. The patient being diagnosed or treated may be sure that he or she is not unwell from the said condition; in most cases they deny they have the condition. This represents poor insight as the patient is unaware of the illness. This issue may inflict great distress on the patient. The insight of bipolar condition is complex. According to Markova and Berrios (1995), the insight of an illness comprises not only the phenomenon, but also constructions by the patient, medical practitioner, and the interactive process. This contributes to the shaping of the final contract. The insight of illness represents an observable fact which takes into account what is being represented or evaluated; rather than what is happening. This brings about a contradiction between the epistemological and ontological viewpoints. Bipolar patient problems and interventions An issue with bipolar condition is that a relapse and sub-syndromal symptoms may occur even with optimum medication treatment. This brings problems with psychosocial functioning. High expressed emotion is associated with increased risk of relapse and poor outcomes. Adjunctive psychosocial treatments can improve clinical outcomes and psychosocial functioning. Patients with the bipolar condition may experience either elevated or downhill mood phase for weeks, even months. This may drastically interfere with the ability of the bipolar patient to manage ordinary activities for instance working. During a manic period, bipolar patients are very competitive and active; outdoing others at work; this is a positive effect. A negative effect is when the patient is experiencing a depressive phase. During this period, the patient will find it very difficult to work and even function normally. These phases can result in loss of job, relationships, etc. which can increase instability. A severe problem associated with bipolar disorders is the high risk for “accidentally” or intentionally killing self. Bipolar condition requires constant administration of medication lack of taking medications may result to a relapse, which is a problem to the patient as well as the family. The main aims of treatment are: to prevent relapse of mood episodes, restore psychosocial functioning, and alleviate acute mood symptoms. The targets of psychosocial interventions in bipolar disorder are essential in recognition of early warning symptoms and early intervention. Also, the targets are essential in reducing the impact of psychosocial factors related to relapse. Evidence-based psychosocial treatments for bipolar disorder include: psycho-education family focused therapy, group therapy, electroconvulsive therapy, interpersonal and social rhythm therapy, and cognitive-behavioral therapy. The therapy based interventions are focused on the cognitive behavior of the patient. These interventions are best used with medication (pharmacotherapy). These interventions extend the duration to relapse, increase medication adherence, and reduce symptom severity. Identification of choice of goals with rationale Family-focused therapy aims to diminish the high levels of stress and conflict in the families of bipolar patients. This is done by having a counseling session with the family as well as the bipolar patient. This therapy session is essential in improving the patient's illness path. Interpersonal and social rhythm therapy is another choice of therapy that can be applied to bipolar patients. This rationale focuses on stabilizing the every day and nightly routines of bipolar patients, as well as resolving main interpersonal issues that the bipolar patient goes through. Cognitive-behavioral therapy helps bipolar patients in modifying dysfunctional cognitions and behaviors that may exaggerate the track of the bipolar disorder. Group psycho-education is another therapeutic technique which offers a supportive, interactive setting in which the bipolar patients learn about their disorder and how to cope with it. These treatment plans are essential in maintain a regular life to the bipolar patient. Medication/therapy and rationale for choice Psychopharmacology is the foundation of treatment for bipolar disorder. The best rationale is psycho-education. Psycho-education provides information about bipolar disorder and the treatment. It teaches early warning symptoms, recognition, and coping skills to prevent relapse. It is a key element across all evidence-based psychotherapies for bipolar disorders. This is because it has a longer time to manic relapse and fewer manic relapses (Perry et al, 1999). Therefore, psycho-education is an effective adjunction maintenance therapy. Change in target symptoms by which intervention effectiveness will be evaluated Studies carried out by researchers reveal some benefit of psychosocial interventions. Therapies overlap in target symptoms for change. The treatment choice is mainly influenced by patient choice, availability of therapist, and individual characteristics. Prognosis with rationale The purpose of diagnosis is to determine the nature of people’s problems so proper treatment can be administered. Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The fourth edition of the DSM provides criteria outlining the conditions that must be present for diagnosis of a particular psychological disorder. There are five axes used in the DSM evaluation of a psychological condition. According to the DSM, there are four primary types of bipolar disorder: Bipolar I Disorder, bipolar II disorder, Bipolar Disorder Not Otherwise Specified (BP-NOS), and Cyclothymic Disorder, or Cyclothymia. Issues that will challenge therapeutic elements/goals Change of a treatment plan is a primary issue that will change the therapeutic elements/ goal. This is because the pharmacological mechanism of action will be affected, affecting the brain. This may lead to a relapse. Lack of plans for early invention will challenge the therapeutic goal/ elements. Usually, a plan is essential in recognition of early warning symptoms. Also, lack of proper and consistent communication with a constant therapist is a main challenge to therapeutic elements/ goals. Mixing up of therapists will lead to mixed advising; thus a constant relapse. Mixing up of medication will challenge therapeutic goals set. References Benazzi F: Prevalence of bipolar II disorder in outpatient depression: a 203-case study in private practice. J Affect Disord 1997; 43:163–166 Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA, Fagiolini AM, Grochocinski V, Houck P, Scott J, Thompson W, Monk T: Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005; 62:996–1004 Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602. Hantouche EG, Akiskal HS, Lancrenon S, Allilaire JF, Sechter D, Azorin JM, Bourgeois M, Fraud JP, Chatenet-Duchene L: Systematic clinical methodology for validating bipolar II disorder: data in mid-stream from a French national multi-site study (EPIDEP). J Affect Disord 1998; 50:163–173 Hirschfeld RM, Calabrese JR, Weissman MM, Reed M, Davies MA, Frye MA, Keck PE Jr, Lewis L, McElroy SL, McNulty JP, Wagner KD: Screening for bipolar disorder in the community. J Clin Psychiatry 2003; 64:53–59 Hirschfeld RM, Cass AR, Holt DC, Carlson CA: Screening for bipolar disorder in patients treated for depression in a family medicine clinic. J Am Board Fam Pract 2005; 18:233–239 Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr, Lewis L, McElroy SL, Post RM, Rapport DJ, Russell JM, Sachs GS, Zajecka J: Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry 2000; 157:1873–1875 Markova,I.S. and Berrios,G.E., 1995. Insight in clinical psychiatry. A new model. J Nerv Ment Dis. 183, 743-751. Manning JS, Haykal RF, Connor PD, Akiskal HS: On the nature of depressive and anxious states in a family practice setting: the high prevalence of bipolar II and related disorders in a cohort followed longitudinally. Compr Psychiatry 1997; 38:102–108 Perry A, et al. BMJ.1999;318:149--152; 2Peet M, Harvey NS. Br J Psychiatry.1991;158:197- 200; 3Cochran SD. J Consult Clin Psychol.1984;52:873--878; 4Colom F, et al. Arch Gen Psychiatry.2003;60:402--407; 5Colom F, et al. Bipolar Disorders. 2004;6:294--298. Read More