Description
Goal:
To analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.
Chapter 6, Case 1
Trisha is a 28-year-old, unemployed white female. She is no stranger to therapy, having seen counselors for most of her teen and adult years. Her friends would describe her as a ?wild woman? who takes no crap from anyone. She has held various part-time jobs for the last few years because she usually gets angry at her boss or coworkers and quits. While she has had a string of boyfriends over the years, she has been seeing one man for the last year or so. He too is unemployed and has both an alcohol and methamphetamine problem. She describes the relationship as ?addictive and dysfunctional, yet exciting and hot.? Trisha is back in treatment at the urging of her parents, who describe her behavior as erratic and unpredictable. They also claim that she has periods where she ?sleeps little and parties lots.? There were also several occasions in the last five years when she was so depressed she didn?t eat or want to leave the house. Her father also admits to periods of depression, and Trisha?s grandfather was diagnosed with manic depression, resulting in numerous hospitalizations in the 1950s and 1960s. Trisha?s only brother died in a car accident several years ago. He was drunk at the time, but she claims he had a long history of depression. Recently Trisha was arrested for disorderly conduct at a friend?s party. She had not slept for nearly 24 hours and was drunk and combative. When she was first approached by police, she solicited them for sex. They report that she was rather hyperverbal and hyperactive. They later had to investigate a complaint from local storeowners for bad checks she wrote in excess of $7,000.
Questions:
Remember to answer these questions from your textbooks and clinical guidelines to create your evidence based treatment plan. At all times, explain your answers.
Summarize the clinical case.
Create a list of the patient?s problems and prioritize them.
Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe? Include the rationale for this treatment.
Include an assessment of treatment?s appropriateness, cost, effectiveness, safety, and potential for patient adherence.
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Chapter 6 ? Treatment of Bipolar Disorder
CASE VIGNETTES
Case 1
11
CLINICAL HISTORY
Trisha is a 28-year-old, unemployed white female. She is no stranger to therapy, having seen
counselors for most of her teen and adult years. Her friends would describe her as a “wild woman’
who takes no crap from anyone. She has held various part-time jobs for the last few years because
she usually gets angry at her boss or coworkers and quits. While she has had a string of boyfriends
over the years, she has been seeing one man for the last year or so. He too is unemployed and
has both an alcohol and methamphetamine problem. She describes the relationship as “addic-
tive and dysfunctional, yet exciting and hot.” Trisha is back in treatment at the urging of her par-
ents, who describe her behavior as erratic and unpredictable. They also claim that she has periods
where she “sleeps little and parties lots.” There were also several occasions in the last five years
when she was so depressed she didn’t eat or want to leave the house. Her father also admits to
periods of depression, and Trisha’s grandfather was diagnosed with manic depression, resulting in
numerous hospitalizations in the 1950s and 1960s. Trisha’s only brother died in a car accident sev-
eral years ago. He was drunk at the time, but she claims he had a long history of depression.
Recently Trisha was arrested for disorderly conduct at a friend’s party. She had not slept for nearly
24 hours and was drunk and combative. When she was first approached by police, she solicited
them for sex. They report that she was rather hyperverbal and hyperactive. They later had to
investigate a complaint from local storeowners for bad checks she wrote in excess of $7,000.
POSTCASE DISCUSSION AND DIAGNOSIS
Trisha has Bipolar Disorder Type I, Most Recent Episode Manic (F30.13). She appeared to have
boundless energy with little need to rest and was engaging in dangerous, promiscuous and irre-
sponsible behavior. She also meets criteria for recent episodes of major depression. According to
Trisha and her parents, she uses alcohol only when she is feeling “high on life” or when she is so
depressed she can’t get out of bed. There is also a positive family history for both unipolar and
bipolar depression.
PSYCHOPHARMACOLOGICAL TREATMENT
Upon consultation with a psychiatrist, Trisha was placed on valproate and titrated to a dose of
750 mg daily. In addition, her psychiatrist added quetiapine 300 mg q.h.s. to assist with sleeping
and restlessness at night. Trisha’s mood has stabilized, and she has been attending therapy twice
weekly and group once weekly. She has also been able to return to a part-time job as a waitress and
is no longer dating her boyfriend, who was recently arrested for methamphetamine use. She hopes
to attend college next year if she is able to save enough money for her own apartment. She has
gained much insight into her illness and now helps other young women in a local support group.
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