+1 862 207 3288 Case Vignette – Joan
Please be sure to go to the Argosy website to complete all readings before beginning the assignment at:
Go to diagnosis and treatment planning and launch class and read modules 1,2,3,4, and 5.
Then the treatment plan attachment chart is a one page chart that you fill in the blank.
It is very important that you go to the argosy and read everything along with the attachments and read originally assigment that was done on jona so that you can see what is wrong with her.Joan is diagnosed with bipolar I. you have to look at whats been written about Joan:
• Describe the most likely recommended treatment methods for this client and the rationale for selecting the same.
I would refer her to a psychiatrist to get her back on Lithium to control her mood. I would use Cognitive Therapy techniques to help her to connect her feelings to her behaviors. I would teach her reality testing techniques to help her to discover if her thoughts about what others are thinking about her are true. I would teach her thought stopping techniques to control the racing thoughts. I would recommend that she write in a journal to identify triggers. I would assess her for suicide ideation, self injurious behaviors and dangerous sexual practices and if she has any of these I would help her to create a safety plan to prevent her from acting out of impulse during a manic episode.
• If the client came to see you for therapy, how would you initially begin to work with him or her?
I would assess her for safety during manic episodes and create a safety plan with her if she has a history of or a pattern of unsafe behaviors. I would build rapport and trust with her because she sounds like she has some paranoia. I would help her to create a daily schedule that will help her to be medication compliant, get regular rest, exercise and a balanced work schedule to keep her mania under control. I would help her to create three simple goals to manage her mood and the mania and check in with her weekly to see how she is progress with her goals.
1. Current symptom picture and pertinent background information:
• Presenting Complaint- Client is presenting at the clinic requesting to start taking Lithium again because she states that she feels “unstable”, she is having difficulty sleeping, feels jittery, feels concerned about what other people are thinking and is having difficulty focusing on work projects because her thoughts are racing.
• Background Information:
o Modeling and Learning- Client was able to graduate from college with high grades, have several friends and keep a job.
o Life Events- The client recently moved to the San Francisco Bay area for a publishing job. Client’s symptoms started four years ago in college during final exams. At that time she began to feel depressed, had difficulty sleeping and eating and lost 15 pounds. She completed her exams, but her symptoms continued for the next two months and she became more isolated socially. After she graduated she felt much better, got a job, and felt increasingly energized. She felt so energized that that she didn’t seem to need much sleep and would wake up after 3-4 hours feeling wide awake and could put in a 10-11 hour day of work. She would feel her thoughts racing with new ideas and seemed to come up with creative ideas, although she did not often carry thru on these and other people didn’t seem to understand them. She was partying and socializing a great deal with the excessive use of alcohol, but denies drug use. At that time she found herself preoccupied with sexual thoughts and found sexual implications in whatever people said to her or what she saw on TV. She was very talkative and felt euphoric except when she felt extremely irritable or “cranky” with people. She would strike up conversations with complete strangers and she thought she could hear people who were not actually talking to her. She thought that her apartment was haunted. The voices would sometimes tell her to do things like line objects up in a certain order, take a different route home or start saying certain words aloud. She also thought that she could read other people’s thoughts and was sure that they could read hers and that they would answer her thoughts even though she did not say them out loud. She made the statement that she thinks she has always been psychic, but that “it just really took off” and she was sensing all kinds of things. Her friends became concerned and took her to the emergency room and then she was hospitalized for several days and put on lithium. Most of her symptoms seemed to abate, although she felt more slowed down and fatigued and her sleeping pattern improved and her appetite increased. In the course of moving to the Bay Area she stopped taking the lithium because her prescription ran out and she lost contact with the prescribing psychiatrist.
o Genetics and Temperament-There is no information about genetics and temperament given by the client, but I would ask her if anyone else in her family suffers from Bipolar disorder or any other psychotic disorders
o Physical Conditions- She did not state any physical conditions, but I would recommend that she have a physical with a medical doctor to ask the doctor if she needs a cat scan or MRI to rule out organic disease like a brain tumor that could be causing the psychosis and mania.
o Drugs- denies the use of drugs, but stated she has used alcohol excessively in the past.
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o Socioeconomic and Cultural Factors-The client is a 26 year old female of unknown ethnicity. The client recently moved to the San Francisco Bay area for a job in publishing and has a Bachelors degree. She has friends, but has a history of isolating herself from them when not feeling well the. Client is mentions that she feels she has always been psychic and it is important to ask her how her culture views psychic attributes and how they affect her life and interactions with her family.
2. Differential diagnosis considerations:
• What are the disorders or groups of disorders that you think need to be explored more to determine the specific diagnosis here?
• Your rationale
3. Multi-axial Diagnosis:
• Numeric codes
• Full names of disorders
Axis 1
Axis 2
Axis 3
Axis 4
Axis 5
2. Differential Diagnosis considerations.
What are the disorders or groups of disorders that you think need to be explored more to determine the specific diagnosis here?
I would rule out Schizoaffective Disorder, Bipolar II disorder, psychotic disorder, mood disorder and Adjustment disorder.
Your rationale
I would need more information on if the psychotic features are mood congruent,
If she is mainly hypomanic when medicated and if adjusting to new events brings out psychotic symptoms and mood symptoms.
3. Axis I- 296.44 Bipolar I Disorder, Most recent episode Manic, severe with psychotic features.
Axis II- None V71.09
Axis III- None
Axis IV- Problems related to the social environment, occupational problems
Axis V-55
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author
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