Bipolar I Disorder Case Study

Introduction

The case study presents a white man who has been diagnosed with bipolar I disorder. For him to resume his wife and community living, he has been referred to occupational therapy. It is through the therapy that he is expected to be evaluated and develop the skills that are required. On Valentine’s Day, the man was involved in an incident where he was admitted to a general hospital. A year ago, before this day, he enucleated his leg after he got stabbed in his right eye. He said that the self-mutilation was due to biblical passage. At the moment, he was taken to a men’s outpatient clinic. Four months later, it was not possible for him to be maintained in a community; thus, he was admitted to a state hospital. As such, this became their first psychiatric hospitalization, even though he had psychiatric consultations when he was at the age of 23 years. Due to emotional problems, it became a problem for him to function at work.

Personal Data

The parents of the patient separated when he was just 6 years old. This was just after his sibling, who is a girl, was born. The man moved in with his mother after the separation. Besides, they also moved with his sister from Virginia to Maryland, thus lacking any contact with his father from that time. His mother is controlling, rigid and very religious in that matter. Baptism leads to church affiliation. During his school years, the patient experienced some emotional problems. In this case, his description fits that of a schizoid child. Thus, he received special education in a school that compensated for his social isolation. More so, special education facilitated interpersonal relationship difficulties. The patient holds a high school diploma. For five years, Mr. Kennedy worked as a horse trainer, and for another five years, he worked in his mother’s florist business.

When he was 24 years old, he got sick and could no longer work. This may be said to be a precipitating incident as it happened after a stranger knocked on a door and asked a man with a similar name as the patient. Afterward, the patient was subconsciously and, at the same was, concerned about the stranger who had knocked on the door. Accompanied by his mother, he attended bible study classes, and it was the place where he met his future wife. They later became engaged. However, he was indecisive and anxious concerning the pending marriage. During this period, he got mutilated in his eye. He stayed in a general hospital for 4 months after when he was discharged. He later followed weekly outpatient visits. The clinic advised him not to marry, but he went against that. However, he was not in a position to consummate his marriage due to impotence. He could not manage feces and had incontinent urine. After the marriage, he was readmitted to a state psychiatric clinic.

He was withdrawn immediately after the admissions as he showed blunted effects. He became delusional as he expressed the idea that there was someone gripping his mind. More so, he said that Jesus was Satan. During this time, his medication was changed to lithium, and it appeared to be effective and efficient from that time.

Client’s Treatment Plan As Recorded In Case Study

The right eye of the patient remained extensive, especially during the first two months of the outpatient tenure. The patient had Poor cooperation and carelessness, causing poor hygiene, stretching of the eye socket and chronic infections. As such, he was not able to use a prosthesis. He, therefore, wore an eye patch.

The initial terms of treatment included rehabilitation. In the planning conference, they had the aim of helping the patient in making efficient adjustments, thus resuming community living and his wife. The wife had an interest in switching roles. She was still working as a rental agent secretary in an apartment complex. All the same, he was still taking care of the home. It was not clear if this was the best arrangement or if the patient should have returned to his former worker.

Another treatment plan included occupational therapy evaluation, which involved the Kohlman evaluation of living skills, a street survival questionnaire and an assessment of sensory-perceptual-motor. These were given by an occupational therapist. In the process, they noted a deficit in the standing balance of the patient. Moreover, the patient had no ability to perform household chores, lacked proper first aid skills, uwas nfamiliar with household tasks, had poor laundry skills not able to identify household safety problems. Further he was not familiar with budgeting, paying bills, grocery shopping as well as banking. He had difficulties in identifying leisure interests and had no motivation to use leisure effectively.

After noting those problems, the therapist established a one-to-one sensorimotor session with the aim of improving the standing balance of the patient. There were arrangements for the patient to attend work adjustment sessions and occupational therapy, which lasted for six months. The program was carried out in horticulture since the patient used a florist shop. However, after a one-week trial, the program failed the floral shop.

The client’s treatment plan is further than is recorded in the case study.

The first phase, as is always the case, is conducting tests and physical examinations. Through this, one will be in a position to rule out other conditions that may be the cause of the emotions of the man. Such problems may be brain tumors, stroke and thyroid problems. While conducting the tests, I will also be interested in family history regarding the condition or any other mental conditions.

According to Kennedy, no family member has been indicated to have any symptoms of the disorder, though there is minimal information about his father. His story involves marital problems and emotions at the workplace. The patient was diagnosed with mental problems as he was noted to have problems with performing house chores, as he was not even familiar with some of them. In most cases, bipolar patients are advised to seek medical care only after being profoundly low. Doctors may confuse the disorder, thus giving the wrong medication (National Collaborating Centre for Mental Health, 2006).

For the patient to recover from bipolar, it would be necessary to be under psychotherapy for a period of several years. Family members should be present during the treatment such that they provide accurate information regarding the patient. Another thing that may provide valuable information includes the use of the Mood Disorder Questionnaire.

Bipolar turmoil can be dealt with and kept up; in any case, it is a lifetime condition, which means the treatment convention must be kept up to dodge a backslide. Treatment of bipolar issues requires a careful evaluation of the patient, with specific regard for the security of the patient and people around him and also thoughtfulness regarding conceivable comorbid mental or therapeutic ailments. Notwithstanding the present disposition expressed, the clinician needs to think about the longitudinal history of the patient’s sickness.

Treatment has the objective of accomplishing reduction, characterized as an entire comeback to the standard level of working and a virtual absence of manifestations. After effectively finishing the intense period of treatment, patients enter the support stage. Now, the essential objective of treatment is to advance assurance against a repeat of depressive or hypomanic conditions. Simultaneously, consideration should be committed to boosting quiet working and limiting sub-edge side effects and antagonistic impacts of treatment.

The regular pharmaceuticals utilized for bipolar confusion are state-of-mind stabilizers, antidepressants and atypical hostile to psychotics, despite the fact that the most recommended prescriptions for bipolar turmoil are mind-set stabilizers. These pharmaceuticals can have diverse reactions for various individuals, making it extremely critical for patients to hold fast to their specialist’s requests and also remain in contact with their specialist and examine any symptoms. The run-of-the-mill solutions utilized for bipolar turmoil are state-of-mind stabilizers, antidepressants and atypical hostility to psychotics, despite the fact that the most recommended drugs for bipolar confusion are temperament stabilizers.

Individuals react contrastingly to various solutions and doses, so it takes experimentation before hitting the nail on the head. Hereditary testing can enable a specialist to better see how a man utilizes distinctive medications, making it less demanding to choose the correct medication for every person.

State-of-mind stabilizers like Lithium can cause a few reactions, for example, anxiety, skin inflammation, heartburn, muscle torment and surprising distress to frosty temperatures.

Atypical antipsychotics are once in a while used to treat indications of bipolar issues. Often, these drugs are taken with different prescriptions, for example, antidepressants. Reactions of numerous anti-psychotics incorporate sluggishness, obscured vision, heartburn, affectability to the sun and menstrual issues for ladies.

Psychotherapy is another essential component of treatment for bipolar turmoil. It offers help, training, and direction to those with turmoil to enable them to figure out how to control their emotional episodes. There are a couple of various sorts of psychotherapy that a man can incorporate into his treatment.

Psychological and behavioral treatment encourages a man to change their negative contemplations and Behavior. Family-engaged treatment includes a man’s family, educating both the patient and the family on ways of dealing with stress for managing the confusion. Relational and social psychotherapy can enable a man to figure out how to deal with their connections and, in addition, make standard plans and manage everyday life issues. At long last, a man may experience psycho-training, which instructs a man about the confusion so he or she will perceive a disposition change and have the capacity to look for treatment and stop issues before they begin.

Describe your role (as an OTA) in the evaluation process.

My role as an OTA would be to help increase confidence and comfort, thus allowing the patients to carry out the role of home management. Helps in improving the ability to plan and execute basic household tasks, which the client here is lacking. I can help the patient is have established basic communication ability specifically to relate with others. This can be in self-assertion and in small groups. As OTA, I can teach techniques that would compensate for visual defects, maintenance of eye sockets and patches, as well as hygiene (Nathan & Gorm, 2015). Teaching techniques that would be helpful in stress management and establishment of the habit of using them. Lastly, I can help the patient in exploring leisure interests and developing a habit of participating in leisure activities.

Observation of the Client’s occupational deficits and related underlying impairments;

As observed in the case study, the patient is having some defects such as visual, lack of balance and lack of connection of things.

Discernment is the instrument by which the cerebrum deciphers tactile data from the surroundings. The apparent data is then additionally handled by the different psychological capacities, and the individual may pick either to react with a verbal articulation or engine act or to just see and consider the watched boosts.

In early improvement, material, proprioceptive, vestibular, and visual discernment give a disguised feeling of the body plot, which is essential to all engine work. The procedure of translating visual info is an educated expertise, as confirmed by a dazed person who, when locate is reestablished sometime down the road, experiences issues comprehending what they see.

Extreme perceptual shortfalls, as often as possible joined with psychological impedances, can influence each region of occupation and can genuine wellbeing concerns.

Describe how you would work in collaboration with your supervising OT using clinical reasoning in selecting evaluation tools and interventions during the initial evaluation for the client.

Clinical thinking is the procedure in which the advisor, associating with the patient and others (for example, relatives or others giving consideration), enables patients to structure importance, objectives, and well-being administration systems in view of clinical information, tolerant decisions, and expert judgment and learning. In the course of the most recent decade, clinical thinking has come to noticeable quality as a subject for ponder. This has happened, to some extent, in view of the abilities expected of physical advisors and the advancement of the calling in a changing human services atmosphere that requires expanding responsibility in basic leadership as a major aspect of the way toward giving alluring outcomes. Another motivation for the rising significance of clinical thinking is that free and capable basic leadership is presently viewed as one of the attributes of an independent profession. Clinical thinking is pertinent in light of the fact that each physical specialist needs to settle on a wide assortment of choices in his or her day-by-day clinical practice. All clinicians, consequently, have an enthusiasm for enhancing their basic leadership. Thinking about basic leadership is a piece of a sound clinical thinking process and is an imperative wellspring of learning in practice.

Select and write treatment goals for the client.

I would use simple criteria of objectives, participation, support and the outcomes of the patient.

What other referrals might the client benefit from? Why? Support your answer.

Other referrals may include mental health specialists. The specialist may help the client in treating recurrent psychotic disorders. They would as well provide psychological interventions, medications as well as combined treatment. More so, the patient may be sent to the inpatient care team. They help people with severe self-neglect and those with risk to life. They offer combined treatments.

Describe the additional treatment methods and interventions you would use.

Another treatment may involve the use of light therapy. Light treatment for occasional full of feeling issues has been examined for quite a while. Normally, it strikes in winter. However, more applications have been going to the bleeding edge.

What occupational therapy interventions and procedures would you use to provide training to the client and his or her family in self-care, self-management, health management and maintenance, home management, community and work or school integration, or any other area of occupation not listed but you deem important?

Living with a man who has bipolar turmoil can be troublesome, causing strain in family and conjugal connections. Family-engaged treatment tends to these issues and attempts to reestablish a sound and strong home condition. Teaching relatives about the ailment and how to adapt to its indications is a noteworthy part of treatment (American Psychiatric Association, 2002). Working through issues in the home and enhancing correspondence is additionally a focal point of treatment.

What methods would you use to enhance the client’s safety, wellness, and performance in activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, play, leisure, and social participation?

Individuals with bipolar turmoil are accepted to have excessively touchy natural tickers, the inside timekeepers that control circadian rhythms. This clock is effortlessly thrown off by interruptions in your day-by-day example of action, otherwise called your “social rhythms.” Social cadence treatment centers around balancing out social rhythms, for example, resting, eating, and working out. At the point when these rhythms are steady, the organic rhythms that control the state of mind stay stable as well.

Describe how you would engage the client and his or her family in occupational performance and evidence-based intervention planning and implementation, considering the client’s occupational profile, client factors, performance patterns, contexts, activity demands, performance skills, and aspects of diversity.

The family, in this case, is very critical. For the reduction of symptoms, there must be a combination family family-focused therapy and pharmacotherapy trials. Family therapy is involved in psych education in regard to the etiology and symptoms of the disorder. Besides, they should acquire skills for medication adherence. For the reduction of conflict, the family members should be aware of problem-solving skills am resolving family issues.

Describe how you would provide therapeutic use of occupation, exercise and activities as part of the client’s intervention.

A crucial focus is on occupational therapy in mental health practices as well as the clients’ interaction as well as communication skills. The skills provided by the occupational therapist help in bringing about positive interaction as well as positive outcomes when individuals interact with people with Bipolar disorder. Such skill enables patients to be treated the clients especially in a severe mental situation. As a therapist, there are a number of ways that the therapy may be applied to the client. It can be a clinical as well as a client setting where it is meant to provide help to clients who have severe mental disorders and enduring mental health problems. Therefore, this method of theoretic therapy is the best since it involves the client’s participation with the experts.

Explain how you would provide training in self-care, self-management, home management, and community and work or school integration for the client.

In self-management of training for the purposes of the integration of the client, community-based self-management is one of the most important aspects. It is a population approach method that aims at approaching the increased population of individuals with mental illness. Self-management and training are the aspects of actively engaging with a mentally ill client; it means that the client has to fully participate in the mediation process instead of being there just to follow the doctor’s recommendation and try to comply with the whole treatment plan. It is important as an expert in treating mental illness to teach patients how to take care of themselves as well as reducing or handling the complication or disability. It is simply through training the patient and telling them what they should do when in such a complication.

Explain how you would provide training in self-care, self-management, home management, and community and work or school integration for the client.

The services of the client with bipolar disorder have shifted from a hospital institution to the community at large. At first, the model was all about medical, and now the focus has shifted to everything surrounding the patient and not just the medical focus. As a mental therapist, I have been trained on how we support the health of the client, and it improves the outcome, and the result for the people in the community, and the treatment environment should be like a home to them.

Provide development, remediation, and compensation for the client’s physical, cognitive, perceptual, sensory, neuromuscular, and behavioral skills.

Patients with bipolar disorder are usually associated with functional as well as cognitive impairment. It consists of cognitive therapies as well as a cognitive behavioral rehabilitation process. This is a usual treatment for bipolar patients. It is a way of preventing new mood episodes and improving the impairment.

Describe how you would modify the client’s environment and adapt processes to facilitate his occupational performance.

Having space in the rehabilitation will make the client feel at home as well as having a supportive community will enable them to appreciate the medication process. The supportive environment will facilitate participation in learning as well as practicing the skills needed to transition to home.

Assess and recommend home and community programming that will support the client’s occupational performance.

The community, as well as the environment, supports the occupational therapist to be able to match the client’s ideals and goals, and an optimal environment is required for intervention. The most effective way of having occupational therapy is one that is client-centered as well as an occupational-based program.

Describe when you, in collaboration with your supervising OT, may reevaluate or have the treatment plan revised.

Occupational therapists have used traditional approaches in the supervision field due to the impact of the management on the delivery system students in placement and the advantage of the collaborative supervision model, which has evolved into a strong alternative supervision approach. The collaborative model is one of the modified occupational therapy, but apprenticeship is the one that is commonly used.

Describe how you would collaborate with your supervising OT for discharge planning. What type of self-care training and/or management referrals would benefit the client and his family to make the discharge transition smooth?  Why? Support your answer.

There are a number of supervisions required to be undertaken before discharging a bipolar disorder patient who has been undergoing occupational therapy.  An assessment is required to support the patient on the homecoming discharge. It is an opportunity in order to identify the strategies and support to help in recovering and being independent. Family members are welcome in the assessment. The patient should be there since the assessment is a predischarge one. It will enable one to identify any challenges one may experience after being discharged.

Case Study Questions

Question 1

Given that the patient stayed in the hospital for over a year, there were other options that could have been used. The patient could have checkups frequently as the doctor would have kept him safe and symptom-free. Besides, the patient could have taken the medicine even when in stable conditions. Since the medication could not have reduced everything, the family could have ensured that the patient lived a lifestyle that supported his wellness.

Question 2

The patient acquired a home art program. He is also able to take a role in homemaking. In the future, he should embrace leisure activities.

Question 3

RUMBER goals need to be:

• Relevant
• Understandable,
• Measurable,
• Behavioral
• Achievable
• Development of social skills
• Exploration of leisure activities
• Creating confidence and comfort
• Compensation of visual defects through acquired techniques
• Teaching management skills

References

American Psychiatric Association. (2002). Practice guidelines for the treatment of patients with bipolar disorder (revision). American Psychiatric Pub.]

Nathan, P. E., & Gorman, J. M. (Eds.). (2015). A guide to treatments that work. Oxford University Press.

National Collaborating Centre for Mental Health (UK. (2006). Bipolar disorder: the management of bipolar disorder in adults, children and adolescents in primary and secondary care. British Psychological Society.