Vignette Case Study and Analysis
Joan is a 26-year-old single female. She recently migrated to the SAN FRANCISCO BAY AREA Bay Area to benefit a posting business company. Joan's delivering complaint is sense unstable. During the procedure for moving to the Bay Area to start a fresh job, she discontinued her medication, Lithium, and lost contact with her prescribing psychiatrist. She described her condition as having difficulty sleeping, being "jittery", having to worry about what other folks are planning, having difficulty concentrating on work projects, and experiencing race thoughts. She had rapid bursts of energy. She slept for three to four 4 time and worked long hours throughout the day. She noticed elated, euphoric. Other times, she experienced irritable toward people. She was partying, socializing, and preoccupied with intimate thoughts. She had bizarre actions such as speaking with complete strangers. She had rapid speech and racing thoughts and media ideas but she was easily sidetracked and did not complete. Joan also possessed inflated self-esteem and grandiosity. She believed that she was psychic and this she was able to read people's heads. Joan has experienced psychotic episodes where she could hear voices showing her to make use of specific routes, or doing things in a certain order and this her apartment was haunted.
Joan reported that, four years ago, she became stressed out during a demanding period of last exams. Throughout that depressive instance, she acquired difficulty sleeping and eating, lost about fifteen pounds and became socially isolated for the next two months. Her sense of depression sustained despite passing her final exam. She explained her condition prior to the period as doing well in her studies, getting high levels, her social life was good, and this she possessed many friends. There is no information regarding genetics or physical disease. Additionally, there is absolutely no information about her family, socioeconomic or cultural factors except that she is a school graduate and a specialist. Joan denies using drugs but admits to partying and socializing (AOU, 2014).
AXIS I: 296. 44 Bipolar I Disorder, Most Recent Tv show Manic, and Severe with Psychotic Features
AXIS II:V71. 09 No diagnosis
AXIS IV:Issues with public environment: Euphoric or irritate with others
Occupational Problems: Difficulty concentrating on project Stressful environment and situations
AXIS V:CURRENT: 60PAST: 33
Differential identification considerations
Joan's symptoms and behaviours meet the criteria of 296. 44 Bipolar I Disorder, Most Recent Instance Manic, and Severe with Psychotic Features (APA, 2000). During her depressive episodes, she acquired difficulty sleeping, lost her desire for foods, lost weight reduction, and was socially isolated. During her mania instance, she felt unstable. She had unexpected bursts of energy. She slept for three to four 4 hours and worked long hours throughout the day. She thought elated, euphoric. Other times, she believed irritable toward people. She was partying, socializing, and preoccupied with sexual thoughts. She experienced bizarre habits such as speaking with complete strangers. She had rapid talk and racing thoughts and reports ideas but she was easily distracted and didn't carry through. Joan also got inflated self-esteem and grandiosity. She thought that she was psychic which she was able to read people's imagination. Joan has experienced psychotic shows where she could listen to voices revealing her to work with specific routes, or doing things in a certain order and this her apartment was haunted. In this period, her friends were concerned about her well-being and they got her to the emergency room and she was hospitalized and put on psychotropic medication. Moreover, she responded well to the treatment. Her symptoms lowered and she slowed up, could sleep, and acquired her appetite again (Brent & Skillet, 2008).
Schizoaffective and schizophrenia disorders are excluded as examination due to the following: in manic-depressive disorders, the psychotic symptoms are congruent with mania or despair. The average person has a period of normal spirits while some of individuals with schizoaffective disorder may have psychotic symptoms in the lack of unhappiness or mania. Schizophrenia has positive symptoms that may include hallucinations, delusions, and/or a thought disorder. Furthermore, people who have schizophrenia have negative symptoms where they experience insufficient interest in getting together with others or the pleasure in previously enjoyed activities. They speak less, and show a demeanor that is rather level or without much expressiveness (Seidman, et al. , 2002).
Substance-induced mood disorder can have manic features, depressive features, or mixed features. The onset of this disorder occurs during intoxication or withdrawal from drugs. Therefore, it is ruled out do to Joan refused using drugs and she actually is not really a heavy drinker.
Cyclothymia is a frequent and chronic moderate form of bipolar disorder. Cyclothymia has several hypomanic shows with shows of depressed ambiance. These shows of depressed spirits are not severe enough to meet the requirements of manic or a major depressive occurrence. Joan's shows are severe and don't meet the criteria of Cyclothymia (APA, 2000). It is difficult to determine whether there are any medical problems that leading to her symptoms since there is no information that shows any history of condition.
It is important to get the appropriate diagnosis and treatment to successfully control bipolar disorder. You can find no known treat. The treatment ideas must focus on managing symptoms and preventing mood episodes by by using a combination of medication and psychotherapy. Medications can include feelings stabilizers such as valproic acid, lithium, and carbamazepine are effective in treating manic and depressive stages of bipolar disorder and help in preventing future symptoms. Antidepressant can be utilized during the depressive stage. However, they have to be used in conjunction with disposition stabilizer. Using antidepressants exclusively may cause mania in folks with bipolar disorder. Also, regulating sleep is very essential for people with bipolar disorder and helpful in stabilizing moods.
Cognitive-behavioral remedy, or CBT, is used to take care of bipolar disorder. It can help patients identify mental poison and conducts and understand how to modify those to create positive change. Other mental health services may entail members of the family, which helps to manage the patient's symptoms and needs (NIMH, 2008; Hirschfield, 2005; Akiskal, 2009).
Agitation or euphoria
Flight of thoughts
Difficulty pursuing instructions
Rapid pace of speech
Talking exceedingly Interruption of others
Decreased dependence on sleep
Altered sense of self-importance
Delusional thought content
High-risk seeking behaviors
Joan will take psychotropic medication as prescribed
Identify factors behind stress which may increase the threat of relapse
Develop a relapse drill for relatives and buddies, which include the role of individuals, responsibilities and plan of action to carry out in case of relapse.
Work on extinguishing self-destructive behavior, i. e. promiscuity, hostility etc.
Joan will collaborate with medical treatment and ensure adherence to mediation
Joan will work with the therapist to determine triggers and causes of relapse.
Joan will participate the process of growing the drill and use family and therapist to be totally involved in the process.
Joan will recongnize negative outcome of her destructive behavior
Joan will work on homework task to track thoughts and urges between classes.
Joan will participate in role-playing to comprehend the results of the behaviors
Joan will value limitations and limits
Monitor Joan's effect, compliances, side effect and success of the medication
Ensure that psychiatric evaluation is in destination to request hospitization if Joan provided any sign of homicidal or suicidal ideation
Identify the sources of stress which could potentially causes relapse such as bad communication with family, sleep style, medication noncompliance. Utilize this information as part of the target treatment.
Educate Joan and family about the signs or symptoms of relapse.
Help client and family to build up comprehensive relapse drill, which include problem-solving ideas, getting in touch with physician, calling disaster if needed.
Explain negative consequence of behavior
Assign research to track thoughts and urges
Practice role-playing and role-play reversal to increase awareness to effect of behaviors
Listen to client appearance of feelings but established limit to hostile behaviors
Setting limitations and boundaries to clients manipulation and breaking of the guidelines.
Potential Ethical Issues
Kitchener (1984) has identified five moral key points to help in ethical decision-making. These key points include autonomy, beneficence, Non-maleficence, justice and fidelity.
The first theory is esteem for autonomy of the average person. Therapist should help Joan make her own decision by giving her with complete information. Her decision must be validated irrespective whether it seems erroneous in the attention of professionals. The second basic principle is Beneficence which looking out for what is best for Joan. Therapists have the responsibility to donate to of Joan (Forester-Miller & Rubenstein, 1992). Nonmaleficence is a crucial rule, which cautions experts to do no damage (Kitchener, 1984; Rosenbaum, 1982; Stadler, 1986). For Joan, may there be unsafe implications of diagnose he with bipolar? Do the benefit compensate for the harm?
When considering justice for Joan, I have to ensure that other people in her situation have access to a similar attention. I dealing with Joan, the therapist must think about family and friends in her circle which may be affected by your choice of the therapist and explain why Joan is getting such treatment. Kitchener (1984) explained that "treating equals evenly and unequals unequally but in proportion to their relevant dissimilarities" (p. 49). Fidelity includes the ideas of devotion toward your client. Trust between customer and therapist is essential in building the relationship. Thus, the therapist has to walk a fine line to fulfill his / her duties.
The American Counseling Association (ACA) has established a guideline to assist professionals to make sound moral decisions and meet challenges (2014). Because of Joan mood disruption and tendency to interpret incidents in sexual lens, the therapist has to ensure that he or she on shield to avoid any ethical problems. The ACA, A. 5. a. , areas "Sexual and/or Romantic Relationships Prohibited Sexual and/or charming counselor-client connections or romantic relationships with current clients, their affectionate companions, or their family members are prohibited. This prohibition pertains to both in person and electronic relationships or romantic relationships (p. 5).
Joan's friends at certain points, when her condition worsen, believed obligated to declare her to a medical center. The therapist must take all the right decisions to ensure her basic safety and that her rights are not violated. ACA, B. 2. a. Serious and Foreseeable Injury and Legal Requirements areas that "The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or determined others from serious and foreseeable injury or when legal requirements demand that confidential information must be revealed.
Counselors consult with other experts when in doubt as to the validity of any exception. Additional concerns apply when dealing with end-of-life issues (p. 7).
Due to the nature of her bipolar disorder, Joan may discontinue her treatment as she did in the past when she migrated to the Bay area. Irrespective, how highly the therapist seems about the treatment, Joan gets the right to make her own decision. ACA Sec. A. 1. c. Counselling Plans states that "Counselors and their clients work jointly in devising counseling plans that offer reasonable offer of success and are steady with the abilities, character, developmental level, and circumstances of clients. Counselors and clients regularly review and revise guidance plans to examine their continuing viability and success, respecting clients' flexibility of preference (p. 4).
Role of Diversity Related Factors in Diagnosing and Treatment Planning
While bipolar is identified mental illness and exists in every civilizations and countries, the field of psychology although came a long way, is still in need of more understanding of cultural
short on ethnical considerations. Although we know that Joan has bipolar, we do not know very well what is her social background and what are the beliefs and sociocentricity about mental health problems in her particular culture. Additionally, medical researchers may have different strategies when diagnosing and treating bipolar. A far more comprehensive research is needed to understand the multicultural variability and its results on diagnosing and treating mental illness. Additionally, cultural awareness a multicultural dialogue should be among mental health professional should be in place. You will discover vast individual dissimilarities within each social group. Stereotyping all a group customers as are as well is a disservice and an obstacle to the healing up process.
There are a number of factors that are must be acknowledge to be able to meet up with the client's needs. Some of these factors include: acculturation, poverty, dialect, transportation, cover and children, educational track record, beliefs, physical characteristics, interpersonal history and existing support. It really is useful to know if Joan was created in the U. S and what is her degree of skills an acculturation in this culture. Joan is a specialist and poverty aspects will not seem to use to her. She seems to be alert to "culture of poverty" idea and know the various established practical procedures to cope with her issues by using mental health interventions.
Joan's native terminology is English. She actually is a university graduate from an American university. Educational history and reading skills has and important part in understanding the idea of treatment and academic experience differs among different ethnic groupings. The neighboring country of Mexico has many local dialects and each has a distinctive culture and a unique oral background.
Several characteristics of the therapist are important in shaping the healing relationship. It is important for Joan to utilize a counselor who's capable of serving her and help her to understand herself in order to move on to the next level. As being a therapist, it's important to give a safe and warm environment. It is unclear if Joan could have any issues about the cultural difference between her and her therapist. This therapist believes that ethnic self-awareness and sensitivity to your client heritage is important since it influences the attitudes, values and biases in the healing processes.
Transportation and real estate is also essential in treatment. Insufficient basic needs and transport makes it difficult for the given individual to continue with treatment. Joan is a middle income member which does not connect with her. However, therapists have to address these issues and bottom the treatment plan on how the individual is likely to be able to work on the treatment while facing each one of these daily issues of even addressing clinics.
Individuals from different ethnic and cultural organizations are different in their values about mental condition, causes, and treatment. In addition they differ on their expectations of the results of the procedure and the therapist assignments in the process of restoration. Joan came up to remedy and appeared to understand the process and what needed from her.
People from different races and cultural background change in the look of them. Nevertheless, appearance in this therapist opinion does not make any difference. It is the belief and sociable and community support of the group that matters. Previous life experiences and history impact the client's respond to treatment. Religious opinion may pose an issue depending on kind of he treatment and whether it's allowed within that spiritual paradigm, If there is a stigma attached to mental ailments within particular groups, requesting help may face many hurdles such as cultural belief in endurance, privacy, and legalities. On top of that, some clients have no idea of resources within their neighborhoods. Therapists have to provide clients with information that will help them utilize holds, such as legal, referral, spiritual and other kind of assist with help them become part of their own curing and prevision of relapses.
about culturally relevant and reactive networks of works with which include legal, religious, and civic components. Recommendation and assistance could become a essential part of empowering the future capacity to prevent or intervene early on in a remission.
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