Question

Jerry is a 35-year-old man who is studying horticulture part-time at his local TAFE and working part-time for the government in a forestry role. Jerry has had bipolar disorder since his late teens but was only officially diagnosed three years ago. Recently, Jerry has started staying up longer during the night working on his assignments, and for the past five days he has not slept at all. For the past month, Jerry has only been sporadically taking his prescribed medication. Last week Jerry’s neighbours made a complaint to the body corporate in the unit where Jerry lives after he did some gardening in his courtyard at 3 am, followed by mowing the communal areas at 4.30 am. Jerry thinks his neighbours need to ‘chill’ and that he was actually in the middle of a breakthrough that could result in reversing global warming. Jerry believes that his neighbours should mind their own business and stop interfering with his creativity, and he cannot understand why they are confused by his ideas. Jerry believes he is on the ‘verge’ of a major discovery. While he was writing his latest assignment, his research helped him unearth a discovery that will reverse global warming, resulting in him making millions of dollars. When the morning came, Jerry quit his job. Jerry’s major concern now is what will happen if he accidentally reverses global warming too much and the temperature becomes too cool. While he is worried about this, he believes everything will probably be okay, because it all comes down to the word ‘land’ and it will ‘even out’, but he does want to seek clarification on this. Jerry is reassured because people live in Iceland, Greenland, Ireland and Poland and these are all cold climates. It will all balance out because there are equal numbers of countries in warmer climates that have the word ‘land’ in them, too, such as Swaziland, Thailand, New Zealand and the Falklands. Outcomes being ‘even’ is of great importance to Jerry. Jerry’s father Paul visited him a few days ago for dinner and is worried about him. Despite Paul making dinner, Jerry couldn’t sit still long enough to eat it. Jerry doesn’t want to talk about the possibility that he may be unwell again, because, he says, ‘It’s not like last time, Dad.’ Yesterday, Jerry attended the Polish embassy requesting they work with him on his project. He demanded to see the ‘most senior person here’ because they would be the only one who could understand his discovery. Both the Thai and Irish embassies had refused to return his calls. Jerry became upset when a representative from the Polish embassy exports department would not meet with him. Jerry was talking rapidly and loudly, and staff could not follow the topic of his conversation. Jerry became irritated when staff didn’t provide the information he wanted and eventually security was called. Jerry was taken to his local hospital for assessment and later admitted.

1. You have been asked to formulate a risk assessmentfor Jerry. Based on the information in the case study, what risks would you identify? Use the form attached to this tutorial guide.
2. Describe these features of the presentation of mania: pressured speech, disinhibition, punning, grandiose delusions, and second person auditory hallucinations. Provide examples from the video, or from Jerry’s case study.
3. Jerry became irritated and security were called, and he was taken to his local hospital for assessment. What is the difference between ‘voluntary’ and ‘involuntary’ treatmentin the context of mental health act legislation in your state or territory?
4. Treatment for Bipolar Disorder includes antipsychotics, anxiolytics, antidepressants and most commonly mood stabilizers. Investigate the following psychotropic medications known as Mood Stabiliser- Lithium Carbonate, Sodium Valproate, Lamotrigine and Carbamazepine. Consider the importance of effective monitoring, consumer experiences(side effects) and safety factors(e.g. Lithium Toxicity). Discover the other therapeutic use for the last three medications.
5. The mental state examination (MSE) is a formal assessment used in both diagnostics and ongoing assessment. How can the principles of a therapeutic relationshipfacilitate the processof obtaining information through an MSE?
6. Australia’s legal system requires health care clinicians to operate within a ‘least restrictive’ framework. Discuss where this approach is evident in the mental health act legislation in your state.
7. What does the mental health legislation act in your state or territory stipulate about ‘recovery’?
8. How can the mental health nurse apply Bandura’s concept of self-efficacyto support consumers in medication self-management?

Answer 1

1)Ans)
Bipolar disorder is actually divided into two different types and they ar the bipolar I disorder and the

bipolar II disorder. In bipolar I disorder the individual is characterized by both extreme patterns of

behavior which are manic and depression, that is the mixed episodes. In bipolar II disorder, the

individual does not experience a complete mixed episode.

Jerry can be identified as being diagnosed with bipolar disorder. There are cases where individuals

with bipolar disorder are showing extreme manic episodes but never any depressive disorders. But

researches have found that these people may face with depression later in their life. It is a kind of

unipolar disorder when we watch from a different angle. The individual shows only hypomanic

episodes and depressive episodes are not seen outside, so it may be wrongly diagnosed as unipolar

disorder. But they may be having depressive episodes which are not recognized by others.

The risk that can occur are mainly that the person may experience high or elevated state and also a

state of euphoria and expansive mood. He can also be interrupted with occasional outburst such as

high irritability and violence. They may even harm people if others does not go along with them. So,

it is necessary to be careful of an individual with bipolar disorder than with an individual with

schizophrenia. They can also have hypomanic episodes and later may lead to depression or

depressive episodes can occur which are left unrecognized.

*jerry was diagnosed with bipolar disorder before few years, it gets progressive as years pass by, showing mania and depression. Abuse, mental stress, a “significant loss,” or some other traumatic

event may contribute to or trigger bipolar disorder. If bipolar is not treated on time, it can degrade his

mental health and result to alcoholism or substance abuse, addiction or suicidal attempts.

2. Ans.)

pressured speech; loud and rapid speech because of anger, its irrelevant which is not understand and to listeners. In case of Jerry, the conversation of Jerry with his dad and his actions

after refusal of phone calls from representatives are some of the examples

disinhibition; a temporary loss of inhibition caused by an outside stimulus ......

disinhibition is a lack of restraint manifested in disregard of social conventions, impulsivity, and poor risk assessment. Disinhibition affects motor, instinctual, emotional, cognitive, and perceptual aspects with signs and symptoms similar to the diagnostic criteria for mania. Disinhibited behaviours are actions which seem tactless, rude or even offensive. They occur when people don't follow the usual social rules about what or where to say or do something. Disinhibited behaviours can place enormous strain on families and carers.

punning; it is the humorous use of a word or phrase with different meanings,grandiose delusions; is a false or unusual belief about one's greatness, power and unrealistic thought. For example, the self-belief of Jerry that he could end the global warming and save the world.

second person auditory hallucinations; feeling of hearing imaginary sounds or commands that a

normal person cannot hear.

3)Ans)

voluntary treatment means a person its self going hospital for an illness..

involuntary means another peoples brings him to hospital for management

In case of Jerry, he received involuntary treatment as he was taken to hospital exceptional to his will

by calling security to control the situation