Question

CASE STUDY

Jon is a psychiatric mental health nurse in a large metropolitan clinic, which is connected to a research hospital. Jon likes the fact that it’s a walk-in clinic.

One day he is just getting ready to eat his sack lunch, when a slender young woman who looks exhausted and timid knocks at his open door.

“Excuse me,” she says. “Can I get into a research project?”

Jon puts down his bologna sandwich. “What’s that?” he says. He’s confused. “Research?”

“Yes,” she says, stepping inside and slipping into the chair beside his desk.

Jon wraps up his sandwich for later.

“I want to know if I can be part of a study for depression,” the woman says. Her mouth trembles. “This is a research hospital, right?”

Jon hesitates, trying to take in what she wants. As he pauses, he does a visual assessment. The woman is in her late 20s or early 30s, attractive, but somewhat bedraggled. She looks as if she’s been on a long, difficult road trip.

“Well,” he says. “I don’t know of any studies going on off hand, but does that matter? I’m sure we can get you the help you need without a study. What seems to be the problem? And what’s your name, by the way? Mine’s Jon.”

“I’m Erika,” she says when her face crumples and she begins to cry. “I’ve screwed up big time!” she says. “I’ve just ruined my life and my son’s life!” And just like that, she is sobbing.

“I’m sure you haven’t ruined anything,” Jon says. He glances at the clock behind Erika, wondering what time the psychiatrist will be back from her luncheon meeting. “Why don’t you tell me what’s happened?”

“I ran away,” she says, still sobbing. “I ran away, walked off my job, and hit the road with my little boy Oscar!”

She lowers her hands from her face. “We just now got back into town. We’ve been sleeping in the car for 3 days.”

“Are you homeless? Do you need a shelter?”

“No,” she cries. “That’s just it! We had a perfectly decent life, and now I’ve blown it.”

“There’s usually something that can be done,” Jon says, handing her a box of tissues. “Why don’t you start at the beginning, and let’s see what we can do.”

“Thank you,” she says, blowing her nose and really looking Jon in the eye for the first time.

Jon smiles. “You’re welcome. Now. Just start anywhere.”

Erika tells Jon that she is a 28-year-old mother who was a “wild teen,” saying that she had a tumultuous relationship with her parents. At age 20, Erika gave birth to her son Oscar, who is now 8. “Oscar,” she says “is the sweetest, most supportive son ever.”

Shortly after Oscar’s birth Erika suffered from severe postpartum depression that plunged her into what she calls “a hellish paranoia. I was some kind of hormonal, psychotic witch for a while. No wonder my fiancé broke it off with me.” She says this with a sad smile and starts to cry again.

Erika has come into the clinic because, she says, “sometimes I think I never recovered from my postpartum depression. I mean, I’ve always been hyper and bad-tempered, which I freely admit. But now I just can’t seem to pull out of it. I can’t sleep; I’m angry all the time; I can’t concentrate on anything, and I’m so depressed I can’t function.”

But things are even worse than Erika is letting on.

“Okay,” she says. “There’s something else. Something even worse.”

She has trouble pulling her tears under control, and it takes her a moment to struggle with that.

“I flipped out at work last week,” she says. “I slapped my supervisor because she was very unfair. She had it in for me. Then I stormed out of work, grabbed my son out of school, and got in the car and just drove, furious and feeling hopeless. We drove and drove and then it was like I woke up and realized I was in another state. I drove all the way to Wyoming, two states away to Oscar’s dad’s house, and all he said was, ‘You walked out on a good job? Well, you can’t stay here and freeload! Get back to Denver and get your job back!’”

“We slept in the car, and I was crying and yelling, and Oscar was crying. It was awful. I’m the worst mother ever. So now I’m back in Denver, with no job and overdue on my rent and no money left in the bank to pay it.”

“No money?”

She shakes her head. “I blew it all on the trip. I was so mad about work, I told Oscar, ‘We’re going on a road trip.’ I thought maybe we’d go to Yellowstone, or maybe Disneyland. And at first he thought it was fun till he saw I was a mess, and then he was just scared. And now we’re back, and I’m broke and unemployed. I never sleep, and I know I talk too much and too fast, but my head is always full of more thoughts and ideas than I can keep track of, and they rush through me like the Indianapolis 500, and sometimes they just come bursting out of my mouth.”

Jon is able to complete an intake assessment of Erika, and when the doctor comes back from her meeting and sees the state Erika is in, she meets with her immediately. She gets Erika help with her most immediate needs, and when Erika refuses hospitalization, concerned about uprooting Oscar any further, the doctor makes a diagnosis and writes her a small, temporary prescription—but only after Erika agrees to come back and start treatment. Erika readily agrees. The doctor subsequently diagnoses Erika with bipolar I disorder. Assuming that the doctor is right, what evidence do you see of this disorder?

In addition to her diagnosis of bipolar I disorder, which signs of mania does Erika displays the most?

Answer 1

A. Bipolar 1 disorder is form of mental illness.A person affected by bipolar1 disorder has had at least one manic episode in life time.A manic episode is a period of abnormally elevated or irritable mood and high energy ,accompanied abnormal behavior thay disrupt life. Most people wit bipolar 1 disorder also suffer from episodes of depression. Flying suddenly from one idea to next, Rapid uninterruptible a and loud speech, inflate image,excessive spending are symptoms exhibit during manic episode and depressive episode in bipolar disorder are Similar to regular clinical depression with depressive mood, low energy, feeling of guilt, ,worthless

From the case study we can observe that Erika had symptoms of Bipolar disorder those are feeling guilty and worthless like she was worest mother, crying, and presented with uninterruptible speech , these symptoms suggest that erika had bipolar disorder.

B. Erika present with uninterruptible speech that was the she displaying most.