Upload an initial post of your most interesting client that you’ve encountered during this clinical experience. The Initial post should be thoughtfully and professionally executed with evidence-based resources clearly integrated and synthesized into all discussion posts. You must provide at least 1 evidence-based resource/reference for all DB posts.
****Here is a scenario that you can use. Just change and reword.*****
This week, I encountered an interesting case involving a 19-year-old Hispanic female who has been diagnosed with bipolar disorder, current episode manic severe with psychotic features. She is currently experiencing a severe manic episode with psychotic features (F31.2). During manic episodes, individuals may display symptoms such as an elevated mood, increased energy, racing thoughts, decreased need for sleep, impulsivity, and in some cases, psychosis. This patient specifically demonstrated decreased need for sleep, impulsivity, and delusions.
One notable aspect of this patient’s condition is her resistance to engaging with healthcare providers, leading to a history of cycling through different professionals. When listening, she exhibits a flat affect and maintains intense, prolonged eye contact, often staring. Her perplexing behavior has left providers puzzled. There was a moment when she appeared catatonic, prompting an attempt at treatment with injectable medication, which yielded no effect. Because mood stabilizers and antipsychotics have documented short- and long-term side effects, their use as first-line therapy in at-risk kids may not be advised. Valproate sodium, for example, has been linked to reproductive-endocrine anomalies and should be taken with caution in women of childbearing age. When it comes to kids with unspecified bipolar illness, another scenario is proposed. These adolescents have the same level of psychosocial impairment, the same number of comorbid illnesses, and the same risk of suicide and substance misuse as those with bipolar disorder I, and they are at a high risk of progressing to bipolar I or II disorder. And, because this patient is not responding to any drugs, developing a pharmacological treatment strategy for her has been difficult (Vieta et al., 2018). Additionally, she enters rooms with a slow gait, wears oversized clothing, and has sunken eyes, likely due to days of sleep deprivation as reported by her parents.
These unusual behaviors emerged a few years ago when her family relocated to a new home. Since then, she has become increasingly nonverbal and responds with only a few words, primarily to her therapist. However, she did express a desire to be placed in a nursing home. When questioned about her reasons, she simply smiled and averted her gaze. Occasionally, she forms a smile on her face and swiftly wipes it away. Consequently, healthcare providers are unsure if this behavior signifies true psychosis or if the patient is seeking attention from her parents, who seemingly devote more attention to her younger brother.
Recently, the situation escalated when the patient took her parents’ car at 5:30 am and drove 45 minutes away to a Dairy Queen, where she was found rummaging through a dumpster. Strangely, she exhibited no signs of mania and refused to answer any questions or explain her actions to her parents. Faced with such unpredictability and unmanageability at home, the parents are now considering a higher level of care for their daughter. According to her therapist, she claims that everyone around her is a robot and expresses a desire to live in a different world.
The current plan involves arranging an appointment with a different psychiatric provider on her next visit. If her communication does not improve, she will be referred to a higher level of care to address her complex needs.
According to a peer-reviewed study, the most important risk factor for having a bipolar spectrum illness is a positive family history of bipolar disorder, especially if the parents had early-onset bipolar disorder.(Vieta et al., 2018) This parents in this family have no history of bipolar disorder, and neither do any of the family members prior to that. Because this patient already has psychopathology in the form of depression, anxiety, mood lability, or subsyndromal mania, she requires existing treatments to address these symptoms, such as pharmacotherapy or psychological therapies such as cognitive-behavioral therapies, family-focused therapy, self-help programs, or mental health first aid. This patient will face a lot of trial and error because she is nearly silent and does not provide any information to her providers or parents. (Vieta et al., 2018)
References
Vieta, E., Salagre, E., Grande, I., Carvalho, A. F., Fernandes, B. S., Berk, M., Birmaher, B., Tohen, M., & Suppes, T. (2018). Early intervention in bipolar disorder. American Journal of Psychiatry, 175(5), 411–426. https://doi.org/10.1176/appi.ajp.2017.17090972Links to an external site.