Bipolar II disorder Case Study



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Bipolar II Disorder Case Study

Renee Bynum

Capella University

Abstract

This paper addresses the case study of Jim Shoo, a young Asian American who has the diagnosis of Bipolar II Disorder. A 5-axis diagnosis will be developed and a treatment plan written out addressing the clients presenting problems and issues. In addition, a review of the impact of social systems on the assessment and treatment of the individual will be addressed.


Diagnosis of an individual with a mental illness is one that is crucial to the well being of the individual and treatment. There are many different types of diagnostic tools that help therapists to properly diagnose individuals. The DSM-IV-TR is the most widely used tool having standard criteria and language for the classification of mental disorders that correlate with the International Classification of Diseases (ICD). In particular, to diagnose Bipolar disorder some additional tools used by therapists consists of questionnaires and interviews to find initial information about the client in order to make a proper diagnosis of the clients’ symptoms.

In utilizing the DSM-IV-TR in the diagnosis, process allows for standard criteria in which to evaluate the clients’ symptoms and properly classify them. A limitation of the DSM-IV-TR is that a label can stigmatize or discriminate those with a diagnosis. It is crucial that counselor’s realize the culture limitations of the DSM and the need to include their clients’ schemas and cultural worldviews in the counseling process for a diagnosis to be meaningful to them (Kress, Eriksen, Rayle, & Ford, 2005). The Structured Clinical Interview (SCID-I) is a routine part of the semistructure interview process for DSM-IV Axis I Disorders (Miller, Johnson, & Eisner, 2009). The SCID-I is a highly reliable interview when diagnosing bipolar disorder compared to other structured interviews (Miller et. al., 2009). In addition, Schedule for Affective Disorders and Schizophrenia (SADS) has proven to be high in validity and reliability. SADS has also shown validity across different cultural and ethnic groups in the United States when addressing bipolar disorder (Miller et. al., 2009). Unfortunately, both SCID-I and SADS lack it reliability when addressing bipolar II disorder. One specific tool that has proven to be both reliable and valid is the General Behavior Inventory (GBI), which was designed to cover bipolar core symptoms (Miller, et. al., 2009).

DSM-IV-TR DIAGNOSIS: Axis I: 296.89 Bipolar II Disorder, Most Recent Episode Depressed, Moderate, With Rapid Cycling

Jim’s most recent episode was depression that lasted a course of two years and was often debilitating. His depressed state had feeling of extreme hopelessness, low energy levels, and loss of interest in activities once enjoyed. He has had feeling of guilt due to his irrational behavior during his manic state and has stated he has had thoughts of suicide. He has had one past hypomanic state in which he felt extremely energized which consisted of speaking loud most of the time with jumbled thoughts, irritability and impulsive behaviors that resulted in financial instability due to high credit card debt due to shopping spree during manic state.

Axis II: None

Axis III: None

Axis IV: Unemployment, Conflict with parents. Jim is currently unemployed and has been in an off and on conflict with parents for at least 3 years due to psychopathology that is contributing to the negative impact that it is having on his environment which is exacerbating his issues.

Axis V: GAF=50 (current) Jim currently qualifies for the GAF score of 50 based on several indicators that are found on the DSM-IV-TR: Suicide ideation, and serious impairment in social and occupational functioning as he is currently unemployed, has alienated his friends, and is in conflict with parents.

Cognitive Behavioral Therapy (CBT) has proven to be a successful treatment for Bipolar Disorders. CBT is a structured method in which the collaboration between therapist and client guides the journey of goal setting and problem solving. As a therapist an initial agreement of should be drawn up in order for the client to understand their part in the therapeutic process. CBT concentrations are on an individual’s patterns of thought process and behaviors that maintain maladaptive and adaptive behavior (Binggeli, 2010). It assumes that these patterns are learned and that new patterns can replace old ones that are no longer beneficial for an individual (Binggeli, 2010). During the initial interview, the therapist will seek out more information about Jim using the following question:



  1. What is your first memory of having these thoughts?

  2. What was your childhood like growing up in American while holding to your native Chinese culture?

  3. How are your emotional problems affecting your life currently?

  4. Is there any mental illness in your family?

Jim’s key issues that will be addressed in treatment will be as follows:

Problem


1. Depression as manifested by low self-esteem, sadness, and suicide ideation.

Goal


Jim’s symptoms of depression will reduce significantly and will no longer interfere with his functioning.

Treatment plan:

a. Jim will identify negative thoughts and feelings and learn to replace them with more positive ones. Jim and the counselor will explore new ways of thinking and challenging the negative thought processes.

b. Jim will not report suicidal ideation for 1 month.

c. Jim will learn new problem solving skills and way of coping. This will be done in session and with homework assignments done weekly.

Problem


2. Feelings of worthlessness and guilt.

Goal


Jim’s feelings of worthlessness and guilt will reduce significantly and will not interfere with his daily life.

Treatment Plan

a. Jim will become educated on how his cognitions and thoughts affect his emotions and behaviors.

b. Jim will evaluate his thoughts and replace them with one’s that are more useful and accurate.

Problem

3. Triggers



Goal

Jim will be able to identify triggers and learn ways to lessen the triggers.

Treatment Plan

a. Jim will learn how to identify triggers by utilizing a journal and following up with therapist to identify triggers.

b. Jim will learn ways to calm down and lower his stress levels in order to decrease stress and reduce triggers.

Problem


4. Dysfunctional communication

Goal


Jim will educate his parents about Bipolar II Disorder and learn ways to express his feelings more openly with his parents.

  1. Jim and his parents will attend family therapy and educate themselves about BD by doing homework which will reduce stress in the family.

  2. Jim will find support groups in order to build a support system of educated and those dealing with BD.

In utilizing CBT Jim will be able to learn new ways to identify precursors to his stress and ways to alleviate it in order to avoid exacerbating his symptoms associated with BD.

In working with Jim, it is essential to understand how social and cultural influences affect his behaviors. Jim’s Chinese cultural background and family value system will be considered in order to determine how it has affected his development. Researcher shows the importance of considering one’s cultural issues when diagnosing or assessing an individual. According to ACA Code of Ethics (2005) cultural sensitivity is taking into account one’s cultural and socioeconomic experiences when diagnosing mental disorders.

Reference

ACA. Code of ethics. In (2005). American Counseling Association. Retrieved from

http://www.txca.org/Images/tca/Documents/ACA Code of Ethics.pdf

Association, A. P., & , (2000). Diagnostic and statistical manual of mental disorders, dsm v-tr..

Amer Psychiatric Pub Inc.

BinggeliLast, N. (2011, Feb. 5). Introduction to cognitive behavioral therapy. Retrieved from

http://www.nelsonbinggeli.net/NB/CBT-Intro_to_CBT.html

Kress, V. E., Eriksen, K. P., Rayle, A. D., & Ford, S. J. W. (2005). The dsm-iv-tr and culture:

considerations for counselors. Journal of Counseling & Development, 83(1), 97-104.

Miller, C. J., Johnson, S. L., & Eisner, L. (2009). Assessment tools for adult bipolar disorder.

Clinical Psychologist, 16(2), 188-201.

www.nacbt.org. (2007, April 05). Retrieved from http://www.nacbt.org/whatiscbt.htm.

Appendix

Jim Shoo is a 19-year-old Asian American man who has lived in the United States his whole life although many of his cultural traditions are those of the Chinese culture. The Shoo family resides in San Jose, California and has a strong Catholic religious background in which they have adhere too. They are an upper class family who values discipline and hard work in order to achieve success within their family of origin. Both his parents are in real estate so working long hours is normal which puts some burden of care giving on Jim as he often cares for his younger siblings as well as his grandmother Lin who lives with them. Jim will be attending college in the fall, and his family has decided that he will be staying in the dorms since it is two hours away from home.

The Shoo family does not know of any history of mental illness, although in Chinese culture the loss of face is important to them, which is why many believe that anything that is shameful should be hidden and many Chinese identify mental illness as being shameful (Kwok, 2000). The social stigma that is associated with shame leads to members of this society refuse to seek help (Kwok, 2002).

Jim has had bouts of sadness for a course of two years in which he says that often times cannot even get out of bed so he tells his parents he is ill. Jim states that he recently felt so energized that he could not keep his thoughts straight and jumped from one idea to another. During this energized state, he did become irritable and others stated that he was louder than usual and wondered if he took something that increased his energy. During the week of high energy, he maxed out two of his credit cards and is not sure how he will pay them off before he goes to school in the fall. It was only a week later that he became so depressed that he did not find any pleasure in anything he did, was so tired he did not want to get out of bed which has continued to be a struggle today. Jim has also had feeling of being worthless and guilt over his spending spree during his high-energy state and has begun to think about suicide, although this would shame is family so that he often reminds himself that it would not be fair to disgrace his family like that. Jim’s high school years where erratic as he would go through times where he would do well academically and then as he would go through his depressed times his grades would drop as he often times did not have the energy or desire to do his work which led to lower grades and constant disapproval and conflict with his parents. These conflicts with his parent often lead Jim to become secluded in his room for hours and sometimes avoids his parents by leaving to school after they had left and be in his room claiming to be boggled down with schoolwork. His social life was off and on as well as when he felt energized he would be more active and seek out friends while during times of depression avoided their calls, these behaviors have led him to currently having a couple of friends.

According to ACA Code of Ethics (2005) the counseling relationship consists of developmental and cultural sensitivity in order to enhance client growth and understanding in the client/counselor relationship. In Jim’s case the counselor will need to get a better understanding of Chinese culture by connecting with other Chinese in the community and building a relationship with other counselors to help build competence when dealing with a diverse clientele. Continued education in multicultural issues will help the counselor to stay current on minority and multicultural issues and research.

Diagnosis is an important issues when dealing with diverse clientele as it may stigmatize the client in which educating the client and his family about mental illness is crucial to the understanding and support of the family.


Reference

Code of ethics. In (2005). American Counseling Association. Retrieved from

http://www.txca.org/Images/tca/Documents/ACA Code of Ethics.pdf


Kwok, Caroline Fei-Yeng, (2002, December, 25). Mental illness-chinese style.

Retrieved from http://www.pendulum.org/articles/articles_misc_chinesestyle.html


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