Professional Documents
Culture Documents
Abstract
In this case study, we will be looking at a young woman named Alice Brown. She is
twenty-five years old and has recently moved to Philadelphia from Seattle, WA. Alice
also has bipolar 1 disorder. Looking back in her history, we will see that she has a
previous history of both depressive and manic episodes. However, she was never
formally diagnosed with the disorder until she was brought to me, having been admitted
to the hospital as a suicidal patient. We will also look at the treatment plan that I plan to
start with Alice, including both medication and therapy. I believe that with her
Biographical Information
Alice Brown is twenty-five years old. Originally from the city of Seattle,
Washington, Alice moved across the country to Philadelphia upon marrying her new
husband back in April of 2010. My client is Caucasian and of English and Italian
descent. Other than her current mental health problems, Alice is in fair health. She has
been in treatment for cystic fibrosis since she was a child, but the illness is well-
controlled and her primary care physician declares her fit to work and do activities as
Clinical History
Ms. Brown has suffered from alternating periods of extreme depression and
hyperactivity for the past few years. It is only recently that she began to seek out more
intensive help. As most cases of bipolar disorder begin, her symptoms started to
manifest around age twenty-one (Fast and Preston, 2006). Upon disclosing her
symptoms to her primary care physician, she was told that her moods were nothing to
worry about. Having said that, Alice has never received any sort of treatment for any
Bipolar Disorder 4
mood disorder, depression, bipolar disorder, or otherwise. However, her moods have
escalated, and Ms. Brown came into my care when she came to my facility’s emergency
perform even the most basic daily functions and is extremely depressed. She currently
harbors a lot of self-blame and anxiety and is prone to impulsively attempting to hurt
herself. She is prone to crying spells that last for hours and seem to start for no reason
at all. She scratches at her wrists with her nails in an attempt to draw blood, so I had to
have Alice put in arm restraints to keep her from further harming herself. Upon
speaking with her family, I have learned that a few months ago she began to have false
delusions about who she is and began to believe that she had “magic powers that could
change the world”, staying up for days at a time, writing impassioned letters to the
strangers. At the time, Alice refused to seek treatment despite the pleas of her family
and close friends, and the condition subsided after a week or so, but her mood shifted
into one of deep depression after a short period of normalcy. Currently, she remains
Diagnosis
Treatment Approach
Given Alice’s past history of what seems to be manic episodes, I will not begin
patient with bipolar disorder an antidepressant carries a risky chance that their
depression will switch into mania (Fink and Kraynak, 2005). I plan to start Alice on
lithium, a mood stabilizer that has antimanic and antidepressive properties. Research
has shown that lithium also may act as a blocker for future manic or depressive
episodes (Castle, 2003), which I think would be extremely helpful in Alice’s case.
I also plan to have some medical tests done on Alice to see if there are any
underlying physical conditions that could be affecting her mood. It is known that thyroid
malfunction, Cushing’s syndrome, diabetes, and even hormone imbalances can affect
mood and mimic bipolar disorder, so it is important to rule out those medical conditions
in the early stages of treatment (Fink and Kraynak, 2005). Tests to check for substance
use such as alcohol and cocaine should also be run on Alice, as substances such as
alcohol and cocaine can have effects that induce bipolar-like symptoms (Yatham, 2010).
If all these tests come back clear and there is no physical or substance-related
reason for Alice’s current psychiatric issues, I will proceed with continuing the lithium
have Alice begin therapy, both individually and in a group with other patients at the
Bipolar Disorder 6
hospital. I believe that cognitive therapy will be best for Alice, as it will allow her to gain
insight into her thought processes and perhaps allow her to change her thinking so that
in the future, she will be more equipped to combat oncoming mood episodes. It is my
hope that with the right combination of medications and a strong commitment to talk
therapy, Alice will be able to avoid drastic mood episodes completely. Of course, Alice
will remain hospitalized until she is no longer suicidal and has a more stable sense of
mood.
I believe that receiving Alice into the hospital at the time that we did has
potentially saved her life. The illness has been caught at an optimal time for treatment,
and Alice is gradually becoming more and more compliant with the treatment plan I
have laid out for her. More importantly, I see a lot of hope for Alice’s future. I think if
she stays on her medication and remains in touch with a psychiatrist and a psychologist
or other therapist, Alice stands a great chance of recovering to a normal life, where her
moods will not rule over her every day. I also think it would be beneficial to have Alice’s
new husband be a part of her treatment, accompanying her to therapy sessions and
When Alice is released from the hospital, I would like her to get in touch with a
support group through the Depression and Bipolar Support Alliance or the National
Alliance for Mental Illness, so that she does not feel alone in her treatment. It is
important that she find some common ground with people who also share her illness
who she can look to for advice or just a reassurance that she is not alone. According to
the Depression and Bipolar Support Alliance, lifestyle changes are also necessary in
order to maintain a healthy, mood-swing free existence, such as eating healthier foods,
getting to bed at a decent hour, and surrounding oneself with people who are “good for
you” and will make recovery that much more of a positive experience. (DBSA, 2006)
With all these lifestyle changes factored in, Alice will be able to enjoy life again and put
References
Depression and Bipolar Support Alliance. (2006, May 10). Recovery steps. Retrieved
from http://www.dbsalliance.org/site/PageServer?pagename=recoverysteps
Fast, Julie A. & Preston, John. (2006). Take charge of bipolar disorder: A 4-step
plan for you and your loved ones to manage the illness and create lasting
Fink, Candida & Kraynak, Joe. (2005). Bipolar disorder for dummies: A reference