Case Study for Patient Tony Balatchu PSY 1010
A 24 year old Native American male presented with periods of high mania followed by periods of low depression that is often unexplained. The patient experienced mood swings that sometimes were comingled with elation and major depression at the same times. Major depression according to ( ) can be defined as having a very low mood for a period of at least two weeks or more for an individual. His sadness would last for periods of a several weeks or more that could not be explained with long bouts of staying in bed unable to get up except for absolute necessities. These periods of sadness were extremely intense and were constant throughout the week’s long periods. During this period sleeping and eating were excessive and all activities including house cleaning, personal hygiene, and job were neglected. After this period of depression the client reported a follow up period of high energy or mania where he reported that he felt more like himself including bursts of high energy and restlessness that could not be contained. Mania can be defined as periods of high excitement and euphoria that can be accompanied with delusions of power and grandeur.
As quickly as the period of elevated mood appeared it would quickly revert to the depressive mood again coupled with a deep sensitivity to rejection and an almost uncontrollable temper. This was evidenced after a recent episode where the male talked about relinquishing all his possessions with the idea that he would travel to Washington, DC and advise the president on Native American rights and the responsibilities of the United States to the indigenous population. It was after a polite rejection letter that the male subject went into an extreme depression with thoughts of self harm that the client decided to come to our offices to seek treatment. The client is also in danger of losing his current job and most importantly has himself noticed that he has been alienated from his friends and close family members
The client has told us that this has been happening for the past 2 years after his parents expired during a home fire possibly caused by a woodstove at their home on the Chiricahua Reservation here in the state of New Mexico. The client said the bouts of major depression and manic happiness began a few months after their deaths. Only recently has it gotten serious enough that it was noticed at his work place and he has been placed on short term leave to try to deal with the problem. The client said his temper and inability to no longer get along with coworkers necessitated the move by management for his protection and that of his coworkers. Before us the client had not sought any help for his problem
The client had also mentioned that his father had exhibited the same symptoms as he was having but like his father the client was treating himself with alcohol, sometimes in excessive amounts. This is a common place thing on the client’s reservation lands as the economy there is poor with little access to good to healthcare. This may be indicative of a genetic predisposition which ( ) defines as the client having a moderate chance of inheriting the disorder through genes for both the alcohol abuse and the depression.
In diagnosing the client’s mental disorder we must first come to terms with the definition of what a mental disorder is. The authors of our text book ( ) mention the current popular term for defining mental disorders as being a harmful dysfunction. There are a couple of basic foundations for this with one being that the disorder is harmful to the patient and possibly to others as well, and two, that it is a dysfunction which means that there is a biological and or behavioral system that is not functioning properly for the client. The authors( ) however prefer to define a mental disorder as behaviors or states of emotion that causes a person suffering in the extreme, keeps a person from being able to socialize with others, and keeps an individual from being able to control dangerous impulses that may affect themselves and others around them.
When the client came to use we evaluated his initial interview. The client showed a great deal of animation and dramatic overtures both vocally and with gestures. When asked what he prompted him to seek us out, he responded with an answer that lasted for at least 6 minutes with no interruptions in his speech. The client was not able to hold onto one topic for very long and at one point went from laughing to crying in a matter of a minute. The client’s speech appeared to be pressured during the interview while he talked of the bouts of depression followed by bouts of hypomania.
The client was given an objective test. We do this as opposed to the projective tests which according to ( ) are tests where an individual is presented with words, pictures, and situations. The response that the individual gives to these is then analyzed to determine the unconscious expressions of the presentations that their personality may reveal. The results of projective tests, however, are highly questionable and have gone out of favor for being a valid test.
What we used for testing the client was an objective test. An objective test is where client’s behavioral answers are taken in response to a questionnaire that has standardized questions that help determine a cause for the client’s condition and so help seek a way of treatment. Although this type of inventorying a client has its validity one must remember that the results of the test are only as valid as the quality of the questions and material being used in the tests.
After the test and in keeping terms with the inventory we have derived from the client with
His own self rating from the scales included in the test we have gone to the in keeping with those definitions we have gone to the DSM-5, latest edition (Diagnostic and Statistical Manual of Mental Disorders) for his diagnosis. The DSM-5 is a manual which is used as a standard when aiding diagnosing mental disorders. The DSM-5 manual was the first real manual to list and categorize mental disorders to be used in clinical settings. The DSM 5 manual first became a publication in 1952 containing about 100 diagnoses and with the latest update has now close to 400 mental disorder diagnoses. The DMS-5 manual is invaluable for coding diagnoses and is used the world over for this purpose. It is even arguably considered the bible of psychiatry and psychology.
In keeping with the conclusions we have drawn with guidance from the DSM-5 we have given a diagnosis of a bipolar disorder which was formally called manic-depressive disorder to the client which comes under depressive and bipolar disorders. According to ( ) a bipolar disorder is a mood disorder that includes alternating periods of both depression and mania. The DMS-5 has actually given this disorder its own category as it has the ability to create a path between schizophrenia and depressive orders. This came about because the manifestation of this disorder may well include depression, schizophrenia, and other such disorders.
In our recommendations for treating Tony we have come to the conclusion that biological treatments will be the best path forward as a foundational treatment for the client along with psychotherapy. As explained by ( ), biological treatments are those that use drugs as a treatment for what may be genetic, biochemical or neurological in nature. For the biological treatments we will be using an antipsychotic drug such as lithium carbonate. An antipsychotic drug which is also known as neuroleptics is one that hinder the sensitivity of ones brain receptors to your own chemicals such as dopamine and serotonin. With this we hope to reduce the client’s delusions and overpowering states of agitation. If this drug proves ineffective then alternative drugs such as Depakote and Tegretol may be used. Care must be taken because of the side effects that can come with these drugs such as toxicity levels, tremors and possible damage to the kidneys. Close blood and liver monitoring will be done to avoid these potential problems.
The inclusion of psychotherapy is something we will add to the client’s treatment in the form of CBT or cognitive behavioral therapy. With the CBT we are in hopes that Tony may profit from the behavioral changing thoughts and possible brain chemical benefits that can be derived from this type of psychotherapy as noted by (Schwartz et al., 1996). We are also recommending to Tony’s company that he be put on long term leave so that he may make an extended stay on the reservation to be closer to his remaining siblings, family and tribe as he has mentioned that that are very close and have been very supportive of him throughout this problem. The client’s grandfather as Tony has told is a revered Shaman among the people of his tribe and very close to him. We are in hopes that the ceremonial and ritualistic ministrations given by the clients grandfather may further help in his treatment with rituals
such as meditation and sweat lodge ceremonies. We will however closely monitor the client about these treatments as they are an unknown quantity in his treatment.