Case NO.
3
Bipolar Disorder
Background information/history/Identification-Data:
Name SR
Age 50 year
Gender Male
Education Level Middle
Birth Level 1st
Material Status Married
No of Siblings 7
Occupation worker
Parents Mother was died and father alive
Religion Islam
Address Multan
Informant
Patient gave information about herself.
Reason for referral
The client come to the BUCH HOSPITAL with the symptoms of hyper motor
activities, aggressive behavior, restlessness, loose of sleep. His son bought him to the
hospital for assessment and control of behavior.
Presenting Complaints:
As reported by the client present complaint are:
غصہ بہت اتا ہے ۔
دل چاہتا ہے میں بولتا رہوں ۔
بھوک بہت لگتی ہے ۔
نیند نہی آتی ہے۔
د وسروں کے مارنے کا دل کرتا ھے ۔
In the last 4 months
History of Present Illness
According to the client´s son the client is very sensitive person. Patient was in usual state
in 10 days back when he developed aggressive behavior try to beat family member and
his wife. The client can`t go to bed early and it looks little time to sleep. There was
insomnia, excessive appetite, self-talk and restlessness. The client has difficulty in
breathing because of overweight.
Past Psychiatric History
Client was already involving in this problem before two years old. When he suffered this
problem then treated from the Mayo Hospital Lahore. But now again he is suffering from
this problem.
Family History
Client belong to a middle class family. The age of client`s was 52 years and he is
professionally worker. The patient has good relationship with his father Her mother was
died. The patient loved her mother very much and had good relationship with her mother.
The relationship of client with her parents was satisfactory. he has 3 brothers and 3sister.
The patient had not good relationship with his brother. He have 4childern .The home
environment of client is normal.
Family History of Illness
Nobody in family has suffered any major illness.
Personal History
Client was born after normal delivery. he achieved development milestones at appropriate
age. No significant illness was reported in childhood. No nail biting bed wetting complaints
were reported. Patient has many friends in his childhood and he was always enjoyed the
parties and weddings.
School and Education
Client was uneducated.
Occupational History
Client was a worker at company.
Sexual History
Client has no sexual History
Pre morbid Personality
Pre morbidly patient was social and had good relationship with family members, relatives
and others. But have aggressiveness.
Psychological Assessment
Informal Assessment
Formal Assessment
Informal Assessment
Behavioral Observation
The behavior of client was polite and respectable. he was very cooperative. he was sitting
with his legs folded in cross position on the sofa and was in elevated mood. he was very
talk active and cooperative. he was willing to discuss his problem. he maintained good
eye contact throughout the session but started crying while discussing his personal
problems.
Mental Status Examination
(A) General Appearance
The client’s appearance was good, his dress was also neat and clean. His Hairs were
well combed
(B) Speech
His speech was normal.
Emotional Expression (Mood)
His mood was not good at that time
Subjective
According to the client he was not happy in the hospital
Objective
His objective mood was satisfactory during all session some he became aggressive but over
all his behavior was cooperative
Thinking and Perception
He have not illusion and hallucination
Alertness
He was fully alerted on my question
Orientation
پندرہ منٹ پہلے میں کیا بات کر رہا تھا؟ :س
جواب میرا نام پوچھا تھا۔
The client was well oriented during interview.
Person
س :میں کون ہوں؟
جواب :اپ ڈاکٹر ہیں
Place
سوال :یہ کون سی جگہ ہے؟
جواب :ہسپتال۔
Time
اس وقت کیا ٹائم ہوا ہے؟
جواب 12 :بجے ہیں۔
Attention and concentration
Attention and concentration was good.
Memory
Immediate memory
سوال:اس گنتی کو دہراؤ تین چار پانچ نو11
ج:تین چار پانچ نو 11۔
Recent memory
سوال :اپ نے صبح کیا کھایا تھا
جواب :پراٹھا اور انڈا
Remote memory
سوال :سیب اور گیند میں کیا مشترک ہے
جواب :کچھ نہیں
Calculation
His calculation was good.
7 + 4 = 11
۔
19 – 6 = 13 .
General knowledge
سوال :پاکستان کب ازاد ہوا
جواب 14 :اگست 1947
Abstract Reasoning
سوال :سیب اور گیند میں کیا فرق ہے؟
کچھ نہیں ۔
Insight
سوال :اپ کو یہاں کیوں الیا گیا ہے؟
جواب :عالج کے لیے۔
Judgment
سوال :راستے میں کوئی چیز ملے تو اپ کیا کرو گے؟
جواب :قریبی پولیس اسٹیشن میں جمع کروا دوں گا
Formal Assessment
Goldberg manic scale
RISB
The patient got 61 on Berg’s Mania Scale
54-UP Severe Mania
Rooter’s Incomplete Sentence Blank (RISB)
Quantitative Scores:
Client obtained135 scores on RISB which is blow the cut off score =135 these score
indicate that client had saver maladjustment of environment
Response Score of value Number of Items Total scores
C3 6 3 36
C2 5 2 12
C1 4 11 44
N 3 9 27
P1 2 7 14
P2 1 2 2
P3 0 6 0
135
P2
Qualitative Scores:
Familial Attitude
According to Client’s answer his familial relationship have positive &good because in
question #4,11, 35 she also describe about his farther good person his feelings towards
his mother is good.
Social & Sexual Attitude
Social attitude is too good but have some complex about his self because he described in
the question #1,5,9,14,21,26,32 and 40, he like social activities and people are not good in
his view & sexual attitude is normal.
General Attitude
In many question 5,21,23,33 & 39 he describe his regarding attitude toward his self
because of using alcohol he lost a lot.
Diagnosis
According to DSM-5 he diagnosed Bipolar 1with single manic episode
Case Formulation
Some studied have produced dates support the connection between stress and the organ of
manic episode all people who had a high of stress in their lives and those who lacked
social support from case confiding relationship are more likely to develop a Bipolar affective
disorder.
Management plan
(1) Short term Goal
(2) Long term Goal
Short Term Goal:
To build report with the client.
To reduce her restlessness.
To reduce her aggression.
To relax her muscular tension.
To manage nutrition plan properly.
Make a timetable for walk at least for ten minutes.
To reduce her tension level.
To engage client to other healthier activities.
Long Term Goal:
To continuation of short term goals.
To enable the client to overcome her aggression.
To utilize her energy in work.
To give her proper training to relax her muscles.
Openly discussion about her problem along with her family members.
To educate the client for the follow up sessions.
Suggested Therapies
Following are the suggested therapies.
1 Behavioral therapy
Relaxation training
Deep breathing
Cognitive therapy.
Pleasant activity scheduling.
Imagery based expose.
Psychodynamic therapy
Interpersonal therapy.
Applied Therapy
i. Muscular Relaxation Technique.
ii. Deep Breathing.
Session’s report
Session No.1 (Duration30 Min)
I took my first session, and as report building is the most important first step for the history
taking and for the assessment patient`s problem, so in the first session I tried to build
support with my client. I took client`s profile and asked his what he feels when he
suffered from the problem.
Session N02 (Duration40 Min)
This session was conducted on next day. I asked the client remaining history. In the
beginning of session, client seemed to be silent but after short time he talked normally,
Then In apply Goldberg manic scale test on client. and the session was ended
SessionNo.3 (Duration30Min)
In this session I take completed medical examination history of the client. and provide
relaxation technique and the session was ended
SessionNo.4 (Duration35Min)
In this session I applied RISB. Examine his behavior and also provide meditation the client
feel relax
Session No.5 ( Duration45Min)
In this session I summarize the previous technique and also guide him,I gave him the
activity schedule and also discuss with him beside that I took the session with his family
members and provide psycho- education regarding his problems. Then apply the the deep
breathing exercise while ,the session was ended.
Reference
Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck Depression Inventory–II (BDI-II)
[Database record]. PsycTESTS. https://doi.org/10.1037/t00742-000
Beck, A. T., & Steer, R. A. (1993). Beck Anxiety Inventory manual. San Antonio, TX:
Psychological Corporation.
Rotter, Julian B.; Rafferty, Janet E. (1950). The Rotter Incomplete Sentences Blank
Manual, College Form. New York, NY
Goldberg JF, Perlis RH, Bowden CL, et al.: Manic symptoms during depressive
(DAST-10) in the Prison Setting. Journal of Psychoactive Drugs Volume 46, 2014 -
Issue 2. Pages 140
Skinner, HA: The Drug Abuse Screening Test. Addictive Behaviors, 1982, 7,
363-371.
