1

Submitted to:

Dr Nabeel

Submitted by:

Fajjar butt (02)

M.S Clinical Psychological

Session (2024-2026)

International Institute of Science, Art and Technology, Gujranwala

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Certificate

It is certified that the Clinical Case report submitted by Miss Fajjar butt, Roll No # 02, Session

2024-2026 has been completed under my supervision according to the set pattern of the IISAT

university and also has been approved for submission in its present form, as to satisfy the

partial fulfillment of the course requirement for the degree of MS in Clinical Psychology.

Supervisor

(Internal Examiner)

Date:
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ACKNOWLEDGEMENT

I express my deepest gratitude and humble thanks to Allah Almighty, who knows what is best

and has blessed me with good health, thoughtful insight, loving parents, and supportive friends

who enabled me to accomplish this task. I also extend my heartfelt thanks to Dr. Nabeel for

facilitating me in every aspect. I am especially grateful for his guidance at each and every stage

of this assignment. Finally, I sincerely thank my family and friends for their constant

assistance, support, and cooperation, which helped me successfully complete my case reports.

Signature
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Summary

The client was a 19-year-old individual who was brought to MATH Hospital, Gujranwala,
with complaints of weakness, numbness, forgetfulness, lack of self-care, high aggression,
fearfulness, increased energy, racing thoughts, risky behavior, grandiosity, and sleep
disturbances. A psychological assessment was conducted using both formal and informal
methods. Informal assessment included behavioral observation, clinical interviews, and a
Mental Status Examination (MSE). Additionally, a detailed clinical interview was conducted
with the client’s parents to gather information about the history of the present illness,
educational history, personal history, and family history. Formal assessment included the
House-Tree-Person Test (HTP), the Patient Health Questionnaire (PHQ), and Rotter’s
Incomplete Sentences Blank (RISB). Based on the findings of both assessments, the client
was diagnosed with Bipolar I Disorder, current episode manic, moderate With Psychotic
(DSM-5 code: 296.44) A proposed management plan was developed techniques such as
Cognitive Behavioral Therapy (CBT), Behavior Therapy, Supportive Psychotherapy, Family-
Focused Therapy, and Interpersonal and Social Rhythm Therapy
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Identifying data

Name B

Age 19

Sex Male

Education Middle school 5th standard

Sibling 5th (3 brothers and 2 sisters)

Birth order last one

Religion Islam

Occupation Un-employed

Marital Status Un-Married

Informal Himself, Parents

Reason and source for Referral.

The client came to the MATH Hospital Gujranwala with the complaints of

weakness, Numbness, forgetfulness, sleeping problems, Racing thoughts, high

aggression, lack of self- care, fearfulness. client run away from around 10-10-24

after leading family members was found from AHF client was referred to the

psychiatrist for the Purpose of Psychological assessment and management of his

problem.
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Presenting complaints

Presenting complaints and their duration were reported by the client and his parents,
who indicated that he had been experiencing these symptoms for the past year

Table 1.1

‫دورانیہ‬ ‫عالمات‬

‫چند ماہ‬ ‫بہت باتونی ہے‬

‫چھ ماہ‬ ‫بہت زیادہ غصہ آتا‬

‫ہے‬
‫چھ ماہ‬ ‫رات کو نیند نہیں آتی‬

‫چند ماہ‬ ‫اجنبیوں کے ساتھ حد سے زیادہ دوستانہ رویہ‬

‫چند ماہ‬ ‫خطرناک رویے جیسے فضول خرچی اور تیز رفتار‬

‫ڈرائیونگ‬

Initial observation

The client was dressed properly for the weather and looked neat and clean. He had an

average height and walked normally when he entered the room, greeting politely. He looked

active and full of energy, and his mood seemed good. He kept good eye contact and sat in a

relaxed way. During the session, he stayed alert, paid attention, and was fully aware of what

was happening. He was friendly and cooperative, and a good connection was built with him.

Developmental History of Problem

The client was born in 2004 through normal delivery. He lived in Pindi Bhattian

and studied up to the 5th grade. His academic performance was average, but he left

school due to a loss of interest. According to his parents, the client had been living a
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normal life until the onset of the current illness, which began approximately one year

ago.

The client reported experiencing symptoms such as weakness, numbness,

forgetfulness, high aggression, fearfulness, risky behavior, irrelevant speech, poor

orientation to time, place, and person, coarse tremors in both upper limbs, high energy

levels, and grandiosity. He also exhibited a loss of appetite and difficulty sleeping,

along with overfamiliarity, irrelevant talking, and episodes of laughing without any

clear reason.

His parents stated that he had been talking excessively and incoherently, making

bizarre statements, and showing a lack of insight into his condition. He behaved in an

overly familiar manner with strangers, approached people as if he knew them, and

engaged in impulsive behaviors such as reckless spending and driving at high speeds.

The client also displayed suspiciousness, refused to eat food, and accused his parents

of mixing harmful substances into his meals. He described feeling euphoric and

invincible, with an inflated sense of self-importance and grandiosity. There were no

signs of Parkinsonism, and he denied any history of substance abuse.

Over time, the client stopped taking care of himself, including bathing, changing

clothes, and grooming. He became short-tempered, aggressive, and would fight with

family members and others. He showed forgetfulness, impulsivity, and a tendency to

leave home and wander several kilometers away for hours. His family also reported

that he sometimes appeared fearful and scared. The client has been under psychiatric

care for the past month.

His family expressed significant concern and distress regarding his current
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condition

Background information

Background information contains the client’s family history and his overall home

environment.

Personal History

The client was last born child. The client was born in LSCS at Lady Willingdon

Hospital by the normal delivery by his mother. no peripartum or postpartum

complications were reported No records of neurotic traits like thumb sucking nail

biting, bed wetting. His growth was normal. His food and sleeping pattern were normal

in his childhood. He was a stubborn child and used to tantrum when not getting what

he wants.

Pre-Morbid Personality.
The client had been leading a normal life prior to the onset of the illness.

There were no psychological or physical problems reported during this time.

However, the client has reported having a low tolerance for stress, which may have

contributed to the development The client's health belief system involved visiting

doctors for regular checkups, indicating a concern for his overall well-being. The

client also reported experiencing fear and anxiety at times of the illness. In his leisure

time, the client used to watch television as a means of relaxation. Family report he

gets fears and scared sometime.

Family information.

The client comes from a caring and supportive family, despite having a

challenging socioeconomic background. His parents belong to a lower

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socioeconomic status and currently live in a rented house measuring 4 marlas, which

includes two rooms, one bathroom, a kitchen, and a small living area for five family

members. The client may have faced financial difficulties and had limited access to

resources outside the home. The client’s home environment was generally caring and

loving, although there were occasional quarrels between parents and siblings.

Father
The father is 54 years old and is described as supportive, affectionate, and caring in his

behavior. He shares a close relationship with his wife and children, including the client

Mother
His mother is 50 years old and shares a caring relationship with the client. She is concerned

about his health and well-being and continues to support him.

Sibling
The client had five siblings (three brothers and two sisters). One brother died three days after

birth. The client is the youngest in the family and studied up to the 5th grade.

Genogram

Father
Mother

Sister
6=
Sister

Brother

Brother
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Table 1.2

Symbols Descriptive

Male (father, brother)

Female (Mother

Satisfactory relationship

The client has a satisfactory relationship with his family

Marital History.
The client is Unmarried

Educational History.

The client studied up to the 5th grade in a government school. He was an average student

and received good grades. According to his father, he discontinued his studies because of

financial problems and lack of interest.

Occupational History

There is no occupational history of the client.

Social History.

The client had no close friends and usually spent time at home watching

television. He does not have a large social circle. When he feels angry, he

sometimes breaks things in the house. He also tends to leave the house when

family members do not listen to him or agree with him.

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History of Family Psychiatry/ Medical Illness

There is a no family history of psychiatry and medical illness

Provisional formulation.
It is hypothesized that the client’s current manic episode is influenced by a combination

of predisposing personality traits such as aggressiveness, high energy, and impulsivity.

Environmental and psychosocial stressors, including family conflict and financial stress, likely

acted as precipitating and maintaining factors. Additionally, poor coping skills, limited self-care,

and low insight may contribute to the persistence and severity of symptoms. The interplay of

these factors has led to the current presentation of Bipolar I Disorder with manic features,

including grandiosity, overfamiliarity, hyperactivity, irritability, and risky behaviors

Psychological Assessment

Psychological assessment is a complex, integrative, and conceptual activity that

involves deriving inferences from multiple sources of information to achieve a

comprehensive understanding of a client or client system. It involves the ability to

measure and formulate degree of need and mental status, develop psychological profiles

in response to particular referral problems, and evaluate outcome with tests, measures,

and diagnostic interviewing across a range of client population. (Peterson et al., 2015, p.

520). The psychological assessment was done formally and informally.

There are two types of psychological assessment.

1. Formal assessment

2. In formal assessment
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Informal Assessment

Informal assessments procedures homegrown methods developed to meet specific

needs. (Neukrug & Fawcett, 2010, p. 196). Though they are subjective, these assessment

procedures are usually set up to meet certain standards (Neukrug & Fawcett, 2010).

This assessment includes:

• Behavioral observation

• Clinical Interview with

• Subjective rating of client symptoms

Behavioral Observation

Behavioral observation is the widely used method of behavioral assessment.

Unlike other methods of behavioral assessment, most of which rely on people’s perceptions of

behavior, behavioral observation involves watching and recording the behavior of a person in

typical environments (Hartman, 2004).

The behavior of the client was cooperative and he responds well. He talked friendly. He

showed his determination to get rid of drugs. Eye contact and motor control also was appropriate

Clinical Interview

A clinical interview is a dialogue between psychologist and patient that is

designed to help the psychologist diagnose and plan treatment for the patient. It is often

called a conversation with a purpose (Allen, 2019).

The purpose of conducting clinical interview in the present case was to obtain

information regarding the history and any previously sought treatment for the client’s

problems. The client’s parents were very cooperative during the interview and responded
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to the questions in detail. They were optimistic about the management of the client’s

problem

Mental status examination

The mental status examination is a clinical assessment of the individual which

reflects both the individual’s subjective report and experience, and the clinician’s

observations and impressions at the time of the interview (Evans, 2002). The mental

status examination is a structured assessment of the patient's behavioral and cognitive

functioning. It includes descriptions of the patient's appearance and general behavior,

level of consciousness and attentiveness, motor and speech activity, mood and affect,

thought and perception, attitude and insight, the reaction evoked in the examiner, and,

finally, higher cognitive abilities.

General Appearance

A young male sitting on chair. he had a aggressive personality. His height was

5.2and eye color was black. His general appearance was normal, grooming and hygiene.

He was attentive throughout the session and answered abruptly to all the questions asked.

He was casually dressed his shirts Client maintained a good eye contact more than half of

the time. Client was cooperative in sense that whatever questions were asked he replied

but on the same side he showed resistance because he didn’t explain the incident properly.

Client was able enough to write. And also, enough able to read correctly

Speech

Pressured, rapid, loud, difficult to interrupt, frequent topic shifts, occasionally

incoherent.

Mood Euphoric with excitement and grandiosity.

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Affect Congruent with mood but quickly shifting to irritability and anger.

Perception

Visual hallucinations; suspicious behavior, refuses food believing contamination.

Thought Process

Disorganized, flight of ideas, tangential, topic shifting.

Thought Content

Bizarre statements, impulsive ideas, overfamiliarity, paranoid thoughts; suicidal

thoughts reported but no attempt.

Cognitive Functioning

Oriented to time, place, and person; general knowledge normal; slight difficulty

reversing months; attention, reading, and writing intact.

Judgment

Poor, evidenced by risky behaviors such as reckless spending and dangerous

driving.

Insight

Limited denies illness or does not recognize severity of behavior.

Visual Analogue Scale (VAS)

The visual analog is a method that can be readily understood by most people to

measure a character or attitude that cannot be directly measured. The visual analogue

scale is of most value when looking at a change within some people and is less valuable

of comparing across a group of people because they have a different sense. It could be
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argued VAS is trying to produce interval/ratio data out of the subject value that is best

ordinal (Katayama, 2012). The scale contains 0 to 10 points for rating. 0 represented at

least problem and 10 represent the maximum problem

Quantitative Analysis.

The quantitative analysis of the client on the visual analogue scale is as follows.

Table 1.3

The table is showing the client’s symptoms and the rating of these symptoms by the client.

Sr. No. Symptoms Client’s Rating

1 Restlessness 7

2 Sleeping problem 6

3 Weakness 6

4 Poor appetite 6

5 Talkative 7

6 Aggression 7

7 Racing thoughts 6

8 Risky Behavior 7

9 High Energy 7

10 Irrelevant talk 7

Quantitative Analysis.

The client on visual analogue Scale experienced Grandiosity, sleeping

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problems, Racing thoughts, Restlessness weakness, Risky Behavior, High Energy,

Irrelevant talk, Aggression, Poor appetite and talkative.

Formal Assessment

Formal assessment used in psychology, combines a process of interviewing a

subject or client and is used primarily when comprehensive and reliable information is

needed for assessment. Formal evaluations include skills and fitness, writing tests,

performance records and win-loss records. (Zakrajesk., 1991).

The following formal tests were used.

• House Tree Person

• Rotter Incomplete Blank Sentence

• Young Mania Rating Scale (YMRS)

House Tree Person

The house tree person test was designed by John Buck in 1948. HTP is a type of

projective test. This technique is designed to aid the clinician in obtaining information

concerning the sensitivity, maturity, and integration of a subject personality with its

environment both in general and specific. House tree person test is used to measure

aspects of a person’s personality through interpretation of drawings and responses to the

questions. The examiner integrates the results of this test in creating a basis for evaluating

the subject’s personality from a cognitive, emotional, intra- and interpersonal perspective.

Administration

A pencil and record form is given to the subject. The subject is asked to fill the

details about her on the record form. When this has been done, the test book is given to
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the subject. Test book consists of 3 blank white pages and a questionnaire. The first phase

is to draw a house, tree, and person with the help of a pencil without using an eraser

within 20 minutes.

Scoring and Interpretation

The HTP scored is both an objective quantitative manner and subjective

qualitative manner. The quantitative scoring scheme involves analyzing the details of

drawings to arrive at general assessment of intelligence using a scoring method devised

by the test creator.

Test Administration

The administration process is quite simple of (HTP), person is presented with a

blank sheet of paper (8 ½ × 11 inches) in a horizontal position and a sharpened pencil

with eraser. Instruct the individual to “draw me a picture that the in it a house, tree, and a

person”. No further instructions or elaborations are given.

Table1.4

Pictures Time Taken

House 3 minutes

Tree 5 minutes

Person 7 minutes

Interpretation

Client takes 15 minutes to draw the pictures

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Qualitative Analysis of Subject’s Drawings

House

The too little size of the house could be a reflection of the client's feelings of

rejection and disconnection from his home life. He may feel like he doesn't belong or fit

in with his family, which could exacerbate his bipolar symptoms and make him feel more

isolated and alone. The strong lines in the house could represent the client's anxiety and

need for protection. He may feel like he's constantly on guard or under threat, which

could make it difficult for him to relax and feel safe. The absence of a window and the

presence of large geometric figures could suggest that the client has experienced some

form of abuse or trauma in his childhood.

Tress
Client drew an abstract tree i.e., realistic, not distinct their problems and tend to

Avoid direct confrontation. Client drew a small trunk that indicates limited ego

strength. Client drew thin trunk that suggests maladjustment. Client drew branches with

limbs moving downward that depicts low level of energy. Dead branches depict client’s

difficulty in getting attention from his environment, hopelessness. Roots drawn that

show mild impairment in orientation

Person

Same sex figure depicts histrionic and manic tendency, restlessness. Figure

depicted in motion depicts fantasy activity. Alterations were made that show anxiety,

conflict area. Client drew an odd shaped head that depicts psychotic aspect. Client

omitted eyes that determine that there is a conflict. Client omitted mouth that shows

guilt. Neck omission shows lack of impulses control and immaturity. Arms drawn from
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body show externalized aggression. Arms are thin and weak which depicts lack of

achievement. Fingers are drawn without hand that show and

intentional aggression Finally, the omission of the feet may indicate strong feelings of

contraction or a desire to withdraw from the environment Lack of detailing shows

withdrawal, reduction of energy. Shading on face show self-consciousness regarding

facial complexion.

Conclusion

All of those drawings showed that the client had a tendency towards rumination or

worrying, had unresolved emotional issues. The small size of the house could be a reflection of

the client's feelings of disconnection from his home life.

Rotter’s Incomplete Sentence Blank Test (RISB)

The Rotter Incomplete Sentence Blank popularly known as RISB was

developed by Rotter and Rafferty (1973). These completions are then scored by

comparing them against typical items in empirically derived manuals for men and

women and by assigning to each response a scale value from 0 to 6. It comes in three

forms i.e., school form, college form, adult form for different age groups, and

comprises 40 incomplete sentences which the client has to complete as soon as

possible but the usual time taken is around 20 minutes, the responses are usually only

1-2 words long such as"I regret ..." "Mostly girls...". The test can be administered

both individually And, in a group, setting It doesn't have long set of instructions and

can be easily worked out on a greater population. RISB was given to client and was

asked to complete the sentence

Scoring and interpretation

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Subject's responses are scored for the presence or absence and the degree of conflict.

Completions are scored on a seven-point scale from o (most positive) to 6 (most

conflict), with 3 being scored as a neutral response, which does not clearly fall into

either the positive or the conflict category. Positive responses are those that express a

healthy or hopeful frame of mind categorized as P1, P2, and P3.

(2) P1 – specific feelings towards people and things. "I like my father" (1) P2

– test indicated a generalized feeling towards people, indicates goals, social

adjustment, opinion, humor and good family life. "I like dogs"

(1) P3 – clearly very good responses: warm and accepting. Such positive

responses are positive attitudes, optimism, warm acceptance, and good-natured

humor.

Conflict responses are those that express as unhealthy or maladjusted frame of

mind, such as hostility, pessimism, mention of specific problems or symptoms, and

negative attitudes, which are categorized into C1, C2, C3.

(4) C1 – responses wherein what is experienced and matter of world state of

affairs, forwarded problems, school difficulties, identification within a minority

groups, physical illness, minor problems. (Specific complaints.)

(5) C2 – more serious: responses that refer to broader and more generalized

difficulties, expressions of inferiority feelings, concern over vocational choice,

difficulty in heterosexual relationship, generalized social difficulty

(6) C3 – most serious: truly an indication of maladjustment, suicidal,

sexual conflict, family problem, fear of insanity, strong negative inferred inner
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conflict.

(3) N – neutral responses are those that are simple descriptions, common

sayings or catch phrases, or simply lacking in personal reference. Can't fall in either

the positive or conflict responses. After all the items have been scored, the individual

item scores are added together to obtain total score, which provide an overall index of

adjustment. If any items were left blank or not scored, the total score is prorated so

that it is comparable to those protocols which a full 40 responses

Table1.5

show quantitative results of RISB

Types of items No. of Responses Scores

Conflict C1 4 16

C2 15 75

C3 7 42

Neutral N 3 9

Positive P1 4 8

P2 3 3

P3 0 0
Cut-off Score=135 Total Score=153

Qualitive analysis

Familial attitude

The client conflicting attitude at home He respond on the item no 4 that Back

Home he doesn’t find peace. he has positive feelings about his parent as he responds

on item no 11 that a mother is a blessing. And in the Item no 35. he responds that My
 22

Father is my friend.

General attitude

The client general attitude shows conflicted attitudes in the client respond on the item

no 6. that At bed the Sleep does not come and in the Item no 12 he feel that something in the

air. He responds on the Item no 13 that his fear was that someone mixed something into his

food. He shows infertility complex at the response of item no 18 that his nerves are very

weak. An ambiguous and conflicting response show in the item no 30 that he hates when the

work is difficult. He also infertility complex was show in the item no 33 that his only

trouble is that when people did not understand him.

Social attitude

Client disappoints from the society he responds on .in item 10 and 19, he said that

people are not good which criticize him. In the item 26 client responds that marriage was an

important He was un-married.

Character attitude

Client usually remains in a depress mood. He showed conflicting attitude A great

proportion of his thoughts were occupied by his illness. In the item no 14 in the item no 16client

responds that he like sport. He said he is naught in childhood in item 17. He responds on item

no 14 that he did not like school its boring to go to the school In item no 27 he responds that he

was best when he was alone. In item no 28 Client responds that Sometimes he feels fear.

Results

The client obtained 153 raw score which indicates that he was maladjusted problems.

Young Mania Rating Scale (YMRS)

Introduction
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The Young Mania Rating Scale (YMRS) is one of the most widely used clinician-

administered rating scales for assessing the severity of manic symptoms in individuals

with bipolar disorder. Developed by Young, Biggs, Ziegler, and Meyer (1978), it was modeled

after the Hamilton Rating Scale for Depression (HAM-D).The YMRS focuses on symptom

severity over the past 48 hours, combining patient self-report with clinician

observation during an interview. The scale contains 11 items, each designed to capture a key

domain of mania, including mood, motor activity, speech, thought content, irritability, and

disruptive behavior.Its strengths include brevity (15–30 minutes), ease of administration,

and widespread acceptance in clinical and research settings. However, it is limited in populations

without manic symptoms, as it was specifically designed for mania

Scoring System

• Total items: 11

• Scoring method:

o 7 items rated 0–4

o 4 items (irritability, speech, thought content, disruptive/aggressive behavior)

rated 0–8 (given extra weight to account for poor cooperation in severe mania).

• Total score range: 0–60

• Anchor points: Each score corresponds to increasing severity of symptoms.

• Flexibility: Once trained, clinicians may assign whole or half points to capture

intermediate severity levels.

Interpretation of Scores
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Interpretation varies slightly across studies, but common guidelines are:

YMRS Score Interpretation

0–12 Euthymia or minimal symptoms

13–19 Mild mania/hypomania

20–25 Moderate mania

≥ 26–60 Severe mania

Baseline comparisons:

o Euthymia: ~2

o Depression: ~3

o Mania: ~12+

Clinical trials often require YMRS > 20, with entry averages around 30.

Table1.6

The table is showing the client’s symptoms and the rating of these symptoms by the client.

Sr. No Symptoms Client’s Rating

1 Elevated Mood 4

2 Increased motor activity 4

energy

3 1
Sexual interest

4 Sleep 3

5 Irritability 2
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6 Speech 4

7 Language-Thought Disorder 2

8 Content 2

9 Disruptive-Aggressive 0

Behavior

10 Appearance 1

11 Insight 4

Diagnosis

Bipolar I Disorder current episode manic, moderate With Psychotic (DSM-5 code: 296.44)

Personality Disorders and Intellectual Disabilities

Personality traits: impulsivity, aggressiveness, fearfulness (rule out Cluster B traits).

No intellectual disability.

Medical condition

No parkinsonism or chronic medical condition identified.

Psychosocial and environmental problem

Family conflicts Z63.5

Financial stress Z59.6

Poor sleep hygiene Z72.820

Disruption of family by separation and conflicts Z63.5

Prognosis
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A prediction of the course, duration, severity and outcome of a condition,

disease or disorder. Prognosis may be given before any treatment is undertaken so that

the patient or client can weigh the benefits of different treatment options (American

Psychological Association, 2013).

The client’s future outlook seems uncertain to poor because of many risk factors.

Since his illness started at a young age (21), he is more likely to have repeated episodes

in life. He left school after 5th grade and is not working, which means he does not have

a stable routine or support system to protect him His severe symptoms, like talking too

much, being aggressive, spending recklessly, and driving fast, show poor control over

his behavior. He also has no healthy coping skills, poor lifestyle habits, and stress at

home, which make things worse. he does not get regular treatment and family support;

there is a high chance his condition will come back again and cause long-term

problems in daily life

Case formulation

B was 21 years old boy He was born in 2004 through normal delivery. He lives in Pindi

Bhattian. He studied up to the 5th standard and was average in academics. He

discontinued his studies due to loss of interest. His illness began in 2024 During the

session; the client was attentive and responded quickly to all questions. He was casually

dressed and maintained good eye contact for more than half of the time. He was

cooperative in answering but also showed resistance, as he did not explain certain

incidents properly

The client reported symptoms of overfamiliarity, irrelevant talk, poor orientation in

time, place, and person, high energy, and grandiosity. These symptoms have interfered
 27

with his daily functioning. He was brought by his parents with complaints of unusual

behavior for the past few days.

According to the parents, the client has been talking incessantly and incoherently,

making bizarre statements. He has also been acting overfamiliar with strangers,

approaching them as if he knows them, and engaging in impulsive and risky behavior,

such as spending money recklessly and driving at high speeds. The Client's energy level

was high He is speaking rapidly, switching topics frequently, He reports feeling

euphoric he presented with symptoms of mood swings. He had been complaining of

weakness, numbness, and forgetfulness. The patient was also experiencing high levels

of anger, aggression, and fearfulness. He had been yelling at his family members,

breaking objects, and threatening to hurt himself and others. He denied any suicidal or

homicidal ideation. There is no evidence of parkinsonism.

Rotter Incomplete Sentence Blank Test, House Tree Person and Young Mania

Rating Scale (YMRS was applied on the client to measure adjustment level, personality

traits and measuring the severity of depression in the client

Predisposing factors

The predisposing factors mean factors that develop the tendency of illness in client,

biological factor, and family history, heritable factor of the disorder There was no

genetic or family history of bipolar disorder. But his personality including

aggressiveness fearfulness, bizarre statement, high energies could be the predisposing

factors that leads to bipolar disorder.

Maintaining factors

The most important maintaining factors that there are no Healthy lifestyle habits,
 28

such as exercise and sleep. Environmental factors such as financial stress or

Relationship conflicts Family. No Coping skills to manage aggression. discourage self-

care, are play important role in determining the risk of bipolar disorder.

Precipitating Factors

Environmental factors such as financial stress or Relationship conflicts Family.

No Coping skills to manage aggression. discourage self-care, are play important role in

determining the risk of bipolar disorder

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Case formulation Summary Table

Presenting Assessment
Complaints Clinical interview
Client
Forgetfulness Mental status examination
High aggression
House tree person (HTP)

Fearfulness Rotter’s Incomplete Sentence

High energies Blank Test (RISB)

Multiple mood
swings Young Mania Rating Scale
Lack of Self care (YMRS

Irrelevant talk

Buzzer statement Precipitating

Predisposing
Factors
Run Away From Home Factors
Stressful Aggressive
Environment personality

Financial Problems
Perpetuating Factors
No Habit
lifestyles
financial stress

Relationship
Conflicts.

Diagnosis
Bipolar I Disorder, current episode manic, moderate
With Psychotic (DSM-5 code: 296.44)
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Proposed Management Plan

1. Psychological Counseling

2. Psycho education

3. Anger Management Tips

4. Deep Breathing

5. Lifestyle modifications

Short term goals

1. Developing a consistent sleep schedule: Sleep is essential for managing

bipolar disorder symptoms, and regular sleep patterns can help stabilize

mood.

2. Maintaining a healthy diet and exercise regimen: A balanced diet and regular

exercise can help reduce symptoms, which are cause for bipolar episodes.

3. Psycho education should be given to client to give him awareness about her problem,

causes and treatment.

4. It is crucial to follow the medication regimen prescribed by the healthcare provider to

manage the symptoms of bipolar disorder effectively.

5. Building a support network: Engaging in therapy, joining a support group, or

confiding in trusted family and friends can help manage the emotional

challenges associated client with bipolar disorder.

Long Term goals.

1. Bipolar disorder is a chronic condition that requires ongoing management. Long-

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term goals should include developing effective coping strategies and medication

management plans to help client to manage symptoms

2. Relationships with family, friends, and mental health professionals who can provide

client support and guidance.

3. Living with bipolar disorder can be challenging, but developing a positive mindset can

help client to cope with difficult times, developing a growth mindset, and focusing on

self- improvement and personal growth.

 32

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