Question

Jay Tolen is a 20-year-old African American male who attends the University at Buffalo and works part time at a physical fitness center. Two weeks ago he moved in with his mother and older sister after his fiancée broke off their engagement over a recurring argument about his starting home improvement projects and never finishing them. She had told him to move out. He has been referred to the mental health clinic by a walk-in health clinic where his older sister had taken him because of her concern about his sudden onset of depression, which she described as “almost paralyzing.” He had stopped attending classes and working. He had lost interest in food and working out. All he wanted to do was sleep. Jay enters the examining room accompanied by his sister with his head down and his shoulders hunched. He is dressed appropriately for the weather in clean clothes. When asked what brought him to the clinic, he shrugs and says that he feels so down that he can hardly drag himself out of bed. He says that he cannot concentrate. He feels worthless and says that he has had thoughts of suicide but he denies having a plan. He has no medical problems and is not taking any medications. He says that he does not smoke or use drugs. He drinks a beer or two when he goes out with friends on the weekend. Family history reveals that his mother is in good health but his father died 2 years ago at the age of 45 in an alcohol-related accident. He describes his father as “larger than life,” always full of energy, but hard to live with because of his unpredictable moods. When asked, Jay denies any previous episode of depression or episodes of elevated mood Perese 14-2 Psychiatric Advanced Practice Nursing Student Case Study or mania. Jay’s sister says that Jay was depressed for 2 months after his father’s death and had received counseling from their priest. She is not aware of any episode of mania. She describes Jay as always lively, carefree, and a punster. He had unlimited energy and was able to work and maintain good grades. He did not need much sleep and was always ready with new ideas of exciting things to do. But in the last week, he has changed. Questions: 1. What diagnosis would you consider? 2. What would you include in a biopsychosocial treatment plan for the patient? 3. What interventions would you consider?

Answer 1

DIAGNOSIS: BIPOLAR DISORDER

Biopsychosocial treatment plan :

• Psychotherapy : This may help Jay to recognise his condition and also improve his relationships within family.
• Cognitive behavioural therapy: Short term treatment , but used to resolve the negative thinking and depression
• Build a supportive relation with patient as it is essential in care which will help to improve positive thinking for the patient .
• Interpersonal psychotherapy is also given to improve the moods of client.
• Questionairre's should be avoided.
• Monitor the physical health his diet , nutrition, personal cleanliness, vital signs and metabolic needs.
• Electroconvulsive therapy.

Interventions :

• Maintaining his daily routine like good sleep,nutritious diet and exercise regimen.
• Make him understand his capacity and his ability to do things