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Integrated Biopsychosocial Case Study

Integrated Biopsychosocial Case Study

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An essay for the 2012 Undergraduate Awards Competition by Eoin Moore. Originally submitted for Medicine at University College Cork, with lecturer Dr. Margaret O'Rourke in the category of Medical Sciences
An essay for the 2012 Undergraduate Awards Competition by Eoin Moore. Originally submitted for Medicine at University College Cork, with lecturer Dr. Margaret O'Rourke in the category of Medical Sciences

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Published by: Undergraduate Awards on Aug 31, 2012
Copyright:Attribution Non-commercial

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10/27/2013

 
 
Integrated Biopsychosocial CaseStudy
 
 Abstract 
 
Case Study
This essay begins with the psychiatric evaluation of a 22 year old female university student with acomplex psychiatric history.Her unfortunate personal circumstances were replete with adversity from a young age. Although sheinitially presented with a clinical picture suggesting a diagnosis of major depressive disorder, it was laterdiscovered that she, in fact, was suffering from bipolar disorder.Furthermore, because of her repeated gestures at self-harm, a diagnosis of borderline personalitydisorder came under consideration. Aside from the medical aspect of her mental health difficulties are theequally important psychological and social factors contributing to her negative state of mind.This patient was an interesting case due to the diagnostic uncertainty pervading her management as wellas being an archetypal depiction of the biopsychosocial model and the importance of patient-centred care.
Biopsychosocial Model
The advent of the biopsychosocial model has revolutionised the practice of healthcare
.
This model
espouses an approach to patient care which considers the patients’ psychological issues and their social
situation, not just the biological and medical aspects of patient care.In no other area of medicine is patient-centred care more fundamental than in psychiatry. Mind, body andsocial situation are all complicit in the development of a mental illness.
 
One can easily appreciate this in Lisa’s case, which
perfectly illustrates the impact that emotional
difficulties, social adversities and genetic susceptibility can have on an individual’s neurochemistry,
culminating in a major mental illness.
The second section of this composition juxtaposes my patient’s ca
se with the literature on thebiopsychosocial model. The predisposing, precipitating, perpetuating and protective factors contributing
to my patient’s illness are defined, as well as the potential treatment options by which these can be
addressed.
 
Presenting Complaint 
Lisa (not real name) is a 22 year old female university student Presented to the ED on 26/02/2012 after an episode of deliberate self-harm
History of Presenting Complaint 
6 week history of low mood and anhedoniaAttributed to relationship difficulties with boyfriendIntense suicidal ideationPreoccupied with ending her lifeBegan to research on the internet about ways to commit suicideHad not yet formulated a planRepeated non-lethal DSHInflicted superficial cuts on upper arms and thighsNot a suicidal gesture; done to relieve tension and distract from negative thoughtsAssociated symptoms:1.
 
Hyperphagia2.
 
Hypersomnia3.
 
Fatigue4.
 
Poor concentration5.
 
Feelings of worthlessness and self-hatredNo hallucinations or delusions elicitedConfided in sister after an episode of DSHBrought to ED with shallow lacerations on thighsAdmitted to psychiatric ward next day, seen on 27/02/2012
Past Psychiatric History
Claims to have suffered from depression since childhoodFirst presented to medical attentionin April 2011Attended GP with 6 week history of depressive symptomsDiagnosed with major depressive episodeTreated with escitalopram and depression remitted, but experienced a relapse in Nov 2011Dose of escitalopram increased by GP and referral made to consultant psychiatrist Admitted to psychiatric ward for 3 weeks in Nov 2011 after episode of DSHTreatment augmented with mirtazapine by psychiatrist and depression remitted again

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