Case Study Identifying Information Brandon is a 16 year old male who is energetic and often hyperactive. Brandon has time periods where he feels sad and has a hard time with being able to “snap out of it” or feel better. Brandon comes from a broken home and had an older sister who was killed in a car accident on prom night when she had been drinking and driving, Brandon’s parents then divorced after the loss of his older sister. He also has a younger sister who has had continuous problems with depression since the death of her sister. Brandon has ran away from home on a couple of occasions but has always retuned after ‘two weeks or less. Brandon has dark brown hair and light brown eyes. He has medium height and a thin build. He was dressed appropriately and his clothing was clean, He was admitted to the group home by his parents who were both present at the admission. Presenting Problem and History of Problem Brandon has been in the hospital on several occasions for threatening or attempting to take his own life. He has attempted this through slitting his wrists, taking an overdose of his medication and drinking alcohol at the same time, and playing Russian roulette. He was brought to the hospital for each occasion and was admitted. He has been brought to the hospital by his parents and on one occasion his best friend who was concerned as he had found Brandon, Brandon has admitted to partaking in risky behaviors such as the use of cocaine, marijuana and alcohol on a frequent basis. He has also admitted to using heroine, ecxtacy, LSD, and mushrooms as well on occasion. Hesays that all of his drug and alcohol use started after his parents were divorced when he felt that he no longer had a family. Brandon has always had problems with an explosive temper but after his sister's death his outbursts became extreme and he became too much for either of his parents to handle or control. He has had problems with trying to get/keep a job as well as problems with friendships. Brandon admits that at times he just “freaks out” when he can no longer stand what is going on in his life and he feels that something needs to be done to stop things. While in the hospital it was observed that Brandon would go fiom the extreme of crying and being sad and curled up in a ball to then screaming, yelling and throwing things. At times while inpatient, Brandon had to be restrained or calmed down with medications. Brandon has been in treatment in the past for his mental health issues but none of the treatment has had lasting results. He has participated in a variety of treatments including: individual therapy, group therapy, outpatient case management services, and psychiatric and medication services. Brandon feels that things are fine and that he just needs to “deal” with his issues and that he has no real problems. As for his substance usage, Brandon admits that he will still smoke marijuana when he feels like it. He does admit that using some of the harsher drugs and drinking alcohol causes him to feel worse. However, he also admits that he will continue to use them as he feels necessary and when he wants to party and have a good time. Brandon has been through rehabilitation services in the past but says that he does not believe any of the stuff that he was taught there and that the people who fall into the trap of believing that information are “stupid and ridiculous.” He also talks about how hewill only do what he has to get out of the group home but that he is not going to do anything else and none of the changes that he agrees to are going to be followed through with Brandon seems to have some negative opinions and typically has a negative attitude about things. Brandon says that he can’t stand his younger sister and has taken little interest in getting to know her or in any part of her life. Brandon’s younger sister, ‘Amy, says that she is often hurt by Brandon’s actions towards her and when talking about this Brandon stated that he didn’t care about her or her “stupid feelings.” Brandon also had negative feelings towards his parents and admits that he could not stand to have to live with his mom and that he would rather not live with his father either but that he could tolerate him if he had to. When asked about how he feels about not having many friends, Brandon has stated that he “preferred” this as he says that he does not like to be around others and that he would rather just be alone. Diagnosis Axis Bipolar Disorder, Mixed, most recent episode depressed Cannabis dependence Alcohol, cocaine, LSD, exstacy and mushroom abuse Axis II—Antisocial personality disorder Axis III—no medical problems, no diagnosis Axis IV—economic difficulty, problems with housing, problems with family relationships, inter-social problems, and problems with finding employment