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Running Head: BIPOLAR DISORDER

Alice Brown: A Study of Bipolar Disorder


Amber Stolarski
Community College of Philadelphia
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Abstract

In this case study, we will be looking at a young woman named Alice Brown. She is

twenty-five years old and has recently moved to Philadelphia from Seattle, WA. Alice

also has bipolar 1 disorder. Looking back in her history, we will see that she has a

previous history of both depressive and manic episodes. However, she was never

formally diagnosed with the disorder until she was brought to me, having been admitted

to the hospital as a suicidal patient. We will also look at the treatment plan that I plan to

start with Alice, including both medication and therapy. I believe that with her

compliance to treatment and a few important lifestyle adjustments, Alice has a

wonderful chance of returning to a fully-functional and fulfilling life.


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Alice Brown: A Study of Bipolar Disorder

Biographical Information

Alice Brown is twenty-five years old. Originally from the city of Seattle,

Washington, Alice moved across the country to Philadelphia upon marrying her new

husband back in April of 2010. My client is Caucasian and of English and Italian

descent. Other than her current mental health problems, Alice is in fair health. She has

been in treatment for cystic fibrosis since she was a child, but the illness is well-

controlled and her primary care physician declares her fit to work and do activities as

she pleases with no restrictions. Alice works in Center City Philadelphia as a

receptionist for a major law firm.

Clinical History

Ms. Brown has suffered from alternating periods of extreme depression and

hyperactivity for the past few years. It is only recently that she began to seek out more

intensive help. As most cases of bipolar disorder begin, her symptoms started to

manifest around age twenty-one (Fast and Preston, 2006). Upon disclosing her

symptoms to her primary care physician, she was told that her moods were nothing to

worry about. Having said that, Alice has never received any sort of treatment for any
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mood disorder, depression, bipolar disorder, or otherwise. However, her moods have

escalated, and Ms. Brown came into my care when she came to my facility’s emergency

room, in imminent danger of committing suicide. Alice currently presents as unable to

perform even the most basic daily functions and is extremely depressed. She currently

harbors a lot of self-blame and anxiety and is prone to impulsively attempting to hurt

herself. She is prone to crying spells that last for hours and seem to start for no reason

at all. She scratches at her wrists with her nails in an attempt to draw blood, so I had to

have Alice put in arm restraints to keep her from further harming herself. Upon

speaking with her family, I have learned that a few months ago she began to have false

delusions about who she is and began to believe that she had “magic powers that could

change the world”, staying up for days at a time, writing impassioned letters to the

government, and engaging in risky, promiscuous sexual activity with complete

strangers. At the time, Alice refused to seek treatment despite the pleas of her family

and close friends, and the condition subsided after a week or so, but her mood shifted

into one of deep depression after a short period of normalcy. Currently, she remains

hospitalized and under my care for an indefinite period of time.

Diagnosis

Axis I: Bipolar I Disorder (depressive episode)

Axis II: N/A

Axis III: Cystic Fibrosis, well-controlled

Axis IV: Stress of recent marriage and recent cross-country move

Axis V: GAF: Highest past year: 75 Current: 30


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Treatment Approach

Given Alice’s past history of what seems to be manic episodes, I will not begin

with an antidepressant, as I would for many patients in depressed moods. Giving a

patient with bipolar disorder an antidepressant carries a risky chance that their

depression will switch into mania (Fink and Kraynak, 2005). I plan to start Alice on

lithium, a mood stabilizer that has antimanic and antidepressive properties. Research

has shown that lithium also may act as a blocker for future manic or depressive

episodes (Castle, 2003), which I think would be extremely helpful in Alice’s case.

I also plan to have some medical tests done on Alice to see if there are any

underlying physical conditions that could be affecting her mood. It is known that thyroid

malfunction, Cushing’s syndrome, diabetes, and even hormone imbalances can affect

mood and mimic bipolar disorder, so it is important to rule out those medical conditions

in the early stages of treatment (Fink and Kraynak, 2005). Tests to check for substance

use such as alcohol and cocaine should also be run on Alice, as substances such as

alcohol and cocaine can have effects that induce bipolar-like symptoms (Yatham, 2010).

If all these tests come back clear and there is no physical or substance-related

reason for Alice’s current psychiatric issues, I will proceed with continuing the lithium

treatment, perhaps augmenting with other medications such as anticonvulsants or even

a small dose of an antidepressant as necessary. In addition to medication, I also will

have Alice begin therapy, both individually and in a group with other patients at the
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hospital. I believe that cognitive therapy will be best for Alice, as it will allow her to gain

insight into her thought processes and perhaps allow her to change her thinking so that

in the future, she will be more equipped to combat oncoming mood episodes. It is my

hope that with the right combination of medications and a strong commitment to talk

therapy, Alice will be able to avoid drastic mood episodes completely. Of course, Alice

will remain hospitalized until she is no longer suicidal and has a more stable sense of

mood.

Prognosis For Recovery

I believe that receiving Alice into the hospital at the time that we did has

potentially saved her life. The illness has been caught at an optimal time for treatment,

and Alice is gradually becoming more and more compliant with the treatment plan I

have laid out for her. More importantly, I see a lot of hope for Alice’s future. I think if

she stays on her medication and remains in touch with a psychiatrist and a psychologist

or other therapist, Alice stands a great chance of recovering to a normal life, where her

moods will not rule over her every day. I also think it would be beneficial to have Alice’s

new husband be a part of her treatment, accompanying her to therapy sessions and

being an actively involved part of the recovery process.


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When Alice is released from the hospital, I would like her to get in touch with a

support group through the Depression and Bipolar Support Alliance or the National

Alliance for Mental Illness, so that she does not feel alone in her treatment. It is

important that she find some common ground with people who also share her illness

who she can look to for advice or just a reassurance that she is not alone. According to

the Depression and Bipolar Support Alliance, lifestyle changes are also necessary in

order to maintain a healthy, mood-swing free existence, such as eating healthier foods,

getting to bed at a decent hour, and surrounding oneself with people who are “good for

you” and will make recovery that much more of a positive experience. (DBSA, 2006)

With all these lifestyle changes factored in, Alice will be able to enjoy life again and put

her current situation behind her, moving on to the future.


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References

Castle, Lana J. (2003). Bipolar disorder demystified: Mastering the tightrope of

manic depression. New York, NY: Marlowe and Company

Depression and Bipolar Support Alliance. (2006, May 10). Recovery steps. Retrieved

from http://www.dbsalliance.org/site/PageServer?pagename=recoverysteps

Fast, Julie A. & Preston, John. (2006). Take charge of bipolar disorder: A 4-step

plan for you and your loved ones to manage the illness and create lasting

stability. New York, NY: Wellness Central

Fink, Candida & Kraynak, Joe. (2005). Bipolar disorder for dummies: A reference

for the rest of us. Hoboken, NJ: Wiley Publishing

Yatham, Lakshmi N. (2010). Bipolar disorder: Clinical and neurobiological

foundations. Hoboken, NJ: Wiley Publishing