CASE VIGNETTE

Case Vignette

Case Vignette

1)Explain how neurobiology may be implicated in the symptoms which Robert is experiencing.

Robert is examined with the bipolar disorder after identification of different symptoms and behavior. Bipolar disorder is a common and serious mental disorder which is synonymous with the older term manic depressive psychosis. It is a comparatively serious and recurrent condition which is characterised by periods of complete normality and indispersed with episodes of either mania (disinhibited and overactive behaviour associated with elation) or depression (lethargy and low mood). The rate of relapse is comparatively high with some studies showing 50 % at one year and as much as 70% at five years. If we consider studies such as that by Perry (et al 1999), we find evidence that this high relapse rate can be positively affected by appropriate and timely intervention (Rao, & Jacobson, 2005).

In any field of medical practice, it is essential to have a firm evidence base as this underpins all rational treatment. The Perry study is well constructed and clearly presented and the findings are backed up with other work in the field. In essence, the authors found that in bipolar disorder, each patient would characteristically present with constant, identifiable and manageable prodromal symptoms of relapse, in some cases as much as two weeks before an episode of mania or depression. These prodromal symptoms were very idiosyncratic to not only the patient but also to which type of relapse they were having.

It follows from this finding that if early signs can be reliably identified then there may be a possibility that early therapeutic intervention may have a beneficial effect. The Perry study examined and evaluated this possibility and found that prompt recognition and intervention by nursing staff could significantly reduce the number of relapses over time and also increase the amount of “well time” before the next relapse (Frisch, & Frisch, 2011). The most significant factor in this reduction was the training of the patient to recognise the prodromal symptoms and this was achieved by a painstaking nurse interview when the common features of the prodrome were discussed and evaluated and then presented back to the patient.

It was found that this intervention significantly decreased the number of manic episodes but had little impact on the depressive episodes. The authors suggest that this is primarily because of a number of different factors namely that the manic prodromes are more distinct and longer than the depressive ones and also that acute mania can be treated both more effectively and also more quickly than the depressive equivalent (Tuckwell, 2005). An incidental finding was that this intervention improved overall measures of social functioning because of the increased confidence in the ability to cope with the relapse. Other studies show that this accumulative improvement was likely to be a result of the regime rather than purely an effect of the attentions of an empathetic therapist.

2)Is Robert in a state of crisis?

A crisisis a temporary state of upset and disorganization, characterized chiefly by an individual's inability ...