Case Study: Bipolar 1 Disorder

Case Study: Bipolar 1 Disorder This case study provides a brief profile of a client referred to as B, followed by an initial diagnosis of B according to the Diagnostic and Statistical Manual (DSM-IV-TR). A discussion of the diagnostic criteria, as applicable to Bs profile is provided and the incidence, course, and outcome of the disorder presented. Bs Profile Bs full profile is presented in appendix 1, but a brief outline of his primary symptoms follows. B is a 40-year old male from a wealthy background. He has a very close relationship with his mother, who struggles with depression. His father has no mental illness and denies that his son does. However, B describes severe episodes of mania, where he becomes involved in impulsive and excessive behaviours such as spending large sums of money or travelling to other countries. He also describes a manic thought pattern, characterised by an influx of ideas that he feels he must act upon. In contrast, B finds that once these episodes disperse he is left with feelings of depression, low self-esteem, and lack of energy. Initial Diagnosis Using DSM-IV-TR, an initial diagnosis for B can be found in the category of mood disorders. In particular, B meets the criteria for Bipolar Disorder, which can be divided into three types: Bipolar 1 Disorder is when the primary symptom is manic or rapid (daily) cycling episodes of mania and depression. Bipolar 2 Disorder is when the primary symptom is depression accompanied by mild manic episodes that are not severe enough to cause marked impairment in functioning. Cyclothymic Disorder is when there is a chronic state of cycling between manic and depressive episodes that do not reach the diagnostic standard for Bipolar Disorder. According to this criteria, Bs diagnosis is that the Bipolar 1 Disorder, whereby manic episodes are characterised by a period of abnormally and persistently elevated mood lasting at least 1-week and where the following symptoms have persisted and been present to a significant degree: increased self-esteem and grandiosity; flight of ideas or subjective experiences and thoughts racing; increase in goal-directed activity socially and occupationally; and excessive involvement in pleasurable activities that have a high potential for painful consequences. Such manic episodes are usually followed by the symptoms characteristic of a major depressive episode, which comprises depressed mood and a loss of interest and pleasure in activities that are usually enjoyed. These symptoms last for at least 2-weeks and cause clinically significant impairment in daily functioning. The following symptoms are also present: fatigue or loss of energy; feelings of worthlessness or guilt; and indecisiveness. B describes episodes of mania that are amazingly intoxicating and give him lots and lots of pleasure and lots of energy and ideas. This energy and abundance of ideas is transferred into Bs work, in part accounting for his professional success, which in turn provides the wealth that supports his manic episodes. For example, B states that During my worse manic periods I have flown from Zurich to the Bahamas and back to Zurich in 3 days to balance the hot and cold weather carrying  £20,000 worth of $100 notes in my shoes. He also describes an array of excessive behaviours likely to have negative consequences, including a  £25,000 shopping spree and a 4 day drug-binge. B further describes the fluctuating intensity of the symptoms of Bipolar Disorder, which comes in different strengths and sizes, expressing that most days I need to be as manic as possible to come as close as I can to destruction, to get a real good high. There is, however, the inevitable crash. This is when B experiences symptoms of depressive episodes when My mind grinds to a halt; I lost all interest in friends, work, eating, drinking, bathing, everything. This is accompanied by a deflation in his self-esteem, accompanied by feelings of inadequacy. Causes of Bipolar Disorder Bipolar Disorder is highly genetic. Indeed, Bs mother has depression and his maternal uncle is described as being highly creative and eccentric. In one study assessing the genetic and environmental contributions to the development of Bipolar Disorder, first-degree relatives of people with Bipolar Disorder (n=40à ¢Ã¢â€š ¬Ã‹â€ 487) were at significantly increased risk of developing the disorder (Lichtenstein et al., 2009). Heritability has been estimated to range from 59-80%, the higher percentage being obtained from studies of genetic twins (Kieseppa et al., 2004; Lichtenstein et al., 2009). Despite the strong genetic aspect of Bipolar Disorder, the evidence shows that life events, coping skills, and family environment also contribute to symptoms. Bipolar Disorder is not only exacerbated by negative life events, but can also cause them. Indeed, B describes how his cycling moods affect my work and personal relationships and everything around me. His father, who denies that his son has any problems does refer to youthful scrapes that B found himself in during his early teens; signs of Bipolar Disorder often manifest in the adolescent years or early adulthood (Akiskal et al., 2000). Bs fathers denial of his sons diagnosis, which he explains as being high spirits and letting off steam as opposed to any abnormality, raises the question as to how abnormal behaviour is defined when making a diagnosis. The general consensus is that abnormal behaviour deviates from some norm and harms the affected individual or others. This could be a statistical deviation or a deviation from an ideal mental health, as highlighted within conceptual definitions of abnormal behaviour (Sue, Sue Sue, 2006). In terms of statistical deviation, B does present with abnormal behaviour as Bipolar Disorder has a lifetime prevalence of approximately 1.3% in adults, as indicated by worldwide epidemiological studies (Maj et al, 2002; Kleinman et al., 2003). Treatment of Bipolar Disorder Treatment is usually a combination of psychological input and pharmacotherapy, with the aim being to reduce the frequency, severity, and duration of manic and depressive episodes. In some instances, hospitalisation with intensive pharmacological treatment is required to stabilise a person with Bipolar Disorder. Treatments are also often aimed at treating co-morbidities, which are frequently found in people with Bipolar Disorder, where excess behaviours such as binge eating, drinking or drug taking can lead to obesity, heart disease, diabetes, and drug addiction (Morriss Mohammed, 2005; Strudsholm et al., 2005). In one study, 81% of people with Bipolar Disorder also had co-morbidity (Fenn et al., 2005). Psychological treatments with empirical evidence supporting their efficacy include interpersonal social rhythm therapy (IPSRT; Frank, 2005), family-focused therapy (Miklowitz et al., 2003), and cognitive-behavioural therapy (CBT), all of which encourage the use of medication alongside the psychological treatment (Mansell et al., 2007). IPSRT focuses on training people with Bipolar Disorder to regulate disruptive sleep patterns, which can cause more frequent mood cycling. It also targets issues around daily routines, stress, and interpersonal relationships. CBT, on the other hand, targets the cognitive issues associated with cycling moods, such as over-optimism, feelings of grandiosity, and goal-oriented thinking, all of which can contribute to risky behaviours. Family-focused therapy provides a combination of psycho-education, where the main goal is to teach people with Bipolar Disorder and their families about the nature of the illness and how family dynamics can help or hinder life with Bipolar Disorder. This might be particular relevance to Bs situation since his father remains in denial of his condition and his mother also struggles with depression and has done for a number of years. First line medication is usually lithium, anticonvulsants, or atypical antipsychotics, but it has been found that some people benefit from thyroid augmentation, clozapine, calcium channel blockers, and electroconvulsive therapy (Gitlin, 2006). Some female patients may benefit from hormonal treatments for mania or hypomania, such as tamoxifen or medroxyprogesterone acetate (Kulkarni et al., 2006). The combination of psychological treatment and medication is designed to treat the specific episode of mania or depression, but the objective also needs to be to produce a treatment plan that assists in managing the condition long-term. Conclusions In conclusion, B has been diagnosed with Bipolar 1 Disorder, as indicated by the DSM-IV-TR. In Bs case the condition is likely to be caused from both genetic factors and environmental circumstances, since depression and eccentricity have been reported in his family and his successful career and subsequent wealth provide opportunities that exacerbate the excessive nature of manic episodes. The most efficacious approach to treating B is likely to comprise both psychological and pharmacological approaches. In particular, B is likely to benefit from family-focused therapy that might address his mothers depression and his fathers denial of his diagnosis. Cognitive-behavioural therapy is also likely to provide B with coping tools for when his cognitions are influenced by manic or depressive episodes. It would also be wise to assess for any co-morbidities that need treating as B does refer to drug binges and excess eating and drinking during manic phases. The overall aim of treatment needs to be to provide the foundations for long-term adjustment to living with and managing the condition. Should Children Be Taught Sex Education? Should Children Be Taught Sex Education? Introduction: Sex relationship education (SRE) in schools which often is seen as inappropriate by parents to teach children at a very young age whereas some may agree to the idea of teaching sex education to children at a young age. Some part of the world it seemed to be appropriate. Sex in general is taboo in western society (Alldred, 2016) and a topic not talk about to children even though it is a beneficial topic which have both positive and negative impact on a child`s developing this is why some parents do not want their children to be taught in school at a young age. (ibid) In some places children are not being taught sex education and in more places than ever before including music videos and social media is playing a big part. Children who were taught at a very young are more aware of birth control and how to protect themselves from any harm of disease. This following assignment will explore on the history of sex education, children`s rights to sex education as well as the positive and neg ative impact on whether sex education is taught in schools from young age and onwards. History From the parents perspective, sex education should not be taught in schools this often involved protecting children from the knowledge of sex even throughout history the idea of children being innocent and vulnerable is not new and this dates back to the period of the 7th century onwards. During this time according to Rousseau (Marshall, 1994) all children were born naturally good and innocent with the need to be protected. This is because of the construction of childhood as we still tend to protect our children from the knowledge of sex people used to have a negative message a child who knows anything about se is not innocent he or she is more likely to be corrupt or wicked. (Cited in the British Library, 2016) This was further supported by Robinson, 2013 that a child seeming to have a good understanding about sexuality is seen as non-innocent or even a corrupted child. Positives People often misunderstand the word sex education wrong, it does not necessarily mean sexual intercourse. In fact, sexuality is more about self-image, developing your own identity, gender and learning about your choices and boundaries limitation as well as to protecting yourself from any harm. (Collective Evolution, 2016. While protecting our children can have both positive as well as negative site throughout their life however their health and well-being are at forefront. Therefore children who were taught at a young age are aware of birth control and are less likely to avoid teenage pregnancy and sexually transmitted infections then those who were taught at later age are more vulnerable to pregnancy and only a two-fifths are aware of birth control (Marsiglio and Mott, 1986). Not always has sex education be harmful to the child`s development, as a research has shown according to NSPCC, 2016 one of ways to prevent all these negative impact is to start talking to your child at a very young age even in the house. By starting talking while they are still in primary school this will also develop their understanding of sex as well as encourage to ask question. Not only does sex education gives children a better understanding and knowledge about it as well as where babies come from but also helps them to protect themselves from any harm (Roleff, 1999). Current law and law in general Sex and relationship education is currently compulsory in United Kingdom from age 11 onwards. It includes teaching children about sexuality and sexual health as well as reproduction. It does not involves early sexual activity (DFEE 2000). But only few parts are compulsory which covers the national curriculum for science, parents have the option to withdraw their children from some parts or if they wish all parts of the sex and relationship education if they wish. To make sure the parents understand that the choice to withdraw their children from that lesson, all school must provide a written policy on sex education which should be access able to all parents for free (ibid). Which is also stated in the Education Act 1996 in section 405 and yet sex education is seen as something bad but the current law in the UK which allowed to have sexual intercourse at the age of 16 years to protect the children to have sex under the age of 16 years old. Any type of sexual connection under the age of 13 years is prohibited to have any sort of sexual activity. This way the current law is protecting the children from any abuse and it is important for a child to understand how to protect themselves and have the right to say no (NSPCC, 2016). The current situation in the United Kingdom is children still dont have the right to sex education, schools have to cover the biology part human body and parents have the right to withdraw their children from that on lesson (DFEE 2000) additionally, children do not get the opportunity to get sex education lesson at home and if they do it is not same as the school.The reason behind is that majority of the parents and educator find this topic difficult to teach children (Welsh, 2001) these difficulties simply leads back to the history as well as the culture as it always has been a taboo topic and that is why they are finding difficult and due to the society we are living is playing a big part too (Robinson, 2013). Negative impact Most parents do not think sex education should be taught to children in school from a young age. Parents are also against the limitation of sex knowledge regarding their child due concern that it could lead to explorations into more details concerning sex, child being excited into learning about their sexuality too early, exploring beyond limit that could leading to graphics. (Roleff, 1999) reason behind this is that children who did not had sex education in school are more likely to be the one who are lack of knowledge as well as misunderstanding and unnecessary of fear. (ibid) Conclusion: Although sex education is seen as a negative topic even throughout the history as well as the culture view of point and the society we are living is playing a big part. But has both negative and positive impact on a child`s development. Research has shown that children that were taught sex education in school at a very young age are more aware of birth plan, teenage pregnancy as well as abuse. I personally agree with the Netherlands and other part of the European country that our children should have the right to sex education and encourage them to ask question for their understanding which is also a part of their development then those who did not had sex education are more likely to be the one who are vulnerable and luck of knowledge and skills which also can lead to low esteem and confident. As this education will prepare them to a mature adult life having knowledge about it and be able to protect yourself and not doing anything without your will. Even though parents often refuse to let their children be taught in school, schools are responsible to provide these kind of lesson for the children in school. Therefore I believe sex education should be taught in schools for many reason as mentioned for both positive and negative site. Reference list: Haydon, D. (2002) Childrens rights to sex and sexuality education in Frankin, B.  (2002) The handbook of childrens rights Jenks, C. (2003) Childhood. London,  Routledge DFEE (2000) Sex and Relationships Education Guidance  http://media.education.gov.uk/assets/files/pdf/s/sex%20and%20relationship%20education%20guidance.pdf Ohchr.org. (2016). Convention on the Rights of the Child. [Online] Available at: http://www.ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx [Accessed 5 Dec. 2016]. Collective Evolution. (2016). In the Netherlands Sex Education Starts in Kindergarten: Heres What They Tell Them & Why. [Online] Available at: http://www.collective-evolution.com/2015/06/22/in-the-netherlands-sex-education-starts-in-kindergarten-heres-what-they-tell-them-why/ [Accessed 6 Dec. 2016]. The British Library. (2016). Perceptions of childhood. [Online] Available at: https://www.bl.uk/romantics-and-victorians/articles/perceptions-of-childhood [Accessed 5 Dec. 2016]. Marshall, J. (1994). John Locke. Cambridge: Cambridge University Press. Marsiglio, W. and Mott, F. (1986). The impact of sex education on sexual activity, contraceptive use and premarital pregnancy among American teenagers. 1st ed. Guttmacher Institute. NSPCC. (2016). Healthy sexual behaviour in children and young people. [Online] Available at: https://www.nspcc.org.uk/preventing-abuse/keeping-children-safe/healthy-sexual-behaviour-children-young-people/ [Accessed 17 Dec. 2016]. Alldred, P. (2016). Get Real About Sex. [Online] Available at: https://books.google.co.uk/books?hl=en&lr=&id=2MVEBgAAQBAJ&oi=fnd&pg=PP1&dq=uncrc+children+right+sex+education&ots=Y4zGD3Tf4T&sig=YaECQKIWidLmChsJsrUfsSrrIUo#v=onepage&q=uncrc%20children%20right%20sex%20education&f=false [Accessed 22 Dec. 2016]. Roleff, T. (1999). Sex education. 1st ed. San Diego, Calif.: Greenhaven Press. Robinson, K.H. (2013), Innocence, Knowledge and the Construction of Childhood.  Abingdon: Routledge.