My case study will be over Bipolar 1 disorder.
The case report provides an opportunity for students to write a realistic profile of an adult who is suffering from a specific disorder. The goal of this assignment is to showcase knowledge of the disorder by synthesizing and applying information learned from readings and lecture. Minimum of three references (empirical articles) should be cited.
-Minimum 1500 words
-APA style (including references)
BOTH Title page and references ARE required (these do NOT count towards the overall word count)
-Double-spaced, Times New Roman, 1-inch margins
a. Provide an overview of the symptom presentation with specific examples of each symptom. Example: “John Doe is a 28-year-old, Hispanic male who was self-referred regarding feelings of anxiety when interacting with others. He reported that he constantly worries about being judged negatively in social situations. Last week, John excused himself from a meeting at work because he worried that his co-workers could see his hands shaking while they were discussing a meeting strategy. He believes they think he is ‘weird’ and has been unable to attend a meeting since.”
b. Discuss the etiology of the disorder and purported risk factors for this particular case. Example: “John Doe has always been a shy child. John reported that he remembers his mother becoming angry if he refused to speak in social situations. John made a few friends in elementary school, but in 3rd grade one of John’s best friends suddenly stopped talking to him. This friend began teasing John at school, calling him names and throwing things at him when the teacher was not looking.
c. Describe the treatment plan with rationale for why the selected treatment is indicated Example: “John Doe would benefit from cognitive-behavioral therapy (CBT) targeting social anxiety disorder (SAD). Specific treatment goals include reduced subjective anxiety in social situations, increased prosocial behavior, improved workplace productivity, and increased social support and communication. The first few sessions will focus on psychoeducation to provide John with a better understanding of SAD and its treatment. The next phase of treatment will focus on exposure therapy. John will be gradually exposed John to social situations of increasing difficulty. For example, John will start by walking down the street and saying a quick hello to the people he walks by. Next, John will add another statement about the weather as he walks by each person. … John will wear a sombrero while shopping at the market. Lastly, John will make ‘dumb’ comments during his work meeting, as his core fear revolves around being teased or ridiculed. Because CBT in combination with a selective serotonin reuptake inhibitor (SSRI; Gould et al., 1997) has been shown to be most effective in the treatment of SAD, John will also be referred to a psychiatrist to initiate a trial of Fluoxetine.”
d. Cite a minimum of 3 references to provide adequate support for your diagnosis, etiology, risk factors, and treatment.
Clinical features, impulsivity, temperament and functioning and their role in suicidality in patients with bipolar disorder
Jim�enez E, Arias B, Mitjans M, Goikolea JM, Ru�ız V, Brat M, S�aiz PA, Garc�ıa-Portilla MP, Bur�on P, Bobes J, Oquendo MA, Vieta E, Benabarre A. Clinical features, impulsivity, temperament and functioning and their role in suicidality in patients with bipolar disorder.
Objective: Our aim was to analyse sociodemographic and clinical differences between non-suicidal (NS) bipolar patients (BP), BP reporting only suicidal ideation (SI) and BP suicide attempters according to Columbia–Suicide Severity Rating Scale (C-SRSS) criteria. Secondarily, we also investigated whether the C-SRSS Intensity Scale was associated with emergence of suicidal behaviour (SB). Method: A total of 215 euthymic bipolar out-patients were recruited. Semistructured interviews including the C-SRSS were used to assess sociodemographic and clinical data. Patients were grouped according to C-SRSS criteria: patients who scored ≤1 on the Severity Scale were classified as NS. The remaining patients were grouped into two groups: ‘patients with history of SI’ and ‘patients with history of SI and SB’ according to whether they did or did not have a past actual suicide attempt respectively. Results: Patients from the three groups differed in illness onset, diagnosis, number of episodes and admissions, family history, comorbidities, rapid cycling and medication, as well as level of education, functioning, impulsivity and temperamental profile. Conclusion: Our results suggest that increased impulsivity, higher rates of psychiatric admissions and a reported poor controllability of SI significantly increased the risk for suicidal acts among patients presenting SI.
E. Jim�enez1, B. Arias2, M. Mitjans2,3, J. M. Goikolea1, V. Ru�ız4, M. Brat1, P. A. S�aiz5,6, M. P. Garc�ıa-Portilla5,6, P. Bur�on5, J. Bobes5,6, M. A. Oquendo7, E. Vieta1, A. Benabarre1 1Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, 2Anthropology Section, Department of Animal Biology, Faculty of Biology, University of Barcelona, IBUB, CIBERSAM, Instituto de Salud Carlos III, Barcelona, Catalonia, Spain, 3Clinical Neuroscience, Max Planck Institute of Experimental Medicine, G€ottingen, Germany, 4Institut Clinic de Neurociencies, Hospital Clinic, Barcelona, Catalonia, Spain, 5Department of Psychiatry, School of Medicine, University of Oviedo, CIBERSAM, Instituto de Neurociencias del Principado de Asturias, INEUROPA, Oviedo, Spain, 6Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain and 7Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
Key words: suicidal ideation; suicidal behaviour; bipolar disorder; Columbia–Suicide Severity Rating Scale
Eduard Vieta, Bipolar Disorders Programme, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036 Barcelona, Spain. E-mail: evieta@clinic.ub.es
Accepted for publication December 7, 2015
Significant outcomes
• Using a novel classification criteria based on C-SRSS (non-suicidal BP, BP with suicidal ideation, but no past suicide attempts and BP who had attempted suicide), we identified 12 variables showing sig- nificant differences among three groups of BP according their suicidality severity: illness onset, diag- nosis, number of episodes and hospitalizations, family history, comorbidities, rapid cycling and medication, as well as level of education, functioning, impulsivity and temperamental profile.
• Increased levels of motor impulsivity, a higher number of admissions and a reported poorer control- lability of suicidal thoughts were found to be associated to a higher risk to attempt suicide among BP who present with suicidal ideation.
• Our data reinforce the dimensional nature of suicidality and runs against the use of traditional dichotomous criteria (attempters vs. non-attempters).
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Acta Psychiatr Scand 2016: 133: 266–276 © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd All rights reserved DOI: 10.1111/acps.12548
ACTA PSYCHIATRICA SCANDINAVICA
Limitations
• The cross-sectional design of the study. • The tertiary nature of recruitment centres. • The absence of gathered data concerning complete suicide.
Introduction
The burden derived from suffering bipolar disorder (BD) is not limited to the consequences of affective episodes. In addition to the higher rates of psychi- atric and physical comorbidity (1) and cognitive and functional impairment observed even during euthymia (2, 3), the emergence of suicidal beha- viour (SB) is a key contributor to the burden associated with BD (4).
Suicidality, understood as the presence of suici- dal ideation (SI) and/or SB, is one of the most sev- ere complications of BD. Around 30–40% of bipolar patients (BP) present SI, and about 25– 50% of them will make at least one suicide attempt (SA) throughout their lives (5). Further, it has been estimated that roughly 15–20% die by suicide (6). Therefore, monitoring of suicide risk factors associated with SA is imperative.
Despite several studies on the impact of different clinical, sociodemographic and biological factors in the emergence of suicidality, identification of reliable factors associated with increased risk of SA remains arduous. Due to the complex nature of SI and SB, it is not unusual to find inconsistent results concerning these issues in BD (7). Of course, SI (5, 8–10) and a history of previous SA (11–15) appear to be the most robust risk factors for SB not only among BP, but also in general. However, less is known about whether characteris- tics of SI influence the transition to future SA. In fact, most studies examining risks for SB simply compared patients with or without a past SA, not differentiating between those with or without a his- tory of SI. Thus, the question of whether BP pre- senting only with SI is significantly different from those who have never had suicidal thoughts remains largely unaddressed.
While it is true that suicide is a complex pheno- type, methodological issues are one of the most rele- vant obstacles to fully understand the factors involved in such behaviour. The lack of a common nomenclature and the absence of a common, univer- sal battery to assess suicidality in BD certainly hin- der the robustness of the data (16, 17). The Columbia–Suicide Severity Risk Scale (C-SSRS) was developed to serve as a practical tool to assess suicidality (17). This semistructured interview assesses the intensity and/or severity of both SI and
SB. It has demonstrated good convergent and diver- gent validity with other multi-informant scales mea- suring the aforementioned domains in several multisite studies of adolescent and adult suicide attempters (17, 18). For this reason, many have acknowledged that the C-SSRS is a suitable instru- ment to optimize the assessment of suicidal thoughts and behaviours avoiding methodological biases in classification (19). It is worth noting that the Food and Drug Administration (FDA) conferred gold standard status to the aforementioned scale leading it to become a preferred instrument for prospec- tively assessing SI and SB in clinical trials (20).
As far as we know, this is the first study carried out with the C-SSRS as a main instrument to cate- gorize SI and SB in a sample of euthymic BP. We hypothesized that the non-suicidal (NS) BP, BP with SI, but no past SA and BP who had attempted suicide groups would differ in terms of sociodemographic and clinical features in a man- ner commensurate with suicidality severity, with attempter BP showing the worst clinical profile and patients with SA, but no past attempts dis- playing a milder degree of severity. Finally, we hypothesized that items from C-SSRS Intensity of Ideation scale would predict increased risk of SA among patients presenting SI.
Aims of the study
In this study, our goals were to examine differences between the three aforementioned groups and to identify factors associated to history of previous suicide attempt (SA) among bipolar patients (BP) presenting suicidal ideation (SI). We also investi- gate the association between some characteristics of suicidal thoughts and risk for SA among BP presenting with SI.
Material and methods
Patients
Two hundred and fifteen bipolar type I or II out- patients were recruited from the Bipolar Disorder Programme (BDP) of the Hospital Clinic of Barce- lona and from mental health services in Oviedo, all under the umbrella of the Spanish Research Net- work on Mental Health (CIBERSAM). The BDP
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Suicidality and bipolar disorder
provides integrated care for high-complexity BP not only from its catchment area, but also nation- ally (21, 22). To study long-term outcomes, the BDP conducts prospective data collection on the course of illness of all BP enrolled in its Pro- gramme since 1992 as described elsewhere (23, 24). Thus, this cross-sectional analysis includes both prospectively and retrospectively collected data.
Inclusion criteria were as follows: (i) bipolar I or II DSM-IV-TR diagnosis, (ii) age over 18 years, (iii) fulfiling criteria for euthymia defined as a score of ≤8 on the Hamilton Depression Rating Scale (HDRS) (25, 26) and a score of ≤6 on the Young Mania Rating Scale (YMRS) (27, 28) at study entry and the baseline assessment period and (iv) capacity to provide written informed consent. Exclusion criteria were the presence of (i) mental retardation (defined as IQ < 70) and/or (ii) severe organic disease. Approval from each institution’s ethics committees was obtained.
Assessments
