What is the chief complaint?

(In the clients own words, and report of

others)
During a manic episode, Mr. Jones maintains that he has a big personality and that
he is just a kid who has never grown up. He adamantly denies that he has a mental
illness or that anything is wrong with him.
ther people, however, report that Mr. Jones takes ha!ardous risks "e.g., trying to #y
$rom a roo$% that endanger himsel$ and others who have to rescue him. He went on
a spending spree "completely out o$ money & days a$ter withdrawing more than
'(&,))) $rom the bank%. He is grandiose and impulsive* he talks nonstop. He invades
the personal space o$ others, is very #irtatious with women, and cannot take no $or
an answer. +nder increased stimulation "e.g., the rock concert%, his behavior spirals
out o$ control and he has to be $orcibly removed by police. Mr. Jones arrives at the
hospital with rapid,-re speech that o$ten makes no sense.
During a depressive episode, Mr. Jones is sad, with downcast eyes and poor grooming
and hygiene. He does not interact with people around him. He shows psychomotor
retardation and slowed thinking, moving and talking slowly and struggling to per$orm
simple math. He has crying spells.
Based on the above information and a close viewing of the movie, what
questions would you raise during history taing? What are some possible
answers? !ou might base your questions on"
#istory of the clients illness
$ast psychiatric history, treatment, and treatment outcomes
$sychosocial history
When did Mr. Jones frst have symptoms or problems? How long has this
been happening?
Mr. Jones reports that he took an overdose o$ .ylenol in college. He isn/t clear
about whether this was an intentional suicide attempt, tending to downplay
the event.
Mr. Jones describes being too much trouble $or others since his college
years. 0ecause his e1act age is not stated, the problems seem to have lasted
about &) years.
Does Mr. Jones have any close friends? Is he connected to his family?
Howard $rom the construction site is a $riend o$ Mr. Jones. He has a genuine
interest in Mr. Jones, invites him $or dinner, visits him in the hospital, and
alerts Dr. 0owen when Mr. Jones/ behavior becomes potentially dangerous.
therwise, Mr. Jones mentions no $riends. He describes a $ormer girl$riend as
being dead, although she is not. 2hen asked i$ his parents are living, Mr.
Jones replies, .hey never were alive. 3t seems that Mr. Jones/ denial o$ his
illness and uncontrolled symptoms have alienated him $rom signi-cant
people.
What is Mr. Jones treatment history? What are barriers to compliance?
Mr. Jones is very $amiliar with commitment proceedings, having gone through
this e1perience repeatedly. 2hen an outpatient, Mr. Jones throws away his
prescriptions. 2hen asked i$ he will call Dr. 0owen $or an appointment, he
says probably not. His ongoing stead$ast denial o$ his illness has prevented
him $rom having e4ective or success$ul treatment.
During a manic phase, Mr. Jones $eels omnipotent and unstoppable, 5ualities
that he likes. He does not like how he $eels "too slowed down, lacking
creativity and energy, -ne hand tremors% when taking medication. 3n $act, he
states he is a junkie who needs his highs.
What other observations do you have about the clients behavior?
6lthough Mr. Jones has an e1pansive elated mood, he 5uickly becomes hostile or
irritated when things don/t go his way. He knocks a medication tray out o$ a nurse/s
hands when she tries to give him his drugs during a cartoon show. 6t Howard/s
house, he yells and curses when Howard doesn/t return his tools immediately. He
stops talking to Dr. 0owen when she mentions his illness or symptoms. He has
e1ceptional math abilities and is obviously intelligent, but he has no steady
employment, lives in a dingy apartment, and has no car.
In your opinion, is the diagnosis discussed above accurate?
7es
What %&'(I)(*+ criteria support (or negate) this diagnosis?
2hen manic, Mr. Jones is grandiose, has pressured speech and racing
thoughts, is distractible, goes on spending sprees, and becomes intimate with
people he just meets "e.g., woman at the bank%. His $amily relationships are
impaired, and he re5uires hospitali!ation as a result o$ his potentially
dangerous behavior.
2hen depressed, Mr. Jones looks sad, cries, and doesn/t engage in activities
or get pleasure $rom any previously pleasurable activities. He has
psychomotor retardation, diminished ability to concentrate, and no energy.
What treatment plan would you outline?
8tabili!ation through medication with minimal side e4ects* outpatient therapy to
monitor compliance and build social skills and relationships* improved community
$unctioning "such as through employment as a stable income source%, and the
creation o$ a structured daily routine
With what e,pected outcomes?
Mr. Jones will comply with treatment, including medication and therapy.
Mr. Jones will acknowledge his bipolar disorder and its e4ect on his li$e.
Mr. Jones will assess his strengths and weaknesses realistically.
Mr. Jones will $unction e4ectively in the community.
Mr. Jones will develop satis$ying, e4ective interpersonal relationships.
Mr. Jones will demonstrate appropriate boundaries.
What factors made %r- .li/abeth Bowen susceptible to the nonprofessional,
unethical relationship with 'r- 0ones?
8he e1perienced the recent loss o$ a relationship. 8he hoped $or a reconciliation with
her e1,partner when, in $act, he brought his new girl$riend to meet her. Dr. 0owen
described her e1,partner as un$eeling, a robot. 0y contrast, Mr. Jones is lively,
#attering, and sensitive to her moods and needs.
Dr. 0owen/s lack o$ sel$,awareness "o$ her own needs and $ragile emotional state% led
her to become personally involved with Mr. Jones. 8he -rst violated pro$essional
conduct "telling him to shut up, taking it personally when he wasn/t committed%.
8he later became involved in a se1ual encounter with him. 8he made one $eeble
attempt to talk to the supervising psychiatrist, but did not $ollow through until it was
too late.
+egarding the character, 1manda, who also has bipolar disorder and
eventually commits suicide" What ris factors were present?
6manda discussed suicide with Dr. 0owen and viewed it as an answer to her
problems "e.g., death is nothing to be a$raid o$ . . . 3/d welcome it.%
8he had a past history o$ -ve suicide attempts.
+pon discharge $rom the hospital, her parents coerced 6manda to leave a
trusted relationship with Dr. 0owen and to see a new therapist "a $riend o$ her
parents%.
9lients with bipolar disorder are at increased risk o$ suicide.