Chapter 4. John’s Case: Acing Tests and Buying Guitars
4.1 Screen 1
1. Person experiences the symptoms of Major Depressive Disorder or Dysthymic Disorder for at least 2 years.
2. During the two-year period, symptoms not absent for more than two months at a time.
3. No history of mania or hypomania.
(Information from: APA, 2013)
1. For 1 week or more, person displays a continually abnormal, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most of every day.
2. Person also experiences at least 3 of the following symptoms:
• Grandiosity or overblown self-esteem
• Reduced sleep need
• Increased talkativeness, or drive to continue talking
• Rapidly shifting ideas or the sense that one's thoughts are moving very fast
• Attention pulled in many directions
• Heightened activity or agitated movements
• Excessive pursuit of risky and potentially problematic activities.
3. Significant distress or impairment.
(Information from: APA, 2013)
Bereavement entails mourning the death of a loved one. The symptoms of bereavement can include many of the same symptoms as a major depressive episode, but these symptoms clearly occur as the result of the loss of a loved one.
1. For a 2-week period, person displays an increase in depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day.
2. For the same 2 weeks, person also experiences at least 3 or 4 of the following symptoms:
• Considerable weight change or appetite change
• Daily insomnia or hypersomnia
• Daily agitation or decrease in motor activity
• Daily fatigue or lethargy
• Daily feelings of worthlessness or excessive guilt
• Daily reduction in concentration or decisiveness
• Repeated focus on death or suicide, a suicide plan, or a suicide attempt.
3. Significant distress or impairment.
(Information from: APA, 2013)
John:
- Acknowledges that he was depressed once
- Asserts that he feels great now
Parents:
- Mom worried he is too “sensitive”
- In high school he dated a girl for a year, but she broke it off
- He called and texted her repeatedly
- John’s symptoms:
He seemed “down”
He stopped hanging out with his friends
No appetite
He lost 15 lbs. in 2 months
- He refused to see a doctor or counselor
- His sadness lasted a few months
1. For 4 days or more, person displays a continually abnormal, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most of every day.
2. Person also experiences at least 3 of the following symptoms:
• Grandiosity or overblown self-esteem
• Reduced sleep need
• Increased talkativeness, or drive to continue talking
• Rapidly shifting ideas or the sense that one's thoughts are moving very fast
• Attention pulled in many directions
• Heightened activity or agitated movements
• Excessive pursuit of risky and potentially problematic activities.
(Information from: APA, 2013)
1. Individual displays a maladaptive pattern of substance use leading to significant impairment or distress.
2. Presence of at least 2 of the following symptoms within a 1-year period:
a) Substance is often taken in larger amounts or over a longer period than intended.
b) Unsuccessful efforts or persistent desire to reduce or control substance use.
c) Much time spent trying to obtain, use, or recover from the effects of substance.
d) Failure to fulfill major role obligations at work, school, or home as a result of repeated substance use.
e) Continued use of substance despite persistent social or interpersonal problems caused by it.
f) Cessation or reduction of important social, occupational, or recreational activities because of substance use.
g) Continuing to use substance in situations where use poses physical risks.
h) Continuing to use substance despite awareness that it is causing or worsening a physical or psychological problem.
i) Craving for substance.
j) Tolerance effects.
k) Withdrawal reactions.
(Information from: APA, 2013)
1. Persons experience a sudden outburst of profound fear or discomfort that rises and peaks within minutes.
2. The attack includes at least 4 of the following:
a) Increased heart rate or palpitations.
b) Perspiration.
c) Trembling.
d) Shortness of breath.
e) Choking sensations.
f) Discomfort or pain in the chest.
g) Nausea or other abdominal upset.
h) Dizziness or lightheadedness.
i) Feeling significantly chilled or hot.
j) Sensations of tingling or numbness.
k) Sense of unreality or separation from the self or others.
I) Dread of losing control.
m) Dread of dying.
(Information from: APA, 2013)
Intake Form
John
- Patient brought in by his parents
What areas of life affected?
John:
- He says school is going well
- He is not worried about grades
- He is skipping class
- Feels his friends are “jealous” → possible grandiosity?
Sleeping habits
John:
- He doesn’t feel a need to sleep
- 2-3 hrs of sleep/night is enough for him
Parents:
- Roommate confirms John’s reported sleep habits
- They are worried about John’s health
Symptoms in past?
John:
- Acknowledges that he was depressed once
- Asserts that he feels great now
Parents:
- Mom worried he is too “sensitive”
- In high school he dated a girl for a year, but she broke it off
- He called and texted her repeatedly
- John’s symptoms:
• He seemed “down”
• He stopped hanging out with his friends
• No appetite
• He lost 15 lbs. in 2 months
- He refused to see a doctor or counselor
- His sadness lasted a few months
Family
John:
- Sister, 6 years younger
- Brother, 8 years younger
- Parents stressed during John’s early childhood
- Felt like his parents didn’t have time for him
Parents:
- John was an unplanned pregnancy
Mom:
- Quit Master’s program
- Worked part time as an accountant
- Regrets not finishing master’s program
- Enjoyed spending time with her children
Dad
- Works as banker
- Struggled financially at first
- Mom feels guilty → John’s experience was different from his siblings’
Relationship with parents
John:
- Close relationship with his parents
- Talks to them once a week
- He has not been calling them lately because of his “projects”
- Parents drove 2 hours to see him because they are concerned
School growing up
Parents:
- A / B student
- Didn’t talk in class much, introverted
- Conscientious in terms of completing assignment and attending school
- Had a few close friends
- His friends were old friends, from Kindergarten to HS
Family history of mental health problems
John:
- Recalls that his grandfather may have had mental problems
Parents:
- Maternal grandfather → bipolar disorder
• On medication, but occasionally would stop taking his meds
• Stopped taking meds around the time of John’s birth and childhood
• Added stress to the family dynamic
• Parents took care of John and grandfather
Alcohol/substance use
John:
- Defensiveness about alcohol and drug use, steers discussion to “money making” schemes
- Goes to parties → is this normal behavior in college?
- Roommate thinks he is doing drugs
Parents:
- Roommate found John with known drug users
- John became violent when roommate tried to make him leave
- Roommate called parents
- John didn’t return until early in the morning
Parents packed his bag, ready to go → worried
- They made an appointment with his physician
1. Presence of a major depressive episode
2. No pattern of mania or hypomania.
(Information from: APA, 2013)
1. Occurrence of a manic episode.
2. Hypomanic or major depressive episodes may precede or follow the manic episode.
(Information from: APA, 2013)
1. Presence or history of major depressive episode(s).
2. Presence or history of hypomanic episode(s).
3. No history of a manic episode.
(Information from: APA, 2013)
A psychodynamic therapist would use psychoanalytic treatment techniques such as free association, or letting the client talk about whatever comes to mind, and therapist interpretation, which involves giving insight and offering an opinion on patterns noticed in the client’s free association and other things such as dreams. A psychoanalyst would treat John by seeing him 3-5 times per week for several years. Psychoanalysis is costly and it requires a large time commitment.
Interpersonal therapy focuses on problems in significant relationships in the patient’s life. Interpersonal therapists treat patients by focusing on their current relationships with the most important people in their lives. These people include partners and spouses, parents, roommates, and children. For John, these would be his parents, his roommate and other friends.
CBT involves challenging distorted thoughts and helping patients change maladaptive behaviors. Cognitive-behavioral therapists work with patients to address their maladaptive thoughts in each phase of the disorder. In John’s case, treatment for his depressive episodes would be similar to treatment of major depressive disorder, including getting him to engage in enjoyable behaviors and challenging negative automatic thoughts. John’s treatment when in a manic episode would include working with him to discourage reckless behavior and address any maladaptive beliefs. CBT would also include monitoring his mood to try to predict his mood episodes.
Medication involves taking a chemical agent prescribed by a medical doctor to alter brain chemistry, which subsequently alleviates symptoms. A psychiatrist, who has a medical degree (MD) would be able to prescribe patients with bipolar disorders a mood stabilizing medication such as lithium. In John’s case, this medication will help reduce the symptoms of his manic and depressive episodes. In addition, this medication would prevent John from developing symptoms of a mood episode in the future. As a therapist, you would continue to meet with John regularly to monitor his symptoms and to refer him to a psychiatrist to adjust the dose of his medication as necessary.
Author: Taryn A. Myers, Virginia Wesleyan College
4.2 Screen 2
Please note:
Clinical Choices allows you to enhance and test your understanding of the disorders and treatments covered in your textbook in a simulated case study environment. It is not intended to replicate an actual intake interview or therapy session, or provide training on therapeutic techniques. Clinical Choices is for educational purposes only and is not intended as a substitute for clinical training.
4.3 Screen 3
The receptionist hands you the intake paperwork prior to your intake interview with your new client, John, and mentions that his parents have brought him in. They seem very worried about their son. Click on the button below to review the paperwork before you begin the interview.
New Client
John: Case #10108
Psychological Clinic
Intake Paperwork
Client Name: John
Age: 20 years old
Gender: Male
Ethnicity: Caucasian
Occupation: College student
Current living situation: I live in an off-campus apartment with my roommate.
Why are you seeking services at our clinic?
My parents brought me here. They say they are worried about me. I’m not sure why they are freaking out so much. I feel like I have had a personality transplant. I do not feel like myself, and I am having a hard time concentrating, but I don’t think I am as sick as my parents think I am.
4.4 Screen 4
You will now ask John and his parents a number of questions you would typically ask during the intake interview. As you conduct the interview with John, begin to think about his symptoms, what his diagnosis might be, and later, what type of treatment might be most helpful to John. Click the “play” button below the illustration to hear John’s and his parent’s responses to your questions. To read the transcript for these answers, click on the “transcript” button. Take notes in the box provided as you listen to John’s responses.
4.5 Screen 5
"Hi John. It’s good to meet you and your parents. What we are doing today is called an intake interview. I’m going to have you tell me what brought you here today, and ask you some questions that I ask everyone who comes to the clinic. This information will tell me how best to help you. This may mean continuing to see me for therapy at this clinic, or it may involve referring you to another mental health professional or facility. Let’s start. Tell me about what brought you to the clinic today."
Transcript
John[speaking very quickly]: My parents made me come. I don’t really know why. The only thing I can think of is [pauses]… I feel like I’ve had a complete personality transplant, maybe in like the last few weeks or so. I don’t think I’m a super creative or original person, but all of the sudden I have, like, so many ideas about ways I could improve my life... ideas for new projects.... [interrupts himself] like, I had this awesome idea! I am going to start a business buying and selling musical equipment on Craigslist. So I bought a bunch of old guitars online. I’m going to fix them up and resell them for a profit. Problem is... I used my credit card to buy them… and my parents found out because they get the bill. [turns to parents, somewhat angrily] They don’t believe in me at all! They can’t see what a great idea this is! I was going to fix them up before they got the bill, but then I got an even better idea! I was watching TV late one night... I don’t really need much sleep these days... and I saw this great opportunity! I could become an online advertising salesrep! I had to pony up a bit more cash up front for that, so I put that on the credit card too, but it’s totally fine… totally... I know it’s a “sure thing” and I’ll be able to make this money back and then some before the next payment is due.
Mom[quietly with concern]: We are really concerned. John has been acting strangely lately. And then we got the bill for the credit card we cosigned for John – and this was for emergencies only! And the bill was over $2,500!
Dad[jumps in, sounding incredulous]: He spent over $1000 online for these old guitars. When I asked him about it, he told me he was going to refurbish them and resell them for a profit. Now, John has always enjoyed playing the guitar as a hobby, and he’s pretty darn good at it, but he has never actually refurbished anything. I don’t even think he owns any tools!
Mom[breaking in]: And then the online advertising thing!
Dad: That was another $1,500! He tried to tell us it was a “sure thing”; that he would have a profit before the payment was due. Well, it’s due tomorrow, and he has yet to bring in a cent!
Mom[upset]: He was always so careful with money in the past. What’s happening, John?
Question 4.1
glgM/NBLmJDC7OnJI5lbWfF1in8b8KISO9NFrFcElOFwNKT+fxALRRDwUF7OuuQ88D+FcqKN8oCVrfv9+eP9E0tXC/EeHjXiKt58P0tql9xruKzN9DOcFhaEkTSSWE2u83pTgwVnUSo6f6BpBzDVEEgyrtZa4mKFCheck Your Notes
John:
- Client brought in by his parents
- Notes that he feels he has a “personality transplant”
- Duration: last few weeks
- Ideas and projects – change from the past (not normally creative)
- Fix up and resell guitars
- Mounting charges on parents’ credit card / parents alerted by large bill
- Opportunity to become online advertising salesrep –charged $1500 fee – “sure thing”
- Reports needing much less sleep
John’s parents:
- Very concerned with son’s strange behavior
- Rung up a lot of money on “emergency-only” credit card
- Used to be “cautious with money”
- Musical and plays guitar
- Not very handy; doesn’t own tools
- John claims business venture is a “sure thing”; parents report that he has not earned anything yet;
- Credit card charges mounting; bill due tomorrow
4.6 Screen 6
"That sounds difficult for all of you. John, what other concerns are you having at this time?"
Transcript
John[speaking quickly and sounding annoyed]: None! I really don’t understand why I am here. Other people have a problem, not me. Everyone else is moving in slow motion … I don’t have time to wait around for them to “get it.” Why can’t they just keep up? Why can’t they just believe in me? I told Calvin ... he’s my roommate … my ideas about the guitars, and he was such a jerk about it– he kept pointing out things he said could go wrong. And mom and dad don’t understand me – they even asked if I am on drugs![contemptuous] On drugs! Don’t you guys even trust me? Don’t you get that I’m finally seeing the world clearly?
Mom[trying to be empathetic and sensible]: Calvin says that you are talking a mile a minute! He said it seems like you’re having a hard time getting all of your ideas out. Calvin is really worried about you, John. He is worried that you are wasting your money!
Dad[breaking into back up Mom]: You were talking so fast, son! I could barely understand what you were saying… your words were all garbled. You were just not making sense. It sounded like you were on drugs! Something is going on, John.
Question 4.2
Knbc7shTUxfJ8cVI+capTPGmtfPl5EsEarnekI+6sNB7yX2LYcrXOa8U7Xqn33WKCheck Your Notes
John:
- No concerns; other people have problems
- Everyone else in slow motion; they can’t keep up with him
- Roommate points out problems with John’s plans
- Parents suspect drug use
Parents:
- John is talking very quickly
- He has a hard time getting ideas out
- They think he sounds like he’s on drugs
- They are very concerned with this behavior
- They mention that the roommate is also worried
Question 4.3
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Hint
Think about which symptom could potentially cause serious issues for John down the road.
4.7 Screen 7
"What areas of your life have been affected? How is your schoolwork going?"
Transcript
John[excited]: School is going great! I’m not worried about my grades. I’ll ace the tests without going to class... I don’t need to do any of those worthless assignments. I tried going to class, but it’s just so boring... [interrupts himself] not to mention a huge waste of time! I could be making money! My friends keep giving me a hard time about it, but they’re just jealous of my ideas and how quickly I can learn things!
Question 4.4
Knbc7shTUxfJ8cVI+capTPGmtfPl5EsEarnekI+6sNB7yX2LYcrXOa8U7Xqn33WKCheck Your Notes
John:
- He says school is going well
- He is not worried about grades
- He is skipping class
- Feels his friends are “jealous” → possible grandiosity?
4.8 Screen 8
"Tell me about your sleeping habits. Have you had any difficulty falling or staying asleep?"
Transcript
John: I don’t get tired any more. I don’t need to sleep. I’m sleeping, like … 2 or 3 hours a night and I wake up feeling great and ready to go! …to work on my next project!
Dad: His roommate told us that John is up most of the night and claims he is not tired. What do you mean you’re not tired? That can’t be healthy! John, you’re going to get even sicker if you don’t get enough sleep!
Question 4.5
Knbc7shTUxfJ8cVI+capTPGmtfPl5EsEarnekI+6sNB7yX2LYcrXOa8U7Xqn33WKCheck Your Notes
Sleeping habits
John:
- He doesn’t feel a need to sleep
- 2-3 hrs of sleep/night is enough for him
Parents:
- Roommate confirms John’s reported sleep habits
- They are worried about John’s health
Question 4.6
FX6U/hkiSos9DCONUgxLeQ+vYtUS8VzHT5wjoTCBdo02C7yhRRIPhXkyQhi4f0byD9iaXVlOhjoZLdXUxpdW4T9ez1dau6Blq2IrxAgLgInsG+7WCRRMJX4i9hSQZA65LUffGlPEJe3QJD1ALhsgUpquQ/VWGSy1BJK3d/9/9RA=4.9 Screen 9
"Have you experienced any psychological symptoms in the past?"
Transcript
John: I don’t remember. I guess I was depressed once in high school. I can hardly remember that now. I really feel great now!
Mom: I’ve always been a little concerned that John was too sensitive. He used to worry about small things all the time. And then when he was 17…
Dad[breaking into finish Mom’s sentence]: ... that girl broke his heart.
Mom[sadly, reminiscing]: He had been dating her for an entire year. Then she broke it off out of the blue and started dating another boy within a few weeks. John tried so hard to get her back. He left her multiple voicemails and text messages every day. She broke his heart. He just seemed so down. He stopped hanging out with his friends … he always had an excuse not to go to events or parties when they invited him out. He had no appetite and lost weight … something like 15 pounds in only a couple of months. I was so worried about him… John, you looked like you were wasting away.
Dad: We tried to get him to see the doctor.
Mom: Or to talk to someone like you … like a counselor. But he wouldn’t hear of it!
Dad: After a few months, he got over it. He started hanging out with his friends again.
Mom[reminiscing, smiling]: It was so nice to see him laugh and smile again! I was so relieved it was over.
Dad: I was glad he finally got over that girl. She wasn’t worth all that, son.
Question 4.7
Knbc7shTUxfJ8cVI+capTPGmtfPl5EsEarnekI+6sNB7yX2LYcrXOa8U7Xqn33WKCheck Your Notes
John:
- Acknowledges that he was depressed once
- Asserts that he feels great now
Parents:
- Mom worried he is too “sensitive”
- In high school he dated a girl for a year, but she broke it off
- He called and texted her repeatedly
- John’s symptoms:
- He seemed “down”
- He stopped hanging out with his friends
- No appetite
- He lost 15 lbs. in 2 months
- He refused to see a doctor or counselor
- His sadness lasted a few months
Question 4.8
According to John and his parents, what symptoms did John exhibit when his girlfriend broke up with him? Check all that apply.
| ricMlHC6ILpEaDu3un9aCg== | Sadness |
| Ravb35nDtnnnzgRqAc9qww== | Happiness |
| WQU/8bXkzJqm2iiZ | Loss of interest in usual activities |
| WQU/8bXkzJqm2iiZ | Social isolation |
| 3hMJDRP6OS+3EJIb | Increased socialization |
| sUEziFBLl5pzvASIRmXn3A== | Racing thoughts |
| 3hMJDRP6OS+3EJIb | Slowing of thoughts |
| sUEziFBLl5pzvASIRmXn3A== | Drug use |
| WQU/8bXkzJqm2iiZ | Loss of appetite |
| /Bna2aWvBJaJZeOkuNLLxQ== | Increased appetite |
| 0hcP5sLXxkoO51b5yGv89w== | Weight gain |
| WQU/8bXkzJqm2iiZ | Weight loss |
| sUEziFBLl5pzvASIRmXn3A== | Slept more |
| hmqUnTyFjR6qHG8eSnTMiQ== | Slept less |
4.10 Screen 10
Question 4.9
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
Remember that John's symptoms included sadness, loss of interest in usual activities, social isolation, loss of appetite, and weight loss.
4.11 Screen 11
"Tell me about your family. What was it like growing up in your household?"
Transcript
John: I have a sister, 6 years younger and a little brother, 8 years younger than I am. They’re pretty cool. Growing up, you guys seemed like you didn’t have time for me.
Dad[a little defensively]: Well, we sure didn’t plan to have kids as quickly as we did. We weren't really ready to start a family.
Mom: John was certainly a surprise. We were married – of course! I quit my Master’s program when I had John. When he was two, I had to get a part-time job as an accountant to help out and ended up staying there. Sometimes, I regret that I wasn’t able to finish my degree. But I loved being able to spend time with my kids when they were younger.
Dad: And because I work in the banking industry, we do fine, now. But those first few years were tough.
Mom: After 5 years or so, we felt okay having more kids. I feel like we were able to be much better parents then. I sometimes feel guilty about how difficult things were during your childhood, John.
Question 4.10
Knbc7shTUxfJ8cVI+capTPGmtfPl5EsEarnekI+6sNB7yX2LYcrXOa8U7Xqn33WKCheck Your Notes
John:
- Sister, 6 years younger
- Brother, 8 years younger
- Parents stressed during John’s early childhood
- Felt like his parents didn’t have time for him
Parents:
- John was an unplanned pregnancy
Mom:
- Quit Master’s program
- Worked part time as an accountant
- Regrets not finishing master’s program
- Enjoyed spending time with her children
Dad:
- Works as banker
- Struggled financially at first
- Mom feels guilty → John’s experience was different from his siblings’
Question 4.11
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"John, can you describe your relationship with your parents?"
Transcript
John: We’re really close. I usually call them at least once a week… I guess I haven’t lately … I’ve just been too busy with all my projects. Still, I don’t understand why they had to jump in the car and drive 2 hours just because my roommate Calvin called them. [To his parents] I mean, c’mon! Don’t you guys trust me anymore?
Question 4.12
Knbc7shTUxfJ8cVI+capTPGmtfPl5EsEarnekI+6sNB7yX2LYcrXOa8U7Xqn33WKCheck Your Notes
Relationship with parents
John:
- Close relationship with his parents
- Talks to them once a week
- He has not been calling them lately because of his “projects”
- Parents drove 2 hours to see him because they are concerned
Question 4.13
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
Think about John's communication with his parents.
4.13 Screen 13
"How did John do in school growing up?"
Transcript
Mom: In school, John was generally an A/B student. He was uncomfortable being the center of attention - he didn’t speak up in class much, but he was very conscientious about his school assignments and rarely missed a day of school.
Dad: He had several close buddies. He’s known these kids since kindergarten. They all hung out together in high school, too.
Question 4.14
Knbc7shTUxfJ8cVI+capTPGmtfPl5EsEarnekI+6sNB7yX2LYcrXOa8U7Xqn33WKCheck Your Notes
Parents:
- A/B student
- Didn’t talk in class much, introverted
- Conscientious in terms of completing assignment and attending school
- Had a few close friends
- His friends were old friends, from Kindergarten to HS
4.14 Screen 14
"Has anyone in your family ever had a mental health problem?"
Transcript
John: Not that I know of. My family is awesome. I mean … who isn’t a little nuts? Wait, seriously… wasn’t Grandpa a little crazy?
Mom[nodding in agreement]: My father did have had a lot of trouble with mental problems. He was diagnosed with… [searching for the correct word] what do they call it now… it was called manic-depression… yes, bipolar disorder… I think when he was in his 30’s. He had to be hospitalized. He was on medication, but he stopped taking it sometimes, and then it would be really hard to be around him.
Dad: He had an episode like this around the time John was born.
Mom: It was almost too much for me at the time. It made our lives so stressful, taking care of a young child and trying to care for Dad.
Dad[agreeing]: Those years were really tough.
Mom: I’ve always wondered if John is so shy and serious and melancholy because things were so stressful those first few years.
Question 4.15
Knbc7shTUxfJ8cVI+capTPGmtfPl5EsEarnekI+6sNB7yX2LYcrXOa8U7Xqn33WKCheck Your Notes
John:
- Recalls that his grandfather may have had mental problems
Parents:
- Maternal grandfather → bipolar disorder
- On medication, but occasionally would stop taking his meds
- Stopped taking meds around the time of John’s birth and early childhood
- Added stress to the family dynamic
- Parents took care of John and grandfather
Question 4.16
How could John’s grandfather’s diagnosis have influenced what is happening to John now? More than one answer could be correct. Select all that apply.
| PoR+eNv2dOHfjcNf | John’s grandfather likely abused John when he did not take his medication. |
| WQU/8bXkzJqm2iiZ | John’s grandfather’s illness likely made things very stressful for John growing up. |
| xdqz80TY1Vwhogjf | John’s grandfather’s illness was passed down to John’s mother genetically and she also has symptoms. |
| nbIRnRe8R9/OaJB+ | John’s grandfather’s illness may have been passed down to John genetically. |
Hint
Think about the ways in which John’s grandfather’s illness might have directly affected John based on the information you just got from John and his parents.
4.15 Screen 15
Question 4.17
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Think about the concerns John’s parents mentioned at the beginning of the interview.
4.16 Screen 16
"John, do you drink alcohol or use any substances? If so, how much and how often? If you would feel more comfortable, we could ask your parents to leave the room while you answer this question."
Transcript
John[raising his voice]: They don’t need to leave the room – I want them to hear this! I don’t see how that matters! I am just seeing the world more clearly, and if I go to parties, so what? I’m in college! And Calvin didn’t have any right to call my parents to have them come get me just because he thinks I’m doing drugs. I’m so frustrated with them all. This really ticks me off! Can’t they just leave me alone and let me work on my projects? They’re getting in the way of me making money. I only came here because I feel like I didn’t have a choice… I was sure it would be a huge waste of time. I was obviously right about that one, just like I’m usually right about everything else!
Dad: Your roommate has some real concerns. He says he found you in a separate room at that party on Friday night hanging out with people who are known drug users.
Mom: Calvin said he tried to get you to leave the party with him. He said that you became angry and physically threatened him! Really, John David! I did not raise you to be violent, and Calvin is your friend!
Dad: Calvin called us because he was worried. He said that we should come and get John. Calvin is a good friend, John. That’s a real man who looks out for his friends.
Mom: And then we drive all the way here, and John, you didn’t even get back until all hours of the morning. Where were you? What were you doing, John?
Dad: We made an appointment with the family physician. We are taking him there tomorrow to get him checked out. We had his bags all packed when he finally graced us with his presence at whatever hour of the morning that was. We’re very worried about you, son.
Question 4.18
Knbc7shTUxfJ8cVI+capTPGmtfPl5EsEarnekI+6sNB7yX2LYcrXOa8U7Xqn33WKCheck Your Notes
Alcohol/ substance use
John:
- Defensiveness about alcohol and drug use, steers discussion to “money making” schemes
- Goes to parties → is this normal behavior in college?
- Roommate thinks he is doing drugs
Parents:
- Roommate found John with known drug users
- John became violent when roommate tried to make him leave
- Roommate called parents
- John didn’t return until early in the morning
Parents packed his bag, ready to go → worried
- They made an appointment with his physician
Question 4.19
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Think about John’s symptoms and whether they are mental or physical.
4.17 Screen 17
Question 4.20
Which of the following symptoms is John currently experiencing? Check all that apply. Use the interview notes to help you remember!
| WQU/8bXkzJqm2iiZ | Racing thoughts |
| PoR+eNv2dOHfjcNf | Slowed thoughts |
| WQU/8bXkzJqm2iiZ | Grandiosity |
| xdqz80TY1Vwhogjf | Low self-esteem |
| PoR+eNv2dOHfjcNf | Talking too slow |
| WQU/8bXkzJqm2iiZ | Talking too quickly |
| 3hMJDRP6OS+3EJIb | Sleeping more than usual |
| WQU/8bXkzJqm2iiZ | Sleeping less than usual |
| WQU/8bXkzJqm2iiZ | Engaging in impulsive behaviors |
| WQU/8bXkzJqm2iiZ | Engaging in risky behaviors |
| PoR+eNv2dOHfjcNf | Social isolation |
| WQU/8bXkzJqm2iiZ | Distractibility |
| xdqz80TY1Vwhogjf | Increase in focus |
| WQU/8bXkzJqm2iiZ | Increased activity |
| PoR+eNv2dOHfjcNf | Decreased activity |
4.18 Screen 18
From the File. You remember a former patient who exhibited symptoms similar to John’s. You review this case to help you diagnose John.
Question 4.21
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Question 4.22
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Think about the following symptoms John exhibits in making your choice:
- Spending money without thinking about the consequences
- Feeling like he does not need much sleep
- Racing thoughts
- Friends noticing his behavior and expressing concern
4.20 Screen 20
Question 4.23
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Hint
Think about the types of episodes John has experienced.
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Question 4.24
kYgJgLWZ0j/hn5QHoerWylpIZb7uX1hpyis1HHa62RXjpf9hJ5EmJLxSw0MxOZPxSMCXalUZmkMgBeWq8E+vKzA2vt9xpyRYH/Yt1oldqj7O9U7n+/i5rLHsSYc=Question 4.25
mrjoKSZxQIuTZBIhE/s982jzO/2Aih6DVaAovy/0dRj6HEoBwGv9ni/y1sOybi7XSdXaM2lSEa6S/CQ5UsbzkeuoNsltsiSe5+S7QZH2RujUG5OnZT0PsbLJGUGx4tu2DQ8+MLZMRXtqPuFlSpIMMQ8Ycd8b9ugD5ifQILNKLPecbvgSU7oX6q7H5E38rtFY6JorKHCWN7knLfjCUld7u4j9YqC/HZcZ7PTilSc12KsafEqtML11CMtebUTMX6wFDszBvchzNLe7xqYKMepPvgwLCLcWb2uaZZs2Asas184+iOiBoNFBig==4.22 Screen 22
Question 4.26
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Hint
In making your choice, think about the fact that research on the brain and genetics has given us the most helpful information about bipolar disorder in recent years.
Question 4.27
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Hint
In making your choice, think about the fact that research on the brain and genetics has given us the most helpful information about bipolar disorder in recent years.
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Question 4.28
Cpyw3mh7sAQJgphyaQxW+nAPT7vrZdlr5LdiAIA0LXRK/aKzQhNuvQGtE23dpxqIMQcQemz/C+qJN3J/lqYqvY16170diqFpUgHXlzcMcUV0BZjrbdzrt6jY3GiBfeT6SGPghYNA98WShj4dqScpzZ5PTp4Z2T16rlKKIqfGiH7w4Ct5SVDldssMAPqM6CGiXpUFPRHrjXGbJJl8HUsmHccSVxvJOruNjsdl6Pv5E07/unXgn6UkU6ggS4BkJsOauNDARBigTqnLcxtcMeCisuDH0Yjtfd7DZvGbWbyU09K9qEbMVXXiLTUnB2SxYz4DoIA7oAMBstcO8uqX+qSNNyH1wYCGnc3hP8pdZqIl18A2uq3BSxE6NUO4LnLr4JVDUhfVAaDcEQW2d+JsPZnRZA==Question 4.29
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4.24 Screen 24
As John’s psychologist you referred John to a psychiatrist, Dr. Samuelson, for medication management. In addition, John started meeting with you on a regular basis for cognitive behavioral therapy. Dr. Samuelson put him on lithium and carefully monitored his dosage. Even so, John experienced some side effects, including trouble concentrating, drowsiness, and increased thirst. Also, whenever he began feeling manic, he would want to stop taking the medication. As his therapist, you worked with him on addressing some of his maladaptive thoughts, such as his idea that his manic state was the “real him.” You also encouraged John to analyze his urges not to take his medication. With your help, John was able to use behavioral techniques such as setting a reminder on his phone and using a pill organizer to help him remember to take his medication and settle into a routine.
After taking the rest of the semester off, John returned to school the following semester. He and Calvin made up and continued to live together. John now appreciates Calvin’s previous concern. John tries to remember to call his parents on a regular basis to reassure them that he is doing fine. John decided to major in business so that he can explore and learn to implement some his “entrepreneurial” ideas in realistic ways.
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Real World Application
Watch the following video about how one family struggled with having to involuntarily hospitalize their father due to his bipolar disorder – called “sectioning” in the United Kingdom – and answer the questions below.