Download Mr. Jones

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Mr. Jones
Overview
Mr. Jones, a man in his 40s, was hospitalized on an emergency basis after disrupting a
concert by leaping on the stage. Just 2 days before that incident, he was detained because
he tried to “fly” off a roof at a construction site where he was working. Mr. Jones was
released from the earlier hospitalization after responding to Haldol and being deemed no
longer a danger to himself or others. Following an unsuccessful attempt at involuntary
commitment by his psychiatrist, Dr. Elizabeth Bowen, Mr. Jones was once again released
from the hospital.
Eventually, Mr. Jones begins to experience symptoms of depression and overwhelming
emotions. He agrees to be hospitalized, saying, “I just can’t take the sadness.” You are a
nurse working at the hospital where Mr. Jones has been admitted.
Client Name: Mr. Jones
Psychiatric diagnosis: Bipolar disorder, manic episode
DSM-IV-TR criteria:
1. Distinct period of abnormally and persistently elevated, expansive, or irritable
mood
2. During the period of mood disturbance, at least three or more of the following:
 Inflated self-esteem or grandiosity
 Decreased need for sleep
 More talkative than usual or pressure to keep talking
 Flight of ideas or subjective experience that thoughts are racing
 Distractibility (attention too easily drawn to unimportant or irrelevant external
stimuli)
 Increased goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation
 Excessive involvement in pleasurable activities with a high potential for
painful consequences (e.g., engaged, unrestrained buying sprees, sexual
indiscretions, foolish business investments)
3. Mood disturbance is sufficiently severe to cause marked impairment in
occupational functioning or in usual social activities or relationship with others, or
to necessitate hospitalization to prevent harm to self or others, or there are
psychotic features.
4. The disturbance is not caused by a substance or medical condition.
Psychiatric diagnosis: Major depressive episode
DSM-IV-TR criteria:
1. Five or more of the following symptoms have been present for at least 2 weeks,
and are a change from previous functioning. At least one of the symptoms is
either depressed mood or loss of interest/pleasure:
Copyright 2008, Lippincott Williams & Wilkins
Mr. Jones - 1
Type responses to questions in the response boxes

Depressed mood most of the day, nearly every day—reported by client as
feeling sad or empty, observed by others such as tearful, crying
 Markedly diminished interest or pleasure in all, or almost all, activities
 Significant weight loss when not dieting or weight gain or changes in appetite
 Insomnia or hypersomnia nearly every day
 Psychomotor agitation or retardation
 Fatigue or loss of energy
 Feelings of worthlessness or excessive or inappropriate guilt (may be
delusional)
 Diminished ability to think or concentrate, or indecisiveness
 Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a plan, or suicide attempt or specific plan for committing suicide
2. Symptoms are not due to a substance or medical condition or bereavement.
3. Symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Copyright 2008, Lippincott Williams & Wilkins
Mr. Jones - 2
Type responses to questions in the response boxes
Date:
Your name:
Name of the client you are assessing: Mr. Jones
Name of the movie: Mr. Jones
What is the chief complaint? (In the client’s own words, and report of others)
Response:
Based on the above information and a close viewing of the movie, what questions would
you raise during history taking? What are some possible answers? You might base your
questions on the:
History of the client’s illness
Past psychiatric history, treatment, and treatment outcomes
Psychosocial history
Response:
What other observations do you have about the client’s behavior?
Response:
In your opinion, is the diagnosis discussed above accurate?
Response:
What DSM-IV-TR criteria support (or negate) this diagnosis?
Response:
What treatment plan would you outline?
Response:
With what expected outcomes?
Response:
Copyright 2008, Lippincott Williams & Wilkins
Mr. Jones - 3
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What factors made Dr. Elizabeth Bowen susceptible to the nonprofessional, unethical
relationship with Mr. Jones?
Response:
Regarding the character, Amanda, who also has bipolar disorder and eventually commits
suicide: What risk factors were present?
Response:
Copyright 2008, Lippincott Williams & Wilkins
Mr. Jones - 4