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Type responses to questions in the response boxes 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 Type responses to questions in the response boxes 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