Reflection on Clinical Experience
Student’s Name
Institution
Date
Reflect on your clinical experience by writing(four to five sentences)responses to each of the
following questions. Include references from the learning activities or from journal articles and
resources located in the Regis Library Database:
1. What were thehighlights of this week'sclinical? Describe a particular patient, patient
interaction, or disease process that stood out to you.
2. Reflect on a situation or a patient presentation that youwere unfamiliar withduring
clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe
how you handled this unfamiliar situation/case.
3. Describe a situation or encounter from this week that led you to anew understanding of
a specific mental health condition.
4. Discuss any interactions with patients that you observed, either in a therapy or a
medication management session, that weremissing some of the conceptsyou have
been learning about regarding therapeutic relationships and communication.
5. How did youapply the content learnedin your online courses to your clinical setting this
week?
6. Which chief complaints did you see most often this week? Providedetails about how you
feltabout developing your own preliminary differential diagnoses lists for these patients
based on the complaints/symptoms they expressed.
7. Given the most frequent psychiatric disorders you encountered in your clinical rotation this
week, what is themost useful set of guidelines(i.e., depression guidelines, Beer’s
criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?
8. Thinking about the common mental health conditions you saw in your clinical this week
(see question #7), did you feel that you hadadequate knowledgeto discuss these
diagnoses with your preceptor? If not, what preparation work do you have planned to help
you feel more confident for the upcoming clinical week?
9. List abrief plan of carefor one of the patients you saw this week. Include your
preceptor’s plan, too. Discuss, briefly, whether or not you agree with your preceptor’s plan
of care. If not, describe what you would have done differently and why.
10. What situation or patient presentation did you see in your clinical setting this week that
hasnot yet been coveredin your online psychiatric courses?
Clinical Objectives
At the successful end of your clinical course, you will attain the following
objectives:
Objective 1 – Related to Adaptation, Nursing Theory and Practice, and
Planning Therapeutic Nursing Interventions
Facilitates collection of the client data base through use of appropriate
interviewing skills
Utilizes nursing and related theories in developing a plan of care
Collects a complete subjective data base for both acute and chronic health
problems
Demonstrates technically proficient physical assessment skills
Appropriately focuses the physical exam based on the health history
Objective 2 – Related to Clinical Management, Decision Making and
Practice
Identifies likely differentials for client’s presentation based on the logical
integration of the history and physical exam
Provides scientific rationales for the consideration of differentials
Accurately assesses the current status of the client with attention to functional
status, developmental milestones, psychosocial well being, health promotion
and prevention
Provides rationales for interventions and plans of care
Manages client in collaboration with other professional members of the team,
consults appropriately
Utilizes interventions that flow logically from assessment of the client’s status
Evaluates patient outcomes to define appropriate interventions
Considers indications, side effects, potential drug-drug interactions in ordering
medications
Objective 3 – Related to Documentation and Therapeutic
Communication
Uses verbal presentations that are concise, accurate and pertinent to the
patient’s presenting problems
Writes clinical notes that are concise, complete and accurate
Develops problem lists that are comprehensive and reflect a holistic approach to
patient health problems
In the professional role the student communicates with all others including, but
not limited to, clients, colleagues, faculty, preceptors and office staff, in a clear,
respectful, civil and informative manner
Objective 4 – Related to Clinical Research and Teaching
Utilizes current literature in designing and evaluating plans of care
Plans care including appropriate diagnostic, therapeutic, and educational
interventions
Integrates current research on pharmacotherapeutics while designing the
therapeutic plans of care for individuals
Communicates current research findings to faculty and peers during clinical
seminar
Objective 5 – Related to Ethical, Legal and Professional Standards of
Practice
Integrates ethical, legal and professional standards of practice in all interactions
with clients and colleagues
Objective 6 – Related to Self-Directed Learning, Professional
Development, and Role of Advanced Practice
Accepts feedback from faculty and community preceptors and incorporates
suggestions for improvement into practice
Develops clinical goals and objectives and assumes responsibility for identifying
and meeting these objectives
Fulfilled the required clinical hours in the area of specialty
Brené Brown on Empathy
Speaker 1:What is empathy and why is it very different than sympathy? Empathy
fuels connection, sympathy drives disconnection. Empathy, it's very interesting,
Theresa Wiseman is a nursing scholar who studied professions, very diverse
professions where empathy is relevant and came up with four qualities of empathy.
Perspective taking, the ability to take the perspective of another person or
recognize their perspective as their truth. Staying out of judgment, not easy when
you enjoy it as much as most of us do. Recognizing emotion in other people and
then communicating that.
Empathy is feeling with people. To me, I always think of empathy as this kind of
sacred space when someone's in a deep hole and then they shout out from the
bottom and they say, "I'm stuck. It's dark. I'm overwhelmed." Then we look and we
say, "Hey," and climb down, "I know what it's like down here and you're not alone."
Sympathy is, "Ooh, it's bad, uh-huh. Uh, no. Do you want a sandwich?"
Empathy is a choice and it's a vulnerable choice because in order to connect with
you, I have to connect with something in myself that knows that feeling. Rarely, if
ever, does an emphatic response begin with, "At least." Yeah, and we do it all the
time because you know what, someone just shared something with us that's
incredibly painful and we're trying to silver-lining it. I don't think that's a verb but I'm
using it as one. We're trying to put the silver lining around it. "I had a miscarriage."
"Oh, at least, you know you can get pregnant." "I think my marriage is falling apart."
"At least, you have a marriage." "John's getting kicked out of school." "At least, Sara
is an A student."
One of the things that we do sometimes in the face of very difficult conversations is
we try to make things better. If I share something with you that's very difficult, I'd
rather you say, "I don't even know what to say right now. I'm just so glad you told
me." Because the truth is, rarely can a response make something better. What
makes something better is connection.
Carl Rogers on Empathy and Presence
Speaker 1: You've heard much in this conference about the skill of empathetic
listening. I simply want to underscore what has been said because I believe it plays
a large part in our future.
I have come to believe that a very sensitive listening is one of the most powerful
forces for growth that I know. When I can let myself enter, softly and delicately, the
vulnerable inner world of the other person, when I can temporarily lay aside my
views and values and prejudices, when I can let myself be at home in the fright, the
concern, the pain, the anger, the tenderness, the confusion which fills his or her life,
when I can move about in that inner world without making judgements, when I can
see that world with fresh, frightened eyes, when I can check the accuracy of my
sensings with him or her, being guided by the responses I receive, then I can be a
companion to that inner person. Pointing to the felt meanings of what is being
experienced. Then I find myself to be a true helper, a welcome companion, an aide
to growth and help.
Listening seems such an easy word. I find it a lifetime task to achieve true listening,
a task well worth the effort. There's another very subtle factor in the healing
relationship which I have experienced, and that I would call presence. It's certainly
known to physicians that to William Henry Welsh, speaking with his father, said the
art of healing seemed to surround his physical body like an aura. It was often not
his treatment, but his presence that cured. I too have experienced this. When I am
at my best as a group facilitator or a therapist, I discover this characteristic. I find
that when I am closest to my inner's intuitive self, when I am somehow in touch with
the unknown in me, when perhaps I am in a slightly altered state of consciousness,
then whatever I do seems to be full of healing. Then simply my presence is
releasing and helpful.
There is nothing I can do to force this experience, but when I can relax and be close
to the transcendental core of me, then I may behave in strange and impulsive ways
in the relationship, ways which I can't justify rationally, which have nothing to do
with my thought processes. But these strange behaviors turn out to be right in some
odd way. At those moments, it seems that my inner spirit has reached out and
touched the inner spirit of the other. Our relationship transcends itself, and has
become part of something larger. Profound growth and healing and energy are
present.
Gerard Egan - The Skilled Helper - SOLER
Rory: Hi. It's Rory from CounselingTutor.com. This presentation is one requested by
those by those who are following me on the Counseling Tutor Facebook page. It's a
presentation on the Skilled Helper Model by Gerard Egan. It's going to be a long
video. You might want to take a few notes. I think I've covered it all. It's very
comprehensive. Without further ado, let's go to the PowerPoint.
Here we are, at the PowerPoint. Here's Gerard Egan. The book that he wrote in
1970 is called The Skilled Helper. I'm delighted to say, Gerard Egan's still with us.
He's still alive, unlike a lot of the theorists on the channel I discuss. He's still with us.
I think he must be in his late 80s now, but with us, he still is.
Just a word about the book, I'll put a link in the description below so you can link to
the book if you want to buy it. However, the covers do change from time to time.
Gerard Egan is a psychologist and emeritus professor, an academic man. He's
written this book which is a world bestselling books. The theory and model is used
by people who help others the world over.
We're going to have a look at the two main components of The Skilled Helper. The
two main components are really theory and the application of theory through the
use of counseling skills. We're going to go to the theory first. To do this I'm going to
show you a graphic. Might be useful to show you a graphic for those of you
watching who are maybe visual learners, a graphic may be useful for you.
The theory in a graphic form is, first of all, exploration. Initially, when a client meets
a helper or a counselor, the first part of the meeting will be exploration. They'll be
exploring the difficulties that the client has. The second is challenging. Here is
where it separates, the Egan Model separates itself from person centered. For
those of you writing assignments, compare and contrast, this might very useful for
you.
We don't challenge in classic person centered therapy. There's a big difference.
This model will challenge. An example of challenge may be a client who said, "I
never get out. I'm always in the house. I never see anybody." Then, a few second
later, they say, "When I was down in the shops talking to my friend, and then when I
went to see my daughter," the challenge would be, "I hear that you say you never
get out, you never see anybody, but I've noticed that you've just said that you saw
your daughter and you were at the shops the other day." You can challenge.
Sometimes people get into a mindset of what they believe to be true is correct.
Once they challenged, it helps them see their opportunities and other possibilities.
Challenging.
The third, which is completely different to person centered therapy and lends itself
more to our friends in the solution focused world, or even our friends in CBT is
action planning, setting some goals and targets for something to happen for the
client to change. It's important in this that it's the clients who sets the target, not the
counselor or the helper. It could be something like, "I'm thinking I'd like to get out a
little more. I might go to the shops twice a week instead of once a week," as a very
simple example. That would be an action plan. The helper would write that down,
make a note of it. It would be agreed.
Then in the next session, there'd be a review. They would start, the helper would
start the review. Once they'd chat that the client was okay and welcomed them into
the room they might say, "Okay, last week, you talked about going down to the
shops. How did that work out for you?" That's how the model works. Exploration,
challenge, action planning and review. It's a very structured model. As I said, it's
used by helping professionals the world over, doctors, dentists, teachers, teaching
assistants, counselors, anybody really whose in the world of helping others,
probably uses the model without even thinking because it's such a well-known
model. I'll just teach it to you. You see other people doing it and you pick it up.
That's the model.
I'm going to just overview the theory so that those of you writing assignments
maybe would get benefit from that. Egan's Skilled Helper Model is what's called an
eclectically based solution focused model. It's based on Carkuff's theory of high-
level functioning helpers. Eclectic means it's drawn from a lot of different ideas in
psychology. Egan's got a lot of different ideas and then what he did is he made his
own model from it. That's eclectic. We're going to talk a little bit about high
functioning helpers, what they are.
A high functioning helper needs to be able to show congruence, that's being
genuine and real, immediacy, that means that they're not afraid of sharing a little bit
of themselves and their emotions around what a client speaks about, as long as it's
respectful and it doesn't take the whole of the session up. Say for instance the client
said, "I've been in a car crash." I might say, "That sounds really scary. How was it
for you?" That's immediacy. Empathy, respect, concreteness and a nonjudgmental
attitude. Concreteness is best described as emotional robustness in that if you're
emotionally robust, you may hear stories that are very, very difficult to hear and as
a helper, you've got to be emotionally strong enough to be able to listen to the
material without being diminished yourself or burst into tears. That's what
concreteness means, emotionally robust.
As I said before, the model could be used by any professional helper as long as
they have the skillset to be able to build an effective relationship. I'm going to come
to that I the next part of the presentation.
As we keep going through the theory, helpers need to be able to share relevant
self-disclosure and confront any discrepancies in the client's story. We talked about
challenge earlier on. I talked about challenge earlier on; also, relevant self-
disclosure. What is relevant self-disclosure? I'll give you another example. If had a
client in this model who said to me, "I'm unemployed and it's really, really difficult at
the moment financially and I'm feeling a bit down about it." I would be able to say,
"Actually, I've been unemployed in the past. I know how difficult it can be. Tell me
what your difficulties are." In that, I've shared a little bit about myself. I've also
acknowledged that maybe my experience of being unemployed and their
experience are totally different things.
Helpers also need to have a good understanding of the SOLER model and be able
to practice it. I'm going to tell you what the SOLER model is and how it's applied in
the next part of the presentation. Egan's theories are built around the theory of
social influence. I'm going to tell you what social influence is. Some of you may
know, but I'll share it with you. Social influence, and I've got to quote it, is behavior
that one person causes in another intentionally or unintentionally as a result of the
changed person perceives themselves in the relationship to the influencer, other
people and society in general. Bit of a wordy quote that really. It effectively means
I'm okay, you're okay.
If the client can see that the person who is the helper is all right, is okay, then what
will happen is that there's a tendency for them to try and access their own coping
mechanisms. A good example of that is our friends in the recovery world. They talk
about visible recovery. Visible recovery is where someone who's had a difficulty
with drugs and alcohol in the past becomes a helper, working with people who are
still in active addiction. It gives hope because what happens is, is the person in
visible recovery is saying by who they are, not just what they say that, "Look, I was
in that situation, but hey, I'm in recovery now. If I can do it, the idea is that you can
too." That is what social influence is. If you associate with people who are okay,
then you're more likely to find your own okayness, if that's a word at all. That's the
basis of social influence. It is a big theory. I've really just kind of paraphrased it a
little bit.
I'm just going to go into those phases that we talked about earlier on. Stage one's
the exploration stage. That's being attentive, using body language, using affirming
gestures such as nodding and affirming verbals. Affirming verbals are some things
like uh-huh (affirmative), mm-hmm (affirmative), that type of thing, where you're
clearly listening and clearly acknowledging the client's story.
Active listening, leaning forward if appropriate, so you're really interested in what
the client's saying. They can see that. Using silence to help the clients explore their
story. Not interrupting, but giving that space and allowing clients to tell their story,
also being very thoughtful about your responses. In this stage, the exploration
phase, it's very important that your thoughtful of your responses. A poorly thought
out response here could close the client down. Then, finally in this phase, you're
exploring the client's frame of reference, what they believe to be their truth. That
comes up a lot in counseling and psychotherapy, frame of reference, that idea of a
person's own subjective reality.
Also in the exploration phase, you're offering acceptance and empathy. You're
trying to see the story from the client's perspective. Being nonjudgmental is really
important here. The client will tell you a lot more if they do not feel judged or
criticized. That's a nonjudgmental attitude. Paraphrasing and summarizing, always
checking your understanding with the client. A paraphrase is just feeding back or
reflecting back in their words, in your words, what they've said. The summary is just
a longer paraphrase, really. It's kind of what you say when you come to the end of a
session where you're kind of summarizing what's happened and what the client
said.
Also in the exploration phase, focusing. That's a really important skill. Which of the
issues seem most important to the client. You'll find that people come to counseling
with lots of different issues. The skill of focusing is very useful to find out which
issue is the most pressing, which one did they want to look at and work on first.
Sometimes, what will happen when they work on one presenting issue, the other
issues tend to get sorted out by default. They're all connected to the bigger issue.
Reflecting feelings, so using words like you sound hurt by that. That sounds difficult.
It sounds like that you might be frightened, asking the client the feelings and help
uncover blind spots or gaps in their perceptions and assessments of their situation.
Maybe if it was someone who's working in a school, a young person may come and
say, "I failed this test. I'm going to fail my exams. I'm not going to get anywhere in
life. It might be a catastrophe." The use of helping uncover blind spots is about, and
looking at perceptions is really about saying, "Okay, is this really the truth? It's a
little bit of a challenge." Saying, "What else could you do to help you get those
grades? Let's have a look at what happened." It's about thinking about gaps in
people's perceptions. "I'll never pass my exam." "But you passed the last one."
These are a gap in perception.
In this phase, question is useful. "Is there anything that you've missed?" You say to
a client, "Is there anything that you've missed? Is there anything that maybe that
you've not thought of?" That opens up a discussion. "Is there any other way of
looking at it?" Sometimes, by getting someone to look at something in a slightly
different way, it may be that the problem they have actually becomes less of a
problem.
Questioning, again, useful questions can be, "How did you feel about that?" "What
were you thinking?" That has to be delivered in a non-judgmental way. Not, "What
were you thinking!?" "What were you thinking when that happened?" "What was
that like?" "What else is there about that?" You're trying to get information. It's a
really exploration phase. You're trying to explore and helping the clients explore all
the options.
Now stage two is challenging. One really good technique is asking someone what
might this look like from another person's point of view. One of the techniques to do
that is to say, "If you had a friend going through this same problem, what would you
tell your friend?" It's amazing that people can tell their friends with absolute clarity
what they would do if they were in the same situation, but the client can't tell
themselves that. That reframing can be quite useful.
"What in particular about this is a problem for you?" Sometimes you can hear a
client's story and you can think, "I'm not quite sure what the problem is here." Ask
them. Yeah? Again, "If you're describing someone else in the situation, how would
you describe them?" Yeah? "What do you think and feel about the situation?"
Then moving into goal setting, this where you seek to move the client forward from
being stuck by identifying an area in which progress can be made. It's quite
different, isn't it, from person centered therapy. It is more of a solution focused
model. It is a solution focused model.
Then finally, stage three, action planning. That is where you're asking the clients to
self- assess, to put an action plan in place. "What are the possible ways forward in
this situation?" is a good question. "What of these feel best for you?" If they've got a
few options, which of these feels best for you? "What will you achieve if you do
this?" You're thinking of what's called future pace. You're thinking of asking people
not only about the decision that they may make, but also the consequences of that
decision. " What will you do first and by when?" You're actually setting people a
goal of I'll do this first. Then I'll do this and I'll do that. This why it's called a solution
focused model because you're getting clients to action plan.
Eventually you come to a review. When clients came back for the next session, you
would start off in this model, after you'd welcomed them and checked they're okay.
You'd go to a review. You'd say, "What have you done this week? What have you
agreed to do and what actions have you taken?" The idea is to turn good intentions
into results. It's important to help the client set realistic, practical goals. The helper's
goal is to revisit the goals set by the client and review the progress made. Always
follow up at the next meeting, which I've said. Remember, if a client hasn't met the
goals, not to be judgmental. Maybe sometimes clients can have really big goals that
may be unattainable. Maybe someone says, "I want to go and get myself a
girlfriend." That's a goal, but in itself, it may be unattainable. You might need to
work out how you're going to meet people in a social setting or any setting where
you may be able to form a relationship. Sometimes the end product, i.e. I want a
girlfriend, or a boyfriend may not be achievable at the first instance. It might be
about thinking about how to I meet people would be probably a better goal. Where
would I meet people? How am I going to get in contact with people? would be a
goal to set.
I'm going to show you again the model's theory in graphic form, just to go over the
structure and just to kind of recap really on what I've talked about today. The
exploration phase, that's very much about listening, using empathy, using attending
skills, really listening to the client and trying to find their frame of reference.
Challenging is about looking at any discrepancies in what they're telling you and
trying to get them to see those discrepancies or maybe kind of work through those
discrepancies and that could be a blind spot where someone doesn't actually
realize how well they're doing. Those are discrepancies and challenging
discrepancies.
The action plan, which is how you're going to move forward, how the client decides
how they're going to move forward, what goals they're going to put in place. Then
finally, the review which would be at the next session where you would be asking
the client how they've got on with their action plan, what's happened, have things
changed and if so how, and if they haven't changed they're maybe thinking about
different goals that they could set for themselves.
Okay, we've had a look at the theory, now let's have a look at the model. Here we
are at the PowerPoints again. We're going to look at the model of helping. It's called
SOLER. It's a useful acronym to help us remind ourselves what skills and way of
being with the client are necessary for this model to be effective.
The first thing is sit squarely or at 45 degrees from the client. In other words, you're
sat facing the client. An open posture, so not being defensive, not having your arms
crossed. Already we're seeing that this is about really being attentive and paying
attention and giving the client your time and space for them to be heard. Lean
towards the clients if appropriate. When people lean towards is when they're
listening. It really does show that we're paying attention and not just listening, but
trying to hear the person, trying to hear their frame of reference and trying to
understand them, but only if appropriate. Maintain eye contact, now you notice I put
a little star next to eye contact. The reason for that is, be thoughtful of other
cultures. Some speakers, especially from the Asian subcontinent may see eye
contact as a sign of disrespect or overfamiliarity. In the West, we tend to see eye
contact as something around honesty, of being real and genuine. It's not the same
for every culture. Be very thoughtful of that. Be relaxed. That's SOLER, squarely,
open posture, lean towards the client, eye contact and be relaxed.
I've just got a little picture here of SOLER in practice. You can see that the two
people, they're connected. One person's leaning forward really listening, the chairs
are at 45 degrees. That's what SOLER looks like in practice.
This comes to the end of the presentation. If you've liked what you heard, then like
us, share us, and subscribe to the channel. As always, thank you for watching.
Question 1
One patient that stood out to me is patient X. Patient X has all physical qualities of a normal
person. He was neatly dressed and looks physically normal. He responded to gestures normally.
At first, it is easy to conclude that such person is normal because we are raised in a setting where
a person who is mentally ill is always not easy to interact, chaotic and dresses with dirty and torn
clothing. Like many people are made to believe, speaking of mentally illness, we can easily think
of such a picture: a dark, person wearing a sick suit being held down by a nurse or a doctor,
forcibly injecting b a tranquilizer, as the patient slowly calms down, he whispered in the mouth
“Let me go out…I am not mentally ill..” However, I realized that clinical observation is not
always reliable because person X was later diagnosed of mental condition.
Question 2
In this week, I learned how difficult it is to diagnose a patient with bipolar disorder. At one point,
the patient could have low mood, reduced activity, and slow thinking. After some hours, his
emotions changes. He started talking so much and his activities increases. He could not even sit
down as before. I learned that these ups and downs of mental emotions are called a "bipolar
disorder." This is one of the conditions I was not familiar with. But from the experience, I have
learned that mental diagnosis sometimes requires time.
Question 3
The diagnosis of bipolar patient taught me a good lesson as far as management of mentally ill
patients is concerned. I learned that in the differential diagnosis of mental illness is a very
complicated task. It requires not only rich clinical work experience, but also a clear and rigorous
logical thinking system. It is difficult to train these short-term on-the-job trainees. But we have
our advantage. Because of our spectator identity, we tend to pay more attention to people than
doctors, not to illness.
Question 4
One of the interactions I observed which missed some of the concepts you have been learning
about regarding therapeutic relationships and communication is where the patient talks anything
that comes to his mind. In such a situation, the doctor has hard time trying to connect the
messages. The patient talks sporadically and his words seems to focus on what comes to his
mind. In such a case, the doctor cannot get the message and hence communication is paralyzed.
Question 5
From this week’s experiences, I learned the value of DSM in mental diagnosis and management.
For example, some people with mental illnesses lack understanding of their condition, which is
not new. This medical term has been incorporated into the Diagnostic and Statistical Manual of
Mental Disorders (DSM, the Bible for Psychiatry), which may include schizophrenia and
anorexia nervosa. I also learned the significance of working with the team because it is not easy
for one person, especially the trainee to make right diagnosis without the help of experienced
psychiatrist.
Question 6
The chief complaint I experienced concern the depression and bipolar disorder. Bipolar disorder
is one of the mood disorders. There are obvious depressive episodes in the first half of the
patient. The performance is characterized by obvious “low mood, reduced activity, slow
thinking”, Clinical manifestations of depression. In the latter part, it is a typical manic episode,
which is exactly the opposite of depression. It shows “emotional increase, increased activity, and
quick thinking”. If there are both depressive episodes and manic episodes throughout the course
of the disease, such alternating episodes Mood disorders, the medical community called "bipolar
disorder." In clinical practice, it is difficult to differentially diagnose both bipolar disorder and
Major Depression Disorder (MDD) because they have similar clinical manifestations, especially
in patients with bipolar disorder during depressive episodes. Using DSM-5 manual, it is possible
to differentiate the two. However, one has to take time before making diagnosis because lack of
patience can force one to diagnose the person with bipolar disorder as depressive.
Question 7
I believed that Beer’s criteria are the best criteria because it is based on evidence-based
recommendations. However, the psychiatrist should not be limited to single criteria because
some conditions cannot be approached using evidence-based recommendations. Some mental
conditions have unique features and it is upon the psychiatrists to identify such uniqueness and
device the best approach. However, Beer’s criteria form the basis for management.
Question 8
Yes, I believe that I had some knowledge to share with preceptor. Although my experience is
still low, I believe that participating in team is good even when one does not have adequate
knowledge because I learned that in psychiatric setting, more knowledge is gained through
experience. I intend to increase my interaction with the psychiatric team because I believe this
would be my best source of knowledge
Question 9
One of the care plans is where patient was given the medication to stabilize his condition. Then
after the medication, the preceptor collected more information about his condition. It is then that
the doctor made adjustment on how the patient should be treated.
Question 10
One of the situations that is not yet covered concern the management of mentally ill patient with
comorbidities. For example, I learned that Schizophrenia, have higher prevalence rates of
somatic problems, mortality for certain pathologies and a lower life expectancy than the general
population. The greater morbidity and mortality is due in many cases to the appearance of
concurrent pathologies, whose prevention, diagnosis and treatment is hindered by the fact of
suffering from a mental illness. The elements that contribute to favor this type of associated
physical disorders are related to a higher prevalence of unhealthy lifestyles
Summary :
Bipolar disorder is a mental health condition characterized by extreme mood swings, including periods
of mania or hypomania (elevated, irritable, or euphoric mood) and depression (low mood and feelings of
hopelessness).
One new understanding of bipolar disorder is that it may be caused by dysregulation of certain
neurotransmitters in the brain, particularly dopamine and serotonin. Dopamine is involved in reward
and motivation, and imbalances in dopamine levels may contribute to the manic or hypomanic episodes
associated with bipolar disorder. Serotonin is involved in regulating mood, and imbalances in serotonin
levels may contribute to the depressive episodes associated with bipolar disorder.
Another new understanding of bipolar disorder is that it is not just a mood disorder, but a complex and
multifaceted condition that affects multiple aspects of a person's life, including their thinking, behavior,
and relationships. For example, during manic or hypomanic episodes, a person with bipolar disorder
may engage in risky or impulsive behavior, have grandiose thoughts, or experience racing thoughts.
During depressive episodes, they may struggle with concentration, motivation, and feelings of
worthlessness.
It's also important to note that bipolar disorder can present differently in different individuals, and
treatment approaches should be tailored to each person's unique needs and experiences. Additionally,
research has shown that psychotherapy can be a helpful adjunct to medication for managing bipolar
disorder, as it can help individuals develop coping skills and manage stressors in their lives.
Another new understanding of bipolar disorder is that there may be a genetic component to the
condition. Studies have shown that bipolar disorder tends to run in families, and that certain genetic
variations may increase a person's risk for developing the condition. However, genetics alone are not
sufficient to cause bipolar disorder, and environmental factors (such as stress, trauma, or substance use)
may also play a role in triggering the onset of the condition.
Furthermore, there is growing recognition that cultural factors may impact how bipolar disorder is
experienced and understood. For example, some research suggests that cultural beliefs about mental
illness and stigma surrounding mental health issues may influence how people with bipolar disorder
seek and receive treatment. Additionally, cultural values and expectations may impact how individuals
and families cope with the challenges of living with bipolar disorder.
Finally, there is ongoing research into new treatments and therapies for bipolar disorder. Some
promising areas of study include the use of non-invasive brain stimulation techniques (such as
transcranial magnetic stimulation or transcranial direct current stimulation), as well as the development
of new medications and psychotherapies that target specific neurotransmitters or brain circuits
associated with bipolar disorder. As research continues to advance, we may gain a deeper
understanding of the underlying mechanisms of bipolar disorder and develop more effective treatments
for this complex and challenging condition.
In addition to the above, another new understanding of bipolar disorder is the importance of early
intervention and prevention. Research suggests that identifying and treating bipolar disorder in its early
stages can improve outcomes and prevent long-term disability. Early intervention may involve a
combination of medication, psychotherapy, and lifestyle changes (such as regular exercise and stress
reduction techniques).
Furthermore, there is a growing awareness of the importance of addressing co-occurring conditions in
individuals with bipolar disorder. For example, many people with bipolar disorder also struggle with
substance use disorders, anxiety, or other mental health conditions. Treating these co-occurring
conditions may improve overall outcomes and quality of life for individuals with bipolar disorder.
Lastly, there is a new understanding of the importance of a multidisciplinary approach to treating
bipolar disorder. This may involve a team of healthcare professionals, including psychiatrists,
psychologists, social workers, and other specialists. Additionally, family and peer support can be crucial
in helping individuals with bipolar disorder manage their symptoms and achieve recovery.
In conclusion, there are many new and evolving understandings of bipolar disorder that continue to
shape our understanding of this complex condition. As research continues to advance, we may gain a
deeper understanding of the underlying causes of bipolar disorder and develop more effective
treatments and interventions to improve outcomes for individuals with this condition.
Another new understanding of bipolar disorder is the role of sleep disturbances in the condition.
Research has shown that sleep disruptions, including insomnia and hypersomnia, are common in
individuals with bipolar disorder and may contribute to mood instability. For example, sleep deprivation
has been linked to manic episodes, while oversleeping has been linked to depressive episodes.
Treatment approaches that focus on improving sleep quality and regularity may be beneficial for
individuals with bipolar disorder.
Additionally, there is a growing recognition of the importance of self-management strategies for
individuals with bipolar disorder. This may involve developing a personalized wellness plan that includes
strategies for managing stress, improving sleep, engaging in regular physical activity, and monitoring
symptoms. Self-management can empower individuals with bipolar disorder to take an active role in
their own care and help them achieve greater stability and recovery.
Finally, there is a new understanding of the importance of addressing social determinants of health in
individuals with bipolar disorder. Social determinants of health refer to factors such as poverty,
discrimination, and lack of access to healthcare that can impact an individual's health and well-being.
Individuals with bipolar disorder who face these challenges may experience greater barriers to accessing
care and may be at increased risk for poor outcomes. Addressing social determinants of health may
involve advocating for policies and programs that promote health equity, as well as providing targeted
interventions and support to individuals with bipolar disorder who face these challenges.
Overall, these new understandings of bipolar disorder highlight the complexity and multifaceted nature
of this condition, as well as the importance of a holistic and individualized approach to treatment and
care. By continuing to advance our understanding of bipolar disorder, we can improve outcomes and
quality of life for individuals with this condition and their families.
Another new understanding of bipolar disorder is the impact of gender on the condition. Research
suggests that there may be gender differences in the prevalence, course, and symptom expression of
bipolar disorder. For example, studies have found that women with bipolar disorder may experience
more depressive episodes, while men may experience more manic episodes. Additionally, women with
bipolar disorder may be at greater risk for certain co-occurring conditions, such as thyroid disorders and
migraines.
Furthermore, there is a growing recognition of the importance of cultural competence in treating bipolar
disorder. Cultural competence refers to the ability of healthcare providers to understand and address
the unique cultural and linguistic needs of their patients. Given the diversity of cultures and backgrounds
among individuals with bipolar disorder, it is important for healthcare providers to be aware of and
sensitive to the ways in which cultural factors may impact diagnosis, treatment, and outcomes.
Lastly, there is ongoing research into the neurobiology of bipolar disorder, including the role of brain
circuits and neurotransmitters in the condition. For example, recent studies have identified changes in
the prefrontal cortex, amygdala, and striatum in individuals with bipolar disorder. Understanding the
neurobiological mechanisms of bipolar disorder may ultimately lead to the development of more
targeted and effective treatments.
In conclusion, the evolving understanding of bipolar disorder highlights the need for individualized and
culturally competent approaches to treatment and care, as well as ongoing research into the underlying
mechanisms of the condition. By continuing to advance our knowledge and awareness of bipolar
disorder, we can improve outcomes and quality of life for individuals with this condition and their
families. So we need to be very careful and consistent in looking forward the health of any such patient
near us and deal with them with love empathy so they don’t feel alone.
