psychology

maternal uncle and grandfather also had

bipolar illness. This episode involved James

discontinuing his lithium use, traveling to

Los Angeles in the hopes of becoming an

actor, spending thousands of dollars on

extravagant merchandise, and finally being

arrested for drunk and disorderly conduct

at a nightclub. James was hospitalized in

an inpatient unit briefly and is now seeking

outpatient treatment.

Key Biopsychosocial Factors:

Biological: There is a family (genetic) history

of bipolar disorder as well as research

supporting a biological basis of bipolar

disorder. Medication is an essential treatment

component.

Psychological: James’s lack of compliance with

his lithium regimen, denial regarding

chronicity of his bipolar disorder, enjoyment

of the manic high, need for control

and independence, emotional losses pertaining

to wife’s death, and a severe

chronic psychiatric condition all play a

role in his illness.

Social: Family and cultural traditions that

(in James’s family) distrust Western

medicine and cultural and general social

isolation also are likely to impact his

illness.

Treatment Goals and Plan: James requires

medication management in addition

to individual therapy in order to achieve

several immediate and long-term goals. After

an initial consultation and assessment

period with James, the following treatment

goals were determined. First, James will seek

to work through the various impediments to

his reliable use of lithium medication. These

involve not only his need to be in control

and not dependent on drugs (or others), but

his family of origin’s negative feelings about

Western medicine. Second, James finds that

when he becomes depressed, he longs for

the ‘‘high’’ associated with mania. Therefore,

the causes of his depression will be

determined as well as improved coping skills.

Third, James is lonely, misses his wife, and

feels isolated from the Hawaiian heritage he

cherishes. Thus, treatment will also address

his interpersonal, social, and cultural needs.

The treatment plan involves the following

components:

1. Collaboration with James’s physician regarding

his lithium regimen.

2. Behavioral contracting, which involves

James’s commitment to maintain his

lithium regimen for at least the first six

weeks of psychotherapy.

3. Exploratory work to understand James’s

disdain for dependence and impediments

to developing a more satisfying interpersonal

life.

4. Psychoeducational materials regarding

bipolar illness, lithium, and traditional

Hawaiian healing techniques and rituals

to aid James in understanding the similarities,

differences, and potential virtues

and liabilities of both traditions.

5. Problem solving regarding increasing social

contacts and cultural identification.

6. Developing improved awareness and

skills for combating depression and curtailing

future manic episodes.

7. Examination of the transference relationship

between James and his psychologist

to better understand James’s interpersonal

issues as well as his need for control

and independence.

This case example illustrates how personality

and culture impact compliance with

medical regimens such as medication, and

the need to work through a variety of

intrapsychic and social issues in managing

a major psychiatric problem such as bipolar

illness. The treatment by necessity

is multidimensional and mindful of the

biopsychosocial influences on human functioning

This is a team assignment this is only my part.

TOPIC Bipolar of the name James

Please refer to Chapters and 9 of Contemporary Clinical Psychology

Write a paragraph or two discussing the biological, psychological, and social factors involved in your selected case

Need references