# Female Patient with bipolar type II

**Name of client:** Patient 3
**Age & gender:** Female, late thirties
**Presenter:** Andy Shaw

## Background

Patient responded to a request for volunteers for this assessment. She moved to Cambodia from Malaysia in 2018 and returned to Malaysia in 2020 after her boyfriend physically assaulted her. While in Cambodia she consumed alcohol daily and partied frequently, but says that the cheap alcohol caused her to lose control and she would scream at random people in the street. She says her drinking issues have repeated at different stages in her life.

Says that her problems began in her early 20’s. The patient is now in her late thirties and says that she feels like she ‘has nothing’ and that her life is out of control.

She is living with her parents and unemployed, saying that she 'does nothing' with her time. Since returning to Malaysia, she no longer drinks alcohol which has helped her regain some control of her life. She has enrolled at an art school which was due to begin three months from the time of our final interview.

The patient was diagnosed as bipolar type II in her 20’s.

## Subjective observation

- Patient described a history of substance abuse (amphetamines, alcohol)
- Some antisocial behaviour - drunkenness, shouting at people on the streets. She blamed this on 'low-quality alcohol'.
- Non-communicative and reclusive while in Cambodia (_descent behaviour_), saying she ‘could not talk’, which made her feel isolated. In hindsight, she believes this behaviour was related to substance abuse, in this case marijuana and amphetamines.
- Dropped out of school. Moved from job to job. She says that she struggles with focus.
- Some history of suicidal ideation, though not recently.
- Patient says that her father has his own issues and is very aggressive.
- Says that she had a good childhood but does not talk to her parents now, despite living with them.
- She originally left home when she was 12 years old.
- Has been prescribed medication to mitigate the symptoms of bipolar in the past but stopped taking this because, she says, it affected her head.

## Objective observation
- Sleep patterns are okay.
- The patient exhibits a general sense of hopelessness, for example: worries that in her late 30’s, she ‘has nothing’
- The patient appeared empathetic and focused during our calls.

## Assessment
**Bipolar type II**
- The patient has been diagnosed with bipolar type II. In the two interviews that we had, she described bouts of, what appear to be, hypomania.
- She was sullen and depressed during our first interview, but more upbeat and optimistic during the second interview.
- Although there are some symptoms and criteria for Antisocial Personality Disorder, these are related to substance abuse, itself a coping mechanism of her bipolar type II disorder.

**Defectiveness (DS)**
* Response is escape - e.g. alchohol and recreational drugs.

**Symptoms**
* Bouts of hypomania
* Substance abuse
* Hopelessness thinking

## Plan
1. **Routine**

It is apparent that the upcoming school placement has had a positive impact and that the patient benefits from a sense of purpose and focus. Routine and schedule are a way for her to **regain control** of her life. She is encouraged to build out this list herself, but the following healthy lifestyle habits are known to combat potential bouts of hypomania and depression.

- Focus on diet and eat at regular times
- Sleep at regular hours
- Exercise at least once per day
- Begin to prepare for the art classes in advance of the school start date

2. **Avoid substance abuse**

- The patient needs to recognise the danger in continued substance abuse. Avoidance should include avoidance of people and places where there is potential for relapse.
- Though there are relationship challenges with her parents, their presence has helped her to stop drinking alcohol and taking recreational drugs. She herself sees this as a positive impact on her life, hence is encouraged to view the positives in her relationship with her parents.
- Patient is about to start a two year class at art school where she will be staying in hostel with other Muslim ladies. She expects that she will have less ready access to alcohol and is encouraged to use this as a springboard to surrounding herself with more positive influences.

3. **Address Hopelessness**

The patients highly negative views of her current situation and where her life is heading should be addressed. As such, the patient should be asked to reflect upon these concepts on a daily basis.

- Avoid fixed beliefs and jumping to conclusions. Switch to probabilistic thinking - our lives and futures are not fixed.
- Take any one of the negative beliefs and make a case for the opposite. For example, 'I am 30 and I have nothing' -> 'I am just 30, about to start a new class and meet new people. The opportunities to change and improve my life are plenty’.
- Is feeling hopeless a way to cope with not taking action?
- Reflect on some of the positives from the past: found a job she enjoyed, independently, in Cambodia. Has stopped drinking - count and celebrate the days since.

As well as this, the patient is advised to seek out friendships with those that she believes will have a more positive impact on her life.

###### tags: `psychology` `soap`