Bipolar Disorder: Mental Health

1. BIPOLAR: Bipolar disorder is a mental health condition defined by periods (better known as episodes) of extreme mood disturbances. Bipolar affects a person's mood, thoughts, and behavior. There are two main types of bipolar disorders: bipolar I and bipolar II. According to the Diagnostic and Statistical Manual of Mental Disorders, in bipolar I disorder, a major depressive episode (one or more) usually occurs, but it is not required. Bipolar II disorder involves one or more major depressive episodes. Common symptoms that occur in a major depressive episode include:Insomnia or hypersomnia, unexplained or uncontrollable crying, severe fatigue, loss of interest in things the patient enjoys during euthymia, and even recurring thoughts of death or suicide. Both disorders may include periods of euthymia (symptom of free or ""normal"" states). Manic episodes last at least seven days. An individual experiencing a manic episode may experience: Feelings of euphoria, less need for sleep, increased sexual desire, hallucinations or delusions, and marked increase in energy. During a manic episode, individuals may engage in risky or reckless behavior. For example, someone may indulge in risky sexual behavior, spend excessive amounts of money, or make impulsive decisions. On the other hand, an individual experiencing a hypomanic episode may experience similar symptoms but their functioning won't be markedly impaired. Many individuals who experience hypomania associated with bipolar II enjoy the increased energy and decreased need for sleep.

Behavior Disorders in Childhood

Fall 2018 Shriver 2. The main character of the movie (Pat Solitano) meets the Bipolar I Disorder diagnoses from the trigger of seeing his wife in the shower with his co-worker having sexual relations while the song from their wedding was playing in the background. His reaction was get violent and hit the man. He already had a delusion about both of them that were conspiring against him, but didn't realize that was a symptom of his disorder yet. The movie begins right after he was released from the psychiatric hospital during 8 months treating his bipolar disorder. He's practically vibrating with intensity as he returns to his parents' home, armed with new knowledge about his disorder, required visits to a therapist, and medication he's disinclined to take. Obsessed with the delusion that he's going to win back his wife, who has taken out a restraining order against him, he spends a lot of time running around the neighborhood to keep in shape and burn off some of that energy. From the beginning, Pat is appealing and scary in equal measure, and when he meets his match in a sultry and seriously depressed widow named Tiffany, the result is edgy and unpredictable attraction. They are also surrounded by family and friends who are odd and obsessive themselves, but also warm and forgiving and unembarrassed by eccentricity. All along the movie, we can see action of Pat that are considered maybe extreme and violent, until the end of it, when he realizes that he was in love with Tiffany.

Developmental History and Symptoms of Concern (10 points)

In the movie we only see Pat, the main character who suffers from the Bipolar Disorder, once he already has the disorder. He was diagnosed with it probably a year previous to the present moment he lives in because he was put in a psychiatric hospital for 8 months. He was sent there because he beat the man he caught his wife cheating with almost to death. He was uncontrollable, impulsive and way too aggressive. Throughout the movie they talk about how everyone discovered he had the disorder after that event. However, in a deep emotional scene where the father is talking to the son (Pat), he gets emotional telling him he is sorry for everything that he did when Pat was a kid, because he always prefered his brother. He gave more attention to him, always felt more proud and so on. This is an indication that when Pat was a child he might have had some symptoms indicating early

Behavior Disorders in Childhood

Fall 2018 Shriver bipolar disorder but they were never sever enough in order to take action (or for people to actually notice). Being diagnosed with it made it easier for people to understand his behavior (the fact that he doesn't have a filter when talking, being impulsive, not knowing how to control himself...and so on). The symptoms he has in the present are slowly minimizing as he takes his medication. However the ones that concern people the most are his mania episodes, impulses and aggressive acts.

Treatment Options

Because bipolar disorder is a lifelong condition and different in every case, there are multiple ways to treat it. However, the best treatment for bipolar disorder is a combination of medication and counseling. Medication is an important part of treating bipolar disorder and stabilizing moods. Some common categories of medication that may be prescribed would be mood stabilizers, antidepressants, and antipsychotics. Each person has a different medication or dosis that will work best for each, as those medications can provoque side effects (such as suicidal thoughts or risk of manias).

Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful.

• Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise.
• Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.

Behavior Disorders in Childhood

Fall 2018 Shriver

• Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and your loved ones understand the condition. Knowing what's going on can help you get the best support, identify issues, make a plan to prevent relapse and stick with treatment.
• Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.

In some cases, hospitalization is required (as the case of Pat). Inpatient treatment in a hospital or long- term care facility may be necessary when your mood is particularly unstable or if you are experiencing psychotic or suicidal thoughts or behaviors. The goal of inpatient treatment is to stabilize your mood and connect you with the needed outpatient support that can reduce frequency or duration of future hospital visits. After that, an outpatient treatment is required for the best result. Pat, after being released of the hospital, had to go to therapy every day, which helped him relieve his worries and thoughts.

Operational Definition of the Problem Behavior(s) and Replacement Behavior(s) (10 points)

The main problem behavior that he has is the lack of self-control and violence response. During the movie, he got into several fights (even with his parents) that is why he should learn some skills on how control himself and be able to resolve his problems in another way. We have seen throughout the movie poor coping skills, poor problem-solving skills, poor social skills, and poor social support. That is why he has to learn all this skills and apply them on his daily life. Sometime breath before making any decision, count to 10, and have a big picture of the situation are the best solutions in front of a risky situation.

No single biological or environmental cause of aggressive behaviour in people with autism or intellectual disability has been identified. Many developmental pathways contribute to the current form of a particular person's aggression. Further, the current factors maintaining aggression may change over time. For example, inadvertently ignoring adaptive communicative responses and differentially

Behavior Disorders in Childhood

Fall 2018 Shriver responding to progressively more intrusive requests may initially shape aggression. Later, this same topography may come to elicit help during periods of illness. It is important to note that aggression often occurs with other challenging behaviours, such as non-compliance, tantrums and self-injury. Applied behaviour analysis (ABA) is the natural science of observable behaviour. It focuses on observable behaviour that is public and measurable. Observable behaviour has several dimensions, such as frequency, duration, latency, intensity and sequencing. Interventions are based on learning principles and an understanding of the idiosyncratic environmental events maintaining each person's behaviour. The most important element of ABA is enhancing the client's quality of life and social acceptance, by teaching behaviours that are valued by the client and significant others around them, and which are also functional in replacing the client's aggression. Thus, ABA emphasises teaching social skills, language skills, educational and vocational skills, and coping strategies, such as relaxation training, problem solving and anger management. Interventions that do not include these elements do not include an essential element of ABA. ABA also emphasises the current environmental events. The history and development of the problem are typically underplayed and contribute relatively little to the understanding of aggression and in guiding treatment. We may speculate on how a particular behaviour was shaped or how a traumatic event might relate to classical conditioning. However, such hypotheses are little more than speculation and not subject to verification.

Two common learning mechanisms are classical (respondent) and operant conditioning. This intervention is based on changing the relationship between antecedents (social criticism) and behaviour (aggression).

Since aggression is mediated by the behaviour of other people, behavioural interventions require that the people around the client change their behaviour. Unfortunately, part of the challenge is that the client has enormously powerful consequences for these people. The client's behaviour may powerfully shape counter-habilitative practices in staff, such as not placing demands on the client wherever possible. There has been extensive research on staff and parent training. Generally, verbal training,

Behavior Disorders in Childhood

Fall 2018 Shriver reading and courses alone may lead to improvements in knowledge. However, such an approach does not lead to improvements in skills or implementation of recommended interventions. To change staff and parent behaviour, direct training using brief instruction, modelling, rehearsal to mastery criterion and feedback may lead to the initial acquisition of the skills. After initial training, considerable effort is needed to ensure maintenance of staff and parent behaviour. The most effective format for this is through direct observation of implementation, feedback on performance and periodic retraining. Finally, we can also use medication to stop such problem behavior, but because the main character of the movie was refusing it, we didn't considered as an option.

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