Introduction
This essay examines the case of Gary, a 19-year-old who withdrew from college following a manic episode indicative of bipolar disorder. His symptoms, including reduced sleep, grandiose beliefs, irritability, and high-risk behaviours such as excessive drinking and sexual activity, led to a diagnosis of bipolar disorder, supported by a history of anxiety and depression. Currently on a mood stabilizer following antipsychotic treatment, Gary’s psychiatrist has recommended adjunctive psychotherapy, with his parents expressing willingness to be involved. This essay aims to explore the nature of bipolar disorder, evaluate the effectiveness of adjunctive psychotherapy, and consider the role of family involvement in treatment. By drawing on academic literature, the discussion will highlight key challenges and implications for Gary’s recovery.
Understanding Bipolar Disorder in Gary’s Context
Bipolar disorder is a chronic mental health condition characterised by extreme mood swings, including manic or hypomanic episodes and periods of depression (Goodwin and Jamison, 2007). Gary’s manic episode, during which he pulled fire alarms under the belief of ensuring safety and expressed grandiose ideas about revolutionising philosophy, aligns with diagnostic criteria for mania outlined in the DSM-5, such as elevated mood, decreased need for sleep, and increased risk-taking (American Psychiatric Association, 2013). His history of anxiety in pre-adolescence and depressive episodes during adolescence further supports the likelihood of bipolar disorder, as early mood disturbances often precede full diagnostic manifestation (Miklowitz and Cicchetti, 2010). This complex presentation underscores the importance of a comprehensive treatment approach that addresses both acute symptoms and long-term stability.
The Role of Adjunctive Psychotherapy
While pharmacological interventions, such as mood stabilizers, are central to managing bipolar disorder by stabilising mood swings, adjunctive psychotherapy plays a critical role in addressing psychological and social factors (Geddes and Miklowitz, 2013). Cognitive Behavioural Therapy (CBT) is particularly effective in helping individuals like Gary identify and modify distorted thinking patterns, such as his grandiose beliefs, and develop coping strategies for managing stress and high-risk behaviours (Lam et al., 2009). Furthermore, psychotherapy can enhance medication adherence, a common challenge in bipolar disorder treatment, by fostering insight into the illness (Scott et al., 2006). However, the effectiveness of psychotherapy may be limited by factors such as Gary’s irritability and intolerance of disagreement, which could hinder therapeutic rapport.Tailoring interventions to his specific needs, perhaps by incorporating motivational interviewing techniques, could therefore be necessary.
Family Involvement in Treatment
Gary’s parents’ willingness to participate in treatment is a significant asset, as family involvement can improve outcomes in bipolar disorder management. Family-focused therapy (FFT) has been shown to reduce relapse rates by educating families about the illness, enhancing communication, and addressing interpersonal conflicts (Miklowitz et al., 2003). Given Gary’s parents’ shock at the diagnosis, psychoeducation within FFT could help them understand bipolar disorder’s biological and environmental underpinnings, reducing stigma and fostering a supportive home environment. However, involvement must be carefully managed to avoid over-dependence or conflict, particularly if Gary perceives their input as intrusive. Striking a balance between support and autonomy is thus critical.
Conclusion
In summary, Gary’s case illustrates the multifaceted nature of bipolar disorder, encompassing manic and depressive episodes alongside a history of anxiety. Adjunctive psychotherapy, particularly CBT, offers valuable tools for managing distorted thinking and enhancing treatment adherence, although challenges such as irritability must be addressed. Family involvement, through approaches like FFT, further supports recovery by fostering understanding and communication, provided it respects Gary’s need for autonomy. The implications of this case highlight the need for integrated, personalised treatment plans that combine pharmacological and psychological interventions while leveraging family support. Future research should explore how best to tailor psychotherapy to young adults like Gary, ensuring both efficacy and engagement in long-term care.
References
- American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
- Geddes, J.R. and Miklowitz, D.J. (2013) Treatment of bipolar disorder. The Lancet, 381(9878), pp. 1672-1682.
- Goodwin, F.K. and Jamison, K.R. (2007) Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression (2nd ed.). Oxford University Press.
- Lam, D.H., Jones, S.H. and Hayward, P. (2009) Cognitive Therapy for Bipolar Disorder: A Therapist’s Guide to Concepts, Methods and Practice (2nd ed.). Wiley-Blackwell.
- Miklowitz, D.J. and Cicchetti, D. (2010) Toward a life span developmental psychopathology perspective on bipolar disorder. Development and Psychopathology, 22(4), pp. 935-948.
- Miklowitz, D.J., George, E.L., Richards, J.A., Simoneau, T.L. and Suddath, R.L. (2003) A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Archives of General Psychiatry, 60(9), pp. 904-912.
- Scott, J., Paykel, E., Morriss, R., Bentall, R., Kinderman, P., Johnson, T., Abbott, R. and Hayhurst, H. (2006) Cognitive-behavioural therapy for severe and recurrent bipolar disorders: Randomised controlled trial. The British Journal of Psychiatry, 188(4), pp. 313-320.
