Mental health articles

OF mental health care and mentally ill

Case study: first onset of bipolar disorder

Case study: Mark – a 24-year-old with first onset of bipolar disorder. Mark was a final-year medical student when he experienced his first and, to date, only episode of mania. He was 24 years of age and was studying for his f inal examinations. As Mark approached his finals, he began working longer and longer hours on his revision while sleeping less and less. He had always been a confident person but he began to feel that he could accomplish anything. He had no concerns about his forthcoming examinations or the other final-year work that he had to complete. He also began to have periods where he was not sleeping for several days at a time. His friends began to notice that his speech was pressured and the content of his conversation became less and less rational and based in reality.

Although Mark felt that he was doing ‘the best work of his life’ his tutors began to express concern about his falling academic standard. He submitted several essays which were overlength, inadequately referenced, rambling and which contained many factual errors. When Mark was confronted with this work he became angry and blamed the markers for not appreciating his ‘special knowledge’. Soon after this confrontation on a Friday night after spending an evening drinking with his friends Mark was arrested by the police after becoming involved in a fight in a pub. While in police custody the custody sergeant became concerned at Mark’s behaviour as he was constantly pacing his cell showing aggression towards police officers and speaking, or rather babbling, incoherently at a very fast pace. The content of his speech was almost nonsensical. The custody sergeant was not sure that Mark had understood the charge against him, and so notified the police surgeon. The police surgeon was concerned about Mark’s psychiatric condition and called the on-call psychiatrist who arranged for Mark to be transferred to the local psychiatric acute admissions unit. When Mark stated that he did not wish to go and that he wanted to be either set free or to be retained in custody it was decided to admit him to hospital under Section 2 of the Mental Health Act . Mark was treated with a mood stabilizer (lithium) and gradually his mood began to become less manic and less thought disordered. However, Mark’s mood drifted over a period of a month from mania to a severe depression with suicidal thoughts. He was then treated with an anti-depressant SSRI (fluoxetine) while the lithium was continued.

During this time the magistrates’ court gave Mark a conditional discharge. Mark’s mood lifted and after seven weeks in hospital his mood had stabilized to the extent where it was felt that he could be discharged to stay with his parents. Mark received community support from a community psychiatric nurse while he was staying at his parents’ home. Mark was finally judged as fit to continue his medical career and he returned to university to repeat his final year. During this time he continued to take lithium and eventually graduated.

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