PSYCHODYNAMICS Bipolar 1 Manic Phase with Psychotic Features Predisposing: Genetic Age Sex Family Dynamics Biological Factors

ctors PRENATAL Precipitating: Lifestyle Educational Status Major Life Events Biochemical Influences

Father

Mother

Had an older sister with mental illness

Had a sister with brain cancer and brother with mental illness

Had one previous miscarriage

Defective genes located in chromosome 18 is transmitted is transmitted DNA replication

Emotional stress due to loss of baby

High Risk of acquiring the defective genes

Parents are scared to have the same situation happen to their next baby Uno might got the defective gene because of the degree of penetrance which a gene produces its effects in a specific group of people

Possible fetal abnormalities in the brain

The next pregnancy is pampered with everything to avoid miscarriage

BIRTH

Father

Mother

Husband was present during delivery

Gave birth via Ceasarean Section successfully

Risk of shortage of oxygen

Was able to provide emotional, physical and financial support

Scheduled Ceasarean Section on March1,1988 (before eclipse)

Delays in restoring the oxygen supply by performing a Caesarean

No complication

Brain damage

INFANCY (Birth-1 year) Trust vs. Mistrust

FATHER

MOTHER

Taken Care of Caregivers

Starts to be busy at work

Having another baby boy in the family

Bottle-fed patient since birth

Unsatisfied Oral Phase

Less parental bonding

Less interaction with son

Attention was divided

Less maternal and child bonding

Later fixations on oral channel

Parents did not teach toilet-training

Jealous for his brother starts

Decreased nutrition of infant

Development of Mistrust

Decreased nutrition of infant

Lack level of immunity from milk

Infection

Impaired brain development

TODDLEHOOD (2-3 years) Autonomy vs. shame and doubt

FATHER

MOTHER Less supervision was given because she just gave birth to Peter and just relies on the care giver Prone to falls and accidents and may cause head trauma Trauma damages neurons Shame and Doubt develop

Busy at work

No time for discipline or punishment

Lack of self-control develops

Child becomes disorganize

Possible Impaired brain functioning

PRESCHOOL (3-5 years old) Initiative vs. guilt

Parenting style is lenient No parents that will answer the why questions

Had convulsion

Child is insensitive to norms

Not brought to hospital

Child is tolerated to things he wanted

Needs are dependent to care giver

Cell discharges too much electrical impulse more than what the nerves can carry

The parents and child has no good interpersonal relationship

Muscle begins to contract and relax repeatedly

Guilt develops

Brain and nerve cell damage

SCHOOLAGE (6-12 years old) Industry vs. Inferiority

Initiates games to cousins and uncles

Entered school at 6 years old

Uno forms a close relationship with others

Father is strict in the childrens study habits

Uno and brother studies up to 2:00 am

Industry develops

Uno is a fast learner and a consistent honor student

ADOLESCENCE (13-18 years) Identity vs. Role Confusion

Father loses his job and now starts to compensate with his children

Influenced by friends

Form/Join a Gang

They stole the cable wires on a nearby property Uno feels that no one loves him and that his brother has all the attention of his parents Father heard from neighbors that Uno has been consistently absent in school.

Unable to cope with peer pressure

Caught by the police and was brought in detention Theft Case

Drinks and smoke

Use marijuana

Depression

Normal brain chemistry is altered

Transferred to public school and repeated first year.

Discouraged to study

Addiction to substance

Role Confusion

EARLY ADULTHOOD (19-30 years) Intimacy vs. Isolation

Uno feels that no one loves him

Sexual desire is strong

Tried to end life through drinking muriatic acid and second attempt is overdosing with multivitamins.

Intimacy

Had a girlfriend named Maricel

Maricel got pregnant and gave birth to a baby girl Unemployment

No signs of toxicity occurred

Development of frustration and anxiety

No medical attention given

Hallucination

Starts to talk by him self near the hospital window

Loud, rapid speech CHANGES IN BEHAVIOR Flight of Ideas Hyperactive Consults to specialist at DMSF October 2009

Check-up at DMH February 2010

Become violent when drunk

Admitted to SPMC Psychiatric Ward January 25, 2011 Prompt medical attention given at CIU Bipolar I

IF TREATED Pharmacology Lithium

Act presynaptically on serotonin sending cells

Psychotherapy Chlorpromazine
Antipsychotic Selectively blocks transmission of nerve impulses in the midbrain Blocks acetylcholines action at cholinergic receptor sites in the midbrain Bipolar usually have mood swings Patient is stimulated to express feelings Teaching in which it improves compliance to medications Helps to understand the effects of manic episodes that hurt the patients self-esteem

Family Psychoeducation Support Trust

Biperiden

Counseling

Care

Blocks the serotonin transporter protein in the pineal body (frontal)

Excess serotonin are taken up by the receiving cell

Cell to cell transport in limbic system is obstructed

Restores the brains normal dopamine and acetylcholine balance

Patience Understanding

Normal Level of serotonin

Relaxes muscle tremors Manic phase is controlled

Prevent denial, guilt and selfblame

GOOD PROGNOSIS

IF NOT TREATED Neurotransmitters (Dopamine, Serotonin) will be unstable

Different organ system will be affected Imbalance Serotonin level Serotonin Build up in the body Decreased concentration of serotonin metabolites in the cerebrospinal fluid and brain tissues Change of mood Serotonin stimulates several internal chemical responses Imbalance Dopamine level Dopaminergic neurons of the midbrain increase

Enterochromaffin cells, release much serotonin because it is uncontrolled

Dopamine binds D1 receptors,

Dilating blood vessels

Serotonin in the blood is increased

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Musculoskeletal

Increasing blood flow to renal, mesenteric, and coronary arteries

Vomiting

Depression

Involuntary muscle movement Death

Increase overall renal perfusion

Irritation of GI tract

High Blood Pressure

Suicide

Increase Urine output