III. Psychodynamics. ( Please use a separate sheet for the graphical illustration.
Tabular Presentation of Predisposing Factors and Precipitating Factors
FACTORS PRESENT
Predisposing Factors
1. Genetics His father has a compulsive
behavior and an history of
assaulting those who do not
share his beliefs. But never
diagnosed with Bipolar
disorder. The chances of
developing bipolar disorder
are increased if a child’s
parents or siblings have the
disorder (NAMI, 2017).
RATIONALE
According to Bhandari M.D.,
the exact cause of bipolar
disorder has yet to be found,
however scientists confirm that
bipolar disorder has a genetic
component, meaning the
disorder can run in families.
Some research suggests that
multiple factors may interact to
produce abnormal function
of brain circuits that results in
bipolar disorder's symptoms
of major depression and
mania. Examples of
environmental factors may
include stress, alcohol or
substance abuse, and lack
of sleep.
First-degree relatives of
people with bipolar disorder
have a sevenfold risk for
developing bipolar disorder
compared with a 1% risk in the
general population. For all
mood disorders, monozygotic
(identical) twins have a
concordance rate (both twins
having the disorder) to to four
times higher than that of
dizygotic (fraternal) twins.
Although heredity is a
significant factor, the
concordance rate for
monozygotic twins is not
100%, so genetics alone do
not account for all mood
disorders (Kelsoe &
Greenwood, 2017).
Adults who have relatives
with the disorder have an
average tenfold increase in
risk of developing the
disorder, according to a 2009
review. Your risk further
increases if the family
member with the condition is
a close relative. That means
if your parent has bipolar
disorder, you have a greater
chance of developing it than
someone whose great aunt
has the condition. Genetic
factors account for about 60
to 80 percent Trusted
Source of the cause of
bipolar disorder. That means
that heredity isn’t the only
cause of bipolar disorder. It
also means that if you have a
family history of the disorder,
you won’t definitely develop
it. Most family members of
someone with bipolar
disorder won’t develop the
condition (Healthline, 2018).

-According to Jayne Leonard

(2019), The exact inheritance
pattern of bipolar disorder is
unclear, but variations in
many genes likely combine to
increase a person’s chance
of developing it. Some
environmental factors also
play a role in triggering its
symptoms.

-According to the National

Institutes of Health
(NIH),some studies indicate
that irregularities in many
genes combine to increase a
person’s chance of bipolar
disorder. The exact way that
this occurs remains unclear.
2. Sex Male Bipolar disorders occurs
almost equally among men
and women. However, young
men early in the course of the
illness are at the higher risk
for suicide especially those
with a history of suicide
attempts, or alcohol abuse as
well as those recently
discharged from the hospital
(Akiskal, 2017).

Bipolar illness in women was

characterised by the
predominance of depression,
as indicated by a depressive
polarity at onset, higher rates
of mixed mania, more
suicidal behaviour, and a
greater number of
temperaments with
depressive propensities. In
contrast, the manic
component was found to
predominate in men. Men
also had an earlier onset of
their illness. Women
displayed more comorbidities
with eating, anxiety, and
endocrine/metabolic
disorders, whereas men were
more comorbid with
alcoholism and other forms of
substance abuse,
neurological, and cancer
disorders (Azorin, 2013).

Men usually present with

manic episodes and have
comorbid drug abuse, while
women usually present with
major depressive episode,
the onset is often later,
comorbidity of physical
pathology is common and
adherence to medication is
greater than in men. In
women who have an earlier
onset of the illness and are
 single, the risk of
nonadherence is higher than
in other groups of women.
There are two time periods
that are very important in
women: pregnancy and
postpartum. Both are critical
periods and a relapse or
recurrence of symptoms at
either stage can have serious
consequences for the woman
and/or her baby. In addition,
the effect of medication on
the fetus is unclear (P Vega,
2021).

-According to Arianna Diflorio

and, Ian Jones (2010), it is
widely perceived that the
reported equal rate of illness
in men and women reflects
no important gender
distinctions. Most studies, but
not all, report an almost equal
gender ratio in the
prevalence of bipolar disorder
but the majority of studies do
report an increased risk in
women of bipolar
II/hypomania, rapid cycling
and mixed episodes.

3. Age The patient is 34 years old. The first manic episode

Although bipolar disorder can generally occurs in a
occur at any age, typically it's person’s teens, 20s, or 30s.
diagnosed in the teenage Currently, debate exists
years or early 20s and 30s. about whether or not some
Symptoms can vary from children diagnosed with
person to person, and attention-deficit/hyperactivity
symptoms may vary over disorder actually have a very
time. early onset of bipolar disorder
(Akiskal, 2017).

Most cases of bipolar

disorder commence when
individuals are aged 15–19
years. The second most
frequent age range
 of onset is 20–24 years.
Some patients diagnosed
with recurrent
major depression may indeed
have bipolar disorder and go
on to develop their first manic
episode when older than 50
years (Medscape, 2019).

According to Stephen Soreff,

MD, (2019), The age of onset
of bipolar disorder varies
greatly. For both BPI and
BPII, the age range is from
childhood to 50 years, with a
mean age of approximately
21 years. Most cases of
bipolar disorder commence
when individuals are aged
15–19 years. The second
most frequent age range of
onset is 20–24 years.

4. Chemical biologic Various theories for the Neurochemical influences of

Imbalances etiology of mood disorders neurotransmitters (chemical
exist. The most recent messengers) focus on
research focuses on serotonin and norepinephrine
chemical biologic imbalances as the two major biogenic
as the cause. Nevertheless, amines implicated in mood
psychosocial stressors and disorders. Serotonin has
interpersonal events appear many roles in behavior:
to trigger certain mood, activity,
physiological and chemical aggressiveness and
changes in the brain, which irritability, cognition, pain
significantly alter the balance biorhythms, and
of neurotransmitters (Akiskal, neuroendocrine processes
2017). (i.e, growth hormone, corticits
of serotonin, and prolactin
levels are abnormal in
depression). Deficits of
serotonin, its precursor
tryptophan, or a metabolite
(5-hydroxyindole acetic acid)
of serotonin found in the
blood or cerebrospinal fluid
occur in people with
depression. Positron
emission tomography
demonstrates reduced
 metabolism in the prefrontal
cortex, which may promote
depression (Akiskal, 2017).

Dysregulation of
acetylcholine and dopamine
is also being studied in
relation to mood disorders.
Cholinergic drugs alter mood,
sleep, neuroendocrine
function, and the
electroencephalographic
pattern; therefore,
acetylcholine seems to be
implicated in depression and
mania. The neurotransmitter
problem may not be as
simple as underproduction or
depletion through overuse
during stress. Changes in the
sensitivity as well as the
number of receptors are
being evaluated for their roles
in mood disorders (Thase,
2017).
.

5. Neuroendocrine Influences Hormonal Endocrine Hormonal fluctuations are

Influences being studied in relation to
depression. Mood
disturbances have been
documented in people with
endocrine disorders, such as
those of the thyroid, adrenal,
parathyroid, and pituitary
glands. Elevated
glucocorticoids activity is
associated with the stress
response, and evidence of
increased cortisol secretion is
apparent in about 40% of
clients with depression, with
the highest rates found
among older clients.
Postpartum hormone
alterations precipitate mood
disorders such as postpartum
depression and psychosis.
 About 5% to 10% of people
with depression have thyroid
dysfunction, notably an
elevated thyroid-stimulating
hormone. This problem must
be corrected with thyroid
treatment, or treatment for
the mood disorder is
adversely affected (Thase,
2017).

Precipitating Factors

1. Substance Abuse The client doesn’t have any According to Rowland and
history of substance abuse.  Marwaha, Substance
dependence was associated
with higher odds of mood
disorders than was abuse;
among the specific mood
disorders, the increased odds
of developing bipolar were
particularly high among
individuals with drug
dependence.

Drug abuse might trigger

bipolar disorder. An
estimated 60 percent of
individuals with bipolar
disorder are dependent on
drugs or alcohol. People with
seasonal depression or
anxiety disorders may also
be at risk for developing
bipolar disorder (Herndon,
2018).

According to Smith PhD.,

people who abuse drugs or
alcohol are also at risk for
developing bipolar disorder.
Substance use doesn’t cause
the disorder, but it can make
mood episodes worse or
hasten the onset of
symptoms. Sometimes
medications can also trigger
the onset of a manic or
depressive

2. Negative Life Events and
Stressful Environment
He is a former high school
teacher who flipped out and
became violent after
discovering his wife was in
the shower with another man.
He has lost everything he
owns, including his home,
job, and wife. After serving
eight months in a state
institution as part of a plea
bargain. When he moves in
with his parents, everything
seems to have changed: no
one will talk to him about his
wife; his former friends have
children; the Philadelphia
Eagles keep losing, making
his father irritable; and his
episode. However, because
substance use can trigger
psychosis, a person may
have to detox from
substances before a doctor
can give them a diagnosis of
bipolar disorder.
According to Jeffrey
Juergens (2021). Frequent
drug use causes physical
changes in the brain. The
most obvious change is to
the brain reward system,
which makes using drugs feel
pleasurable. However,
changes in the brain reward
system lead to compulsive,
drug-seeking behavior. Drugs
can rewire other parts of the
brain that affect mood and
behavior. Drug abuse and
addiction can cause changes
in the brain that lead to
bipolar disorder.Even people
who were mentally healthy
before their addiction can
develop bipolar disorder.
According to Smith PhD.,
people who experience
traumatic events are at
higher risk for developing
bipolar disorder. Childhood
factors such as sexual or
physical abuse, neglect, the
death of a parent, or other
traumatic events can
increase the risk of bipolar
disorder later in life. Highly
stressful events such as
losing a job, moving to a new
place, or experiencing a
death in the family can also
trigger manic or depressive
episodes. Lack of sleep can
also increase risk of a manic
new therapist appears to episode.
encourage infidelity as a form
of therapy.
Negative life events were
significantly associated with
both subsequent severity of
mania and depressive
symptoms and functional
impairment, whereas positive
life events only preceded
functional impairment due to
manic symptoms and mania
severity. These associations
were significantly stronger in
BD I patients compared to
BD II patients. For the
opposite temporal direction
(life events as a result of
mood/functional impairment),
we found that mania
symptoms preceded the
occurrence of positive life
events and depressive
symptoms preceded negative
life events (Koenders, 2014).

Sometimes a stressful event

or major life change triggers
a person’s bipolar disorder.
Examples of possible triggers
include the onset of a
medical problem or the loss
of a loved one. This kind of
event can bring about a
manic or depressive episode
in people with bipolar
disorder (Herndon, 2018).

According to John L. Beyer,

MD, Maragatha Kuchibhatla,
PhD, Frederick Cassidy, MD,
and K Ranga R Krishnan, MD
(2009), found that negative
Stressful life events are much
more frequent in patients with
bipolar disorder than controls.
This is consistent with much
of the literature in multi-aged
bipolar subjects.

Stressful life events can

trigger bipolar disorder in
someone with a genetic
vulnerability. These events
tend to involve drastic or
sudden changes—either
good or bad—such as getting
married, going away to
college, losing a loved one,
getting fired, or moving
(Melinda Smith, M.A. and
Jeanne Segal, Ph.D., 2020).

Johnson and Roberts

(1995), indicated that life
stress appears to exert an
important effect on the
course of bipolar illness.

In an experimental study,
Milkowitz and Goldstein
demonstrated that high
expressed emotion (critical,
hostile, or emotionally over-
involved attitudes) among the
relatives of patients suffering
from bipolar disease are
associated with high rates of
patients sufferring from a
relapse (Miklowitz et
al. 1988).
 BIOLOGICAL PSYCHOLOGICAL ENVIRONMENTAL

PRENATA INFANC TODDL PRESCH SCHOOL ADOLESCE YOUNG INTERN EXTERNA

L Y ER OOL AGE NCE ADULTHO AL L
OD
-Patient’s -Just Same as Inference Inference: -the client -Trauma
1. Genetics Inference: primary like the : is a former -Low or
-His father, is a -According caregiver during previous The high self stressful
full-fledged to was his his phases of Erikson's adolescent school esteem life
Philadelphia Mcfarland, biological prenata his life, fourth mind is teacher events.
Eagles fan with prenatal parents. l, when the psychoso essentially a who Inferenc
full-fledged rituals disturbance When infancy client was cial crisis, mind or flipped out e: Inference
and a history of s during the asked if and asked involving moratorium, and :
game-day third he was toddler about his industry a became Accordin
outbursts that trimester of being stage, preschool (compete psychosocial violent g to
have gotten him pregnancy breastfed the stage, he nce) vs. stage after Erkson, Environm
kicked out of the causing by his client doesn’t Inferiority between discoverin he views
ental
stadium; abnormality mom, the doesn’t have any occurs childhood g his wife individu
assaulting those in the brain client have idea during and was in the al as an factors:
who do not share structure doesn’t any about it at childhood adulthood, shower optimisti
his beliefs. His have any idea all. between and between with c one in Life
and
manic bouts are functioning idea about the ages the morality another the events,
mirrored by his related to about the Inference of five and learned by man.  sense
father’s obsessive- stress or what had things : twelve. the child, that he such as
compulsive viral happene that and the - At his demonst abuse,
disorder, which infection d during happen Initiative According ethics to be therapist's rates
he's managed to and his ed versus to developed office, Pat that mental str
conceal as complicatio infancy during guilt is the Erikson, It by the adult loses it in each ess, a
fanatical n at delivery stage. he was third is at this (Erikson, the waiting phase of
Philadelphia such as at this stage of stage that 1963, p. room when growth “significan
Eagles hemorrhage Inferenc phase Erik the child’s 245). he hears has its
t loss,” or
enthusiasm (The can e: of his Erikson's peer the song strength
team will lose if predispose Accordin life. But theory of group will The fifth played at as well another
the remote is an g to Erik one psychoso gain stage of Erik his as its
traumatic
moved), as he individual at Erikson, thing cial greater Erikson's wedding. weakne
believed. developing the he was developm significan theory of sses
future central sure of ent. ce and psychosocial and that
mental crisis at is that, During the will development -He wakes dailures event,
Inference: disorder. this stage he was initiative become a is identity vs. his parents at one
may
Biological traits: is trust depend versus major role in the stage of
Research According versus ed on guilt source of confusion, middle of develop trigger an
suggests that to mistrust. his stage, the child’s and it occurs the night ment
imbalances in Antaiotong, This mother children self- during can be initial
with a rant
neurotransmitters the child stage on assert esteem. adolescence against the rectified episode in
or hormones that still needs begins at doing themselve The child , from about depressing by
affect the brain to be birth and his s more now feels 12-18 years. success a
ending of
may play a role reassured lasts until activitie frequently the need During this Ernest es at susceptibl
(Newman, 2020). by the the child s of through to win stage, Hemingwa later
caregiver’s is around daily directing approval adolescents y's novel A stages e person
encourage 18 living play and by search for a Farewell to (Sigmun (Newman,
ment and months such as other demonstr sense of self Arms, his d Freud)
applause old. taking a social ating and personal parents low self 2020).
Many studies of for steps Accordin bath, interaction specific identity, realize he esteem
bipolar patients and taken by g to clothing . competen through an is very is the
their relatives have the child Erikson, and cies that intense unstable. result of -
shown that bipolar towards it is the toileting According are exploration an
According
disorder sometimes independen most . to Erik valued by of personal unachie
runs in families. ce. important Erikson, society values, ved to Lex et
Perhaps the most period of Inferen success and begin beliefs, and - His develop
al.,
convincing data child's ce: leads to to develop goals. therapist mental
come from twin life, as it Erikson feelings of a sense of has task. Patients
studies. In studies shapes ’s autonomy pride in Erikson diagnosed
of identical twins, their view theory , failure their claims that with
him as
scientists report of the builds results in accomplis the suffering bipolar
that if one identical world as sequen feelings of hments. If adolescent from bi-
twin has bipolar well as tially shame children may feel reported
polar
disorder, the other their upon and are uncomfortabl disorder more life
twin has a greater overall the doubt. encourag e about their and wants
chance of personali precedi This stage ed and body for a events
him to
developing bipolar ty. ng occurs reinforced while until return to before
disorder than stages during for their they can his meds.
relapse
another sibling in Erikson and the presc initiative, adapt and
the family. believed also hool years they begin “grow into” -the client
Researchers that early prepare , between to feel the changes. thinks he compared
conclude that the patterns s the the ages industriou Success in can get
with
lifetime chance of of trust way for of three s this stage better
an identical twin (of help the and five. (compete will lead to through euthymic
a bipolar twin) to children develop The child nt) and the virtue exercise
also develop build a mental begins to feel of fidelity. and phases;
bipolar disorder is strong phases assert confident Fidelity positive they also
about 40% to 70% base of which control in their involves thinking.
(WebMD, 2018). trust follow. and ability to being able to He's experienc
that's Accordi power achieve commit determined ed more
crucial ng to over their goals. If one's self to to get back -
In more studies at life events
for their Erikson environm this others on together Genetic
Johns Hopkins social , ent by initiative is the basis of with his s relative to
University, and people planning not accepting wife, -
emotiona at activities, encourag others, even despite the Chemic healthy
researchers
l every accomplis ed, if it is when there fact that al
interviewed all first- individuals
develop stage hing tasks restricted may be she has imbalan
degree relatives of ment. If a experie and facing by ideological taken out a ce in the and to
patients with child nce a challenge parents or differences. restraining brain
physically
successf conflict s. teacher, order and (brain
bipolar I and bipolar ully which then the he can't structure ill
II disorder and develops acts as According child get within and
trust, a to Bee begins to According to 500 feet of function patients;
concluded that Bee (1992),
they will turning (1992), it feel her. of the no
bipolar II disorder feel safe point in is a “time inferiour, what should brain)
was the most and the of vigor of doubting happen at significant
secure in course action and his own the end of Inference: Inferenc
common affective this stage is difference
the of their of abilities e:
disorder in both world. develop behaviors and “a Biologically in the
family sets. The You're ment. that the therefore reintegrated and When
sense of number of
researchers found essentiall Erikson parents may not psychologi someon
y shaping believe may see reach his self, of what cally, e life events
that 40% of the 47 their d these as or her one wants to young develop
do or be, was found
first-degree personali conflict aggressiv potential. adulthood s bipolar
and of one’s
 ty and s e." If the child appropriate is disorder,
determini centre cannot sex role”. fundament it usually
relatives of the During
ng how on an develop During this ally a starts comparing
bipolar II patients they will individu this period the stage the period of when
the bipolar to
also had bipolar II view the al’s specific body image maturation they're
world. On ability primary skill they of the and in late
disorder; 22% of unipolar
the other to feature feel adolescent change, adolesc
the 219 first-degree hand, develop involves society is changes. although ence or depressio
relatives of the Mistrust a the child demandin the degree young n and
can psychol regularly g (e.g., If the child of change adulthoo
bipolar I patients interacting schizophr
cause ogical being develops may seem d.
had bipolar II children quality with other athletic) identity he less Rarely,
children at enia.
disorder. However, to or a then they has striking it can
become failure school. may confident than the happen
among patients Central to
fearful, to develop a sense of changes earlier in -
with bipolar II, confused develop this stage sense of self, that childhoo
researchers found , and that is play, as Inferiority. emotional occurred d. According
anxious, quality. it provides stability and during Bipolar
only one relative children Some to Kessing
all of At such testing out childhood disorder
with bipolar I which momen with the failure adult roles if and can run et al.,
disorder. They make it ts, opportunit may be failed to adolescen in
y to necessary Suicide of
concluded that difficult to there is develop the ce. As just families
form rich explore so that adolescent one (WebM a mother
bipolar II is the healthy potenti their the child would have example, D,
interperso can or of a
most prevalent relations al a feeling of the 2020).
hips. for pers nal skills develop confusin and physical
diagnosis of sibling
This, in onal through some alienation changes of Bipolar
relatives in both turn, can growth  initiating modesty. (Keltner, the disorder was
bipolar I and bipolar lead to but also activities. Again, a 2007). transition is widely associate
poor soci some balance from believed
II families. between d with
al potenti Erikson childhood to be the
support, al risk Once competen claims that into result of
ce and increased
2. Biological isolation, of children In response adolescen chemica
and loneli failure. reach the modesty to role ce are l risk of first
differences. Peopl
ness. preschool is confusion transforma imbalan
e with bipolar necessary psychiatri
Autono stage or identity tive, with ces in
disorder appear to . Success c
 Infants my (ages 3–6 in this crisis, an bodies the
whose versus years), stage will adolescent growing in brain.
have physical
needs shame they are lead to may begin to dramatic The admission
changes in their arise, and capable of the virtue experiment bursts and chemica
with
brains. The come to doubt is initiating of compe with different taking on ls
significance of view the the activities tence. lifestyles secondary responsi mania/mix
world as second and (e.g., work, sex ble for
these changes is a safe stage asserting education or characteris controlli ed
still uncertain but place of control The latest political tics as ng the episode;
may eventually and Erik Eri over their review by activities). puberty brain's
people kson's world unfolds. As function death of a
help pinpoint Aas et al. Also
as helpful stages  through was young s are relative by
causes and of social pressuring people called
published someone
dependa psycho interaction move from neurotra other
(Mayoclinic, 2021). in January into an
ble. social s and 2016. The adolescen nsmitter causes
The most develop play. identity can ce into s, and
most result in
Inference: fundame ment. According adulthood, include was not
relevant rebellion in
ntal This to findings of physical noradre
the form of associate
Experts stage in stage Erikson, this changes naline,
life occurs preschool establishing continue to serotoni d with
believe bipolar review a negative
begins in betwee children are: occur, but n and
disorder is partly identity, and increased
the first n the must Childhood they are dopamin
stage of ages of resolve in addition to more e. risk of
caused by an trauma this feeling
Erik- 18 the task influences gradual. There's
underlying problem Erikson’s months of initiativ of Individuals some admission
the unhappiness
with theory of to e vs. clinical begin the evidenc ; recent
psychoso around guilt.By . steady e that if
specific brain circuit course by
cial age 2 learning weight there's unemploy
s and the leading to
develop or 3 to plan an earlier gain that an ment,
functioning ment. years. and age of In will imbalan
This Accordi achieve adolescence characteriz ce in the divorce, or
of brain chemicals onset. It
occurs ng goals also (ages 12– e levels of marriage
called 18), children
between to Erik while increases adulthood, 1 or
neurotransmitters. 1 year of son, ch interacting face the task but these more also
the
Three brain chemic age.An ildren  with likelihood of identity changes neurotra showed
infant is at this others, of a rapid vs. role are not as nsmitter
als --
 strongly stage preschool cycling confusion. A discontinu s, a
depende are children course, ccording to ous as person
norepinephrine
nt,develo focused can the Erikson, an they are at may moderate
(noradrenaline), ping trust on master occurrenc adolescent’s the develop
effects.
serotonin, and is solely develop this task. e of main task is beginning some
dopamine -- are based on ing a Initiative, psychotic developing a of sympto
the greater a sense of features, sense of adolescen ms of
involved in cargiver’s sense ambition the self. ce (Cole, bipolar According
both brain and ability to of self- and number of Adolescents 2003; Zag disorder. to
bodily functions. quality to control. responsibi lifetime struggle with orsky and For
provide lity, mood questions Smith, example Koenders
Norepinephrine and meet Accordi occurs episodes, such as 2011). , there's et al.,
and serotonin have the ng to when the risk of “Who am I?” evidenc
needs. Erikson parents suicide and “What Intimacy e that Negative
been consistently
Failure to , self allow a ideation do I want to versus episode life events
linked to psychiatric develop control child to and do with my isolation is s of
mood disorders trust will and self explore attempts, life?” Along the sixth mania were
such result in confide within and the way, stage of may significantl
fear and nce limits and substance most Erik occur
as depression and a belief begin then misuse. adolescents Erikson's when y
bipolar disorder. that the to support Gender try on many theory of levels of
associate
Nerve pathways world is develop the child’s issues different psychosoci noradre
inconsist atthis choice. have selves to al naline d with
within areas of ent and stage. These been see which developme are too
subseque
the brain that unpredict Childre children found as ones fit; they nt. This high,
regulate pleasure able. n can will well. explore stage and nt severity
No child do develop Females various roles takes episode
and emotional is going more self- with and place s of of mania
reward are to on their confidenc bipolar ideas, set go during depressi and
regulated by develop own. e and feel disorder als, and young on may
a sense Toilet a sense of reported attempt to adulthood be the depressiv
dopamine. of 100% training purpose. childhood discover between result of e
Disruption of trust or is the Those trauma their “adult” the ages of noradre
100% mostim who are more selves. approximat naline symptoms
circuits that
doubt. portant unsucces frequently Adolescents ely 18 to levels and
communicate using Erikson event sful at this and had a who are 40 yrs. becomin
functional
 believed at this stage— stronger successful at During this g too
that stage. with their associatio this stage stage, the low
dopamine in other
successf They initiative n with a have a major (NHS, impairmen
brain areas ul also misfiring more strong sense conflict 2019).
t, whereas
appears connected develop begin or stifled severe of identity centers on
to psychosis and s ment was to feed by over- clinical and are able forming Brain positive
all about and controlling course to remain intimate, scans
chizophrenia, a striking a dress parents— (i.e. rapid true to their loving cannot life events
severe mental balance themsel may cycling, beliefs and relationshi diagnos only
disorder between ves.Thi develop early age values in the ps with e bipolar
the two s is feelings of of onset, face other disorder, preceded
characterized by opposing how the guilt. suicide of problemsa people. yet functional
distortions in reality sides. toddler attempts, nd other research
Nina’s strives and more people’s According ers have impairmen
and illogical
infancy for depressiv perspectives to Erikson, identifie t due to
thought patterns years autono e . When During this d subtle
and behaviors was not my. It is episodes). adolescents stage, we differenc manic
(Bhandari, 2021). stated essenti are begin to es in the symptoms
nor al for apathetic, do share average
describe parents During the not make a ourselves size or and mania
d. not elementar conscious more activatio
y school severity;
3. Chemical However, tobe search for intimately n of
tracing overpro stage identity, or with some for the
biologic
back her tective (ages 6– are others. We brain
Imbalances opposite
symptom at this 12), pressured to explore structure
- Various theories
s of stage. children conform to relationshi s in
for the etiology of temporal
obsessiv A face the their parents’ ps leading people
mood disorders
e parent's task ideas for the toward with direction,
exist. The most
compulsi level of of industr future, they longer- bipolar
recent research mania
ve protecti y vs. may develop term disorder
focuses on
behavior, veness inferiority.  a weak commitme (NAMI, symptoms
chemical biologic
research willinflu Children sense of self nts with 2017).
imbalances as the preceded
ers found ence begin to and someone
cause.
out that the compare experience other than the
Nevertheless,
One of child's themselve role a family
psychosocial occurrenc
the ability s with confusion. member.
stressors and
their
interpersonal potential to peers to They will be Successful
events appear to causes achieve see how unsure of completion
trigger certain that has autono they their identity of this e of
physiological and been the my. If a measure and stage can
positive
chemical changes focus of parent up. They confused result in
in the brain, which recent is either about the happy life
significantly alter research notreinf develop a future. relationshi
the balance of in the orcing, sense of Teenagers ps and a events,
neurotransmitters field the pride and who struggle sense of and
(Akiskal, 2017). is childho child accomplis to adopt a commitme
od will feel hment in positive role nt, safety, depressiv
trauma. shamef their will likely and care e
INFERENCE: Erik ul and schoolwor struggle to within a
Erikson will k, sports, “find” relationshi symptoms
Neurochemical highlighte learn to social themselves p. preceded
influences of d the doubt activities, as adults.
neurotransmitters possible his or and family Avoiding negative
(chemical result of herabilit life, or intimacy,
fearing life
messengers) unmet ies. they feel
focus on serotonin needs in "Erikso inferior commitme events.
and this area n and nt and
norepinephrine as as believe inadequat relationshi
the two major mistrusT. s that e because ps can
biogenic amines Nina’s children they feel lead to
implicated in mood records who that they isolation,
disorders. regarding experie don’t loneliness,
Serotonin has her nce too measure and
many roles in toddler much up. If sometimes
behavior: mood, stage is doubt children depression
activity, not given at this do not . Success
aggressiveness nor stage learn to in this
and irritability, stated. will lack get along stage will
cognition, pain Nonethel confide with lead to the
biorhythms, and ess, we nce in others or virtue
neuroendocrine can still their have of love.
processes (i.e, trace powers negative “Through
growth hormone, back her later in experienc the lens of
corticits of past life"(Wo es at a
serotonin, and using the olfolk, home or psychosoci
prolactin levels are behavior 1987). with al
abnormal in that she peers, an developme
depression). manifest As inferiority nt theory, it
Deficits of ed. Nina toddler complex is clear
serotonin, its apparentl s (ages might that the
precursor y 1–3 develop ability to
tryptophan, or a demonstr years) into adole form
metabolite (5- ated begin scence an intimate
hydroxyindole disobedie to d relationshi
acetic acid) of nce to explore adulthood ps is
serotonin found in her their . largely
the blood or mother. world, dependent
cerebrospinal fluid An hour they upon
occur in people before learn healthy
with depression. her final that emotional
Positron emission performa they and mental
tomography nce, her can developme
demonstrates mother control nt
reduced instructe their throughout
metabolism in the d her to actions life,” says
prefrontal cortex, take a and act clinical
which may rest and on their psychologi
promote not environ st Carla
depression compete ment to Marie
(Akiskal, 2017). because get Manly,
she is not results. PhD,
feeling They author
Dysregulation of well and begin of Joy
acetylcholine and her role to show From Fear.
dopamine is also in playing clear “If an
being studied in Black prefere individual
relation to mood Swan nces encounters
disorders. have for psychosoci
Cholinergic drugs completel certain al
alter mood, sleep, y elemen blockages,
neuroendocrine destroye ts of the ability
function, and the d her. the to form
electroencephalog Nina did environ lasting
raphic pattern; not listen ment, intimate
therefore, to her such as relationshi
acetylcholine mother. food, ps will be
seems to be She toys, negatively
implicated in refused and impacted.”
depression and to follow clothing an
mania. The and .A adolescent
neurotransmitter believed toddler’ might
problem may not it. In the s main experience
be as simple as same task is feelings of
underproduction or way, to betrayal
depletion through Nina resolve following
overuse during might the a platonic
stress. Changes in have issue relationshi
the sensitivity as develope of auto p or friend
well as the number da nomy breakup.
of receptors are childhood vs. Ruptures
being evaluated trauma shame of this type
for their roles in during and can lead to
mood disorders these doubt b feelings of
(Thase, 2017). years y anxiety, a
that working fear of
4. Neuroendocrine leads to to attachment
Influences her establis , and a
disobedie h bent
Inference: nce indepe toward
occurring ndence self-
Hormonal in her . This is isolation.
fluctuations are young the “me
being studied in adult do it” People in
relation to years. All stage. early
adulthood
depression. Mood these For (20s
disturbances have childhood exampl through
been documented experien e, we early 40s)
in people with ces have might are
endocrine connectio observ concerned
disorders, such as n to the ea with intima
those of the following buddin cy vs.
thyroid, adrenal, stages. g sense isolation. A
parathyroid, and of fter we
pituitary glands. autono have
Elevated my in a developed
glucocorticoids 2-year- a sense of
activity is old self in
associated with child adolescen
the stress who ce, we are
response, and wants ready to
evidence of to share our
increased cortisol choose life with
secretion is her others.
apparent in about clothes However, if
40% of clients with and other
depression, with dress stages
the highest rates herself. have not
found among older Althoug been
clients. h her successfull
Postpartum outfits y resolved,
hormone might young
alterations not be adults may
precipitate mood appropr have
disorders such as iate for trouble
postpartum the developing
depression and situatio and
psychosis. About n, her maintainin
5% to 10% of input in g
people with such successful
depression have basic relationshi
thyroid decisio ps with
dysfunction, ns has others.
notably an an Erikson
elevated thyroid- effect said that
stimulating on her we must
hormone. This sense have a
problem must be of strong
corrected with indepe sense of
thyroid treatment, ndence self before
or treatment for . If we can
the mood disorder denied develop
is adversely the successful
affected (Thase, opportu intimate
2017). nity to relationshi
act on ps. Adults
her who do not
environ develop a
ment, positive sel
she f-concept i
may n
begin adolescen
to ce may
doubt experience
her feelings of
abilities loneliness
, which and
could emotional
lead to isolation.
low self
-
esteem  In
and particular,
feelings adolescent
of s are faced
shame. with the
task of
individuatin
g from
their
parents
while
maintainin
g family
connected
ness to
facilitate
the
developme
nt of the
identities
they will
take into
adulthood.
At the
same time,
the
overactive
motivation
al/emotion
al system
of their
brain can
contribute
to
suboptimal
decision
making
(Crosnoe
and
Johnson,
2011). As
a result,
many
adolescent
s tend to
be strongly
oriented
toward and
sensitive to
peers,
responsive
to their
immediate
environme
nts, limited
in self-
control,
and
disinclined
to focus on
long-term
consequen
ces, all of
which lead
to
compromis
ed
decision-
making
skills in
emotionall
y charged
situations
(Galván et
al.,
2006; Stei
nberg et
al., 2008). 
 Resolution: Resolution: Resolutio Resolut Resolutio Resolutio Resolution: Resolution: Resoluti Resolutio
Vulnerability to Intra- n: ion: n: Guilt n: Role Isolation on: Low n:Frustrati
develop illness psychic Mistrust shame Inferiority Confusion self on
Trauma and esteem
doubt

Vulnerability to Intra-psychic Mistrust Shame and Guilt Inferiority Role Confusion Isolation Confusion and Frustration
develop illness Trauma Doubt

Weakened Ego Low Self Esteem

State of Equilibrium Precipitating Factors

State of Disequilibrium

Balancing Factors CRISIS

IV. Crisis Intervention
PREDISPOSING FACTORS
 Age: 36yrs old
 Sex: Male
 Genetics
 Chemical biologic Imbalances
STATE OF DISEQUILIBRIUM
Perception of Events
Positive Perception
He viewed the event positively, he
has a fresh viewpoint on life: he
tries to find the silver linings in
everything he encounters. Pat's
new hopeful view is based on
the Latin term "Excelsior," which
means "always higher" or "ever
upward." Meanwhile, Pat suffers
from a series of panic attacks in
his new life, culminating in a
violent reaction to Ernest
Hemingway's A Farewell to
Arms, which he tosses into the
yard, shattering his bedroom
window in the process.
He's feeling better, or so he
thinks, and he's eager to get
back to real life, although his
hopes for that life are
stupendously unrealistic. He
believes he can rebuild his
marriage, even though his
estranged wife has taken out a
restraining order against him.
(His discovery of her
extramarital affair instigated the
act of violence that got him put
away in the first place.)
PRECIPITATING FACTORS
 life events, trauma and stressful environment
BALANCING FACTORS
Situational Support
Actual:
Family support and friends
was there, however when he
moves in with his parents,
everything seems to change:
no one wants to talk to him
about his wife; his old friends
have families; the Philadelphia
Eagles keep losing, making his
father grumpy; and his new
therapist appears to
encourage infidelity as a kind
of therapy.
Tiffany Maxwell, a girl with
problems of her own. In their
fragile mental states, Pat Jr.
and Tiffany embark on a
love/hate friendship based
primarily on what help the
other can provide in achieving
their individual goals. But they
may reevaluate their goals as
their relationship progresses.
Coping Mechanism
Actual:
He spends a lot of time
running around the
neighborhood to stay in
shape, wearing a garbage
bag over his clothing to
induce more sweating.
Obsessed with the delusion
that he'll win back his wife
—who, by the way, has
filed a restraining order
against him.
Ideal:
-Mental reframing involves
taking an emotion or
stressor and thinking of it in
a different way. Perfecting
this technique can literally
change your perspective in
tough situations. It takes
time and practice, but you
can get better at doing it if
you practice it.
-If you're feeling upset or
anxious, act in the opposite
way your emotions tell you
to act. Opposite-to-emotion
thinking is how it sounds:
You act in an opposite way
from what your emotions
are telling you to do. If you
can manage it, the results
are incredible.
Ideal:

Being surrounded by people

who are caring and supportive
helps people to see
themselves as better capable
of dealing with the stresses
that life brings. Research has
also shown that having strong
social support in times of crisis
can help reduce the
consequences of trauma-
induced disorders including
PTSD (Amy Morin, 2020).

Research shows that social

support provides important
benefits to our physical and
emotional health. Stress may be
related to a number of health
concerns, from mental health
problems to chronic health
problems like heart disease and
migraines, and mental health.
However, social support can help
protect people from the harmful
effects of stress. When dealing
with a stressful situation, people
are less likely to report stress-
related health problems when
they feel like they have support
from others

According to CMH BC and

Anxiety Canada, many of the
people in your life can provide
social support. These include
your parents, spouse or
partner, children, siblings,
other family members, friends,
co-workers, neighbours, health
professionals, support groups,
and sometimes even
strangers. Receiving support
from the people you are close
to may be more beneficial to
your physical and emotional
health than those you don't
know well.
 CRISIS

 reduced need for sleep (Insomnia)

 Poor appetite
 Talkativeness
 Pressured speech
 Experiencing unusual anger or irritability
 CRISIS INTERVENTIONS (Ideal)
Family therapy for the patient, to educate and
help him find ways to cope with the crisis and
strengthen the patient’s support system.
Specific Interventions:
 Established rapport or good relationship
to the client
 Utilize therapeutic communication
 Promote rest and proper nutrition
 Engaging the client in individual and
group therapy groups
 Providing positive reinforcements for
appropriate behaviors
 Encouraging the client to employ stress
management and relaxation techniques
such as guided imagery, and listening to
relaxing music.
 Establish rapport
 Identify the most important concern
at that moment
 Assess the person’s perception of
the problem
 Facilitate the person’s expression of
emotion
 Recognize the person’s needs
 Implement interventions designed to
address the needs
 Guide the person toward identifying
a plan of action to an acceptable
resolution
(Belleza, 2020)
CRISIS INTERVENTIONS (Actual)
 Significant other provided positive
reinforcement, and assurance
 Prolonged trainings, and a supportive
environment to achieve plans
 Established rapport and good
relationship to the client
 Kept client in calm environment /
lessen environmental stimuli
 Assess the potential for violence and
use safety precautions (e.g., suicide,
homicide, self-destructive behavior)
 Gave acknowledgement and
recognition
 Promoted safety of patient and others
 Provided therapies such as:
o Name Tag Making
o Spin the Wheel
o Self Portrait
o Emotion Thermometer
o Clay Molding
o Colored Cards, Pick Me
o Zumba
o Making of Woven Paper
Bracelet
o Stress Ball Making
o Teaching of Hand Gestures
with Song Lyrics
 CRISIS INTERVENTIONS (Ideal)

 Remove from stimuli. The physical

environment can make a patient feel
threatened and/or vulnerable. Removal
from a noisy environment to a quieter
space helps reduce a patient’s stress
and frustration.
 Set clear limits and expectations. Tell
the patient that injury to self or others
will not be tolerated.
 Minimize provocative behavior. It is
important to remain calm and to speak
in a calm voice. Movements should be
slow, and actions should be announced
prior to initiating them. Avoid touching
the person unless asking permission
first. Posture and behaviors can make a
patient feel threatened and/or
vulnerable, so a calm demeanor and
facial expression should be maintained.
Keep hands visible and unclenched, as
concealed hands might imply a hidden
weapon. Avoid confrontational body
language such as hands on hips, arms
crossed, directly facing the patient, and
continuous eye contact.
 Use concise and simple
language. Agitated patients may be
impaired in their ability to process
information. Repeating the message
and allowing adequate time for the
patient to respond can be helpful.
 Use active-listening skills. Identify
feelings and desires. Listen attentively
 and empathize with the person’s
feelings.
 Collaborate. Use a collaborative
approach with the goal, of helping the
patient calm themself.
 Offer choices and optimism. Realistic
choices aid in empowering the patient
to regain control and feel like a partner
in the process.
 Do not:
o Criticize the patient
o Argue with the patient
o Interrupt the patient
o Respond defensively
o Take the patient’s anger
personally
o Lie to the patient
o Make promises about something
that may not happen (Judith
Swan, MSN, BSN, AND, 2020).