BIPOLAR DISORDER Playbook
Nursing 480 Visual Report Created by: Jennifer Blaha Jon Bonner Kristin Donato Kevin Mendoza and
RemBrandt Victa
Introduction Pat Solitano was your average, everyday Joe working during the day and coming home to his newlywed wife at night. He thought he had it all until one dreadful day when he came home early to his beautiful wife cheating on him. This drove Pat into a violent rage that almost cost the unfaithful stranger's life. Pat was soon admitted into a mental institution for his serious actions. After some time, Pat Solitano’s mother, Dolores, conditionally released him from the mental institution, requiring that he move back into his parents’ house, take his scheduled medication, as well as regularly visit with a therapist. Although supportive of their sons road to recovery, tension rose with Pat and Patrizio, Pat’s father, as they had to learn how to live with one another again. Try as she may, Dolores was usually unsuccessful with playing mediator within the family. It wasn’t until Tiffany showed up, a friend of a friend, that Pat Jr. began to change his attitude and learn how to live his new life.
Movie Screencaps. (2012). Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/5/
BIpolar Disorder Family functioning is greatly impacted when one of the family members have bipolar disorder. Bipolar disorder creates dramatic shifts in an individual’s mood and also has the potential to disrupt family relationships and levels of functioning (Kaakinen, DuffGedaly, Hanson, & Coelho, 2015, p. 538). In addition it can adversely affect the individual’s life by creating academic problems, losing jobs, creating relationships problems, leading to legal issues such as restraining orders and even confrontation with the police (Kaakinen et al., 2015, p. 538). It is estimated that bipolar disorder affects 5.7 million American adults, which is roughly 2.6 percent of individuals age 18 and older in the United States population (Townsend, 2014, p. 499).
Bipolar disorder is characterized by mood swings such as extreme depression to euphoria also referred to as mania that affect energy, activity level and the individual’s ability to carry out activities of daily living (NIMH, 2016). It is important to make a distinction between a manic episode and hypomania. A manic episode can be severe enough to require hospitalization to prevent harm to self or others. A person with manic episode has marked impairment when it comes to social activities and occupational functioning (Townsend, 2014, p. 499). Whereas hypomania is a milder form, which does not require hospitalization or cause impairment to occupational functioning or social activities. In order for the depression component to be considered as bipolar instead of a major depressive disorder the individual has to have had at least one manic episode. An individual with bipolar disorder also can have hallucinations or delusions.
the Solitano family Pat Solitano is a 29 year old man that recently separated from his wife after she was caught cheating on him. Pat, unable to control his anger, lashed out and violently attacked the man, almost killing him. Pat was admitted into a mental institution where he hoped to learn how to control his outbursts. After being discharged from the hospital, Pat moved back into his parents house and began working on the next chapter of his life.
Pat Solitano Sr. (Pat’s father), also known as Patrizio, is a 56 year old married man. He has a serious gambling problem and finds himself in sticky situations after betting huge amounts of money. He is an avid football fan and has a dream of opening a restaurant in the near future. Patrizio finds himself getting into petty arguments semi-regularly with his son after he moved back into the house. While supportive of his journey to wellness, the two continue to disagree on lifestyle choices and expect very different things from one another.
Dolores Solitano (Pat’s mother) is a 54 year old stay-at-home mom. She constantly plays mediator between her son and husband and does her best to keep the peace within the household. She is very supportive of her son’s road to recovery and does what she can to help him heal.
Tiffany Maxwell is a 24 year old recovering addict and widow that is mutual friends with one of Pat’s friends. The two meet at a dinner and soon take on a dance competition together. While the two constantly argue and disagree, they also greatly aid in each other's healing process and become a huge support system for one another. Movie Screencaps. (2012). Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/5/
Pat SolitANO Pat Solitano was recently released from a psychiatric hospital that he was sent to after accepting a plea bargain in court. Pat was sent to the psychiatric hospital for eight months after finding his wife cheating on him with her work colleague. This traumatic event sent him into a blind rage that led to almost killing the man. Pat also has a restraining order against him by his estranged wife, which he has attempted to go break several times. Pat found out at the hospital that he had undiagnosed Bipolar Disorder with mood swings, delusions, and weird thinking brought on by severe stress. Pat most likely has Bipolar I Disorder, which is characterized by an individual who has had at least one manic episode or is currently experiencing a manic episode (Townsend, p. 501). He does not see the problem of having a lack of sleep or waking up his parents in the middle of the night to discuss his thoughts on a book or to ask for help with finding his wedding video. Along with this Pat did not want to continue taking his psychiatric drugs because he did not like how they made him feel. Pats behavior caused him to have multiple confrontations with the police due to his erratic behavior. As time progressed Pat began to routinely take his medications and found that exercise and dancing were coping strategies that helped him manage his bipolar symptoms and be able to function on a normal level.
Movie Screencaps. (2012). Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/5/
Pat SolitANO Before his separation, Pat was considered to be in Duvall’s Developmental and Family Life Cycle stage of a married couple; where he and his wife were “establishing their relationship as a married couple, blending their individual needs, developing conflict-and-resolution approaches, communication patterns, and intimacy patterns” (Kaakinen et al., 2015, p. 80). Once Pat realized his wife was unfaithful to him, they separated, and began planning their ultimate divorce. Pat’s move back into his parents’ house fit within the category of a boomerang child, a phrase for returning home, and both mom and dad had to adjust their lives to accommodate their grown son once again living with them (Kaakinen et al., 2015, p.43). Kaakinen et al. (2015) stress that, “families are seen as a system in that what happens at one level has powerful ramifications at other levels of the system” (p. 79). This disequilibrium caused a great amount of stress within the family which challenged the familial roles and structure. The decision to separate and eventually divorce meant that Pat had to accept his own part in the failure of the marriage and adapt to his new life living apart (Kaakinen et al., 2015, p.81). While not easy, it was necessary and the end result was a much happier life than ever imagined.
Movie Screencaps. (2012). Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/5/
Culture and religious traditions The Solitano family is rooted in a culture of sports and gambling. Showing a following of the Philadelphia Eagles, the family engages in betting money on the outcome of an upcoming Philadelphia Eagles game. The Solitano family sees Pat as their good-luck charm and this creates a lot of conflicts. Pat joins his brother for one of the Eagles games, in which his father bet all his money on for the restaurant. Knowing that Pat was a good-luck charm, his father was confident to win, but a fight broke out between Pat and some fans at a tailgate party. The Eagles lose which eventually leads to him losing a sum of the families’ money, and Patrizio, his father, attributes the Eagles loss to the fight.
Movie Screencaps. (2012). Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/5/
Most of the Solitano families’ income stems from the father’s addiction to gambling. Patrizio was laid off from work and lost his pension. In order to fill the financial void that the Solitano family has dealt with, gambling was an easy option for him to take. Ultimately, his goal was to to open a restaurant of his own to provide the family’s source of income.
Culture and religious traditions
Pat is also involved with dance practices with a woman named Tiffany, as a way for him to relieve his stress and ultimately show his estranged wife that he has been doing better both physically and mentally. Whenever Pat was with Tiffany for practices, the Eagles would win. Dance practices affected his family because on the chance that he could be at the Eagles game to be the “good-luck� charm, he can choose to attend dance practices instead.
Movie Screencaps. (2012). Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/5/
Strengths and challenges Strengths for the family in dealing with Pat’s bipolar disorder include establishing a sense of closeness because the family comes together in support for Pat’s return to the household. The family also supports Pat in his dancing endeavors which is seen as an outlet to channel his negative energy into. One challenge the family faces most often is that Pat’s bipolar disorder can arise sporadically. For one instance, when he reads Ernest Hemingway’s novel in his room, he felt a strong connection with the novel and did not like how the novel concluded. Pat punches the window pane, waking up his family in the process and causing a small argument. Another instance in where the family experiences a spontaneous bipolar episode is when Pat’s mother, Dolores, tries to help him find Pat’s wedding video, in which he becomes increasingly frustrated which causes him to elbow his mother inadvertently. This situation led to a police visit with a complaint about a house disturbance, which yet posed another difficulty handling Pat’s bipolar disorder.
Movie Screencaps. (2012). Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/5/
Communication Practices
Movie Screencaps. (2012). Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/5/
Communication practices that the family engages in are conflicting conversation and interpersonal communication. With conflicting conversation, it is mostly driven by the father, with the mother trying to be the mediator of the conversation. However, this conversation is always held face-to-face with the family present, which allows for interpersonal communication at the basic level of human interaction.
Application of Family Theory: Family Assessment and Intervention Model The Family Assessment and Intervention Model views the family unit as a dynamic, open system interacting with the environment. It specifically focuses on what causes the family stress and how they react to the stressor. In addition to identifying the stressors, this model also identifies the family’s strengths to build their problem-solving strategies (Kaakinen et al., 2015).
Kaakinen et al. (2015). Retrieved from Family Health Care Nursing: Theory, Practice, and Research
This model describes families creating a normal range of response to the environment, known as the normal line of defense, which can represent the family’s level of stability. When this flexible line no longer protects the family system against a stressor, the stressor has broken through the normal line of defense. Families also have a line of resistance, which aims to stabilize and return the family to it’s normal line of defense or even a higher level of stability.
Family Assessment and Intervention Model: 3 Family Systems Stressor-Strength Inventory (FS I) Part of this model is the FS3I, an assessment, intervention, and measurement tool to help determine the stressors and strengths of the family. Nurses working with families who are undergoing stressful health events can use this tool to identify the stressors and build on the strengths of the family. Individual family members or the entire family together can complete the FS3I. This tool is divided into three sections: ➢ General family stressors, such as a chronic illness, finances, or housekeeping standards. ➢ Specific family stressors, such as a car accident, family divorce, or birth of the first child. ➢ Family system strengths, such as a supportive extended family, effective communication, or religious faith.
Once information is collected, the qualitative and quantitative data is used to determine the level of prevention and intervention needed. Interventions for FS3I are divided into three sections: ➢ Primary intervention: Focus on health promotion activities by providing families with information about their strengths, support their functioning capabilities, and encourage health with education. ➢ Secondary intervention: Help family handle stressors. find and use appropriate treatment. ➢ Tertiary intervention: Maintain family stability after treatment has been completed.
the Family Assessment and Intervention Model & 3 Family Systems Stressor-Strength Inventory (FS I) with the Solitano Family Essentially, what we want to do is assess the stressors and strengths of the family in order to determine what kind of care, guidance, or assistance they will need. In the case of the Solitano family, we have been able to roughly put together an assessment of the family using the Family Systems Stressor-Strength Inventory and basing what it would like around what we saw in the film. It is as follows:
We first start off with an introduction to the family and their main concern.
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Family Systems Stressor-Strength Inventory (FS I) The following covers Part 1 (General Family Systems Stressors) and Part 2 (Specific Family Systems Stressors)
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Family Systems Stressor-Strength Inventory (FS I) This is a continuation of Part 2 (Specific Family Systems Stressors)
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Family Systems Stressor-Strength Inventory (FS I) This is the final section of Part 2 (Specific Family Systems Stressors)
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Family Systems Stressor-Strength Inventory (FS I) This is Part 3, where it covers the Family Systems Strengths.
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Family Systems Stressor-Strength Inventory (FS I) This is the final section of Part 3 (Family Systems Strengths)
After completing the assessment, you then calculate each of the parts in order to get an average. The average will indicate at what level of stress they are at. It is important to note when using this, you will need to use separate scoring measures for each individual of the family and one from the perspective of the person who is assessing the family. In short, their problems rely on maintaining the health of Pat and making sure he does not relapse back into the mental health facility and being able to manage his Bipolar Disorder.
Family Health Interventions
Based on the findings on the Solitano family’s stressors and their strengths, the interventions are at the tertiary level. Tertiary prevention and intervention focus on maintaining family stability after treatment has been implemented or completed. The main goals of family health interventions for bipolar disorder is to help the individual stabilize and recover from episodes, improve medication adherence with the help of the family, and to ease the stress on the both the individual and the family to improve relationships within the unit.
Movie Screencaps. (2012). Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/5/
Family Health Interventions
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Psychoeducation in addition with pharmacotherapy Pharmacotherapy is treatment through the administration of drugs. For bipolar disorder, medications aim to improve quality of care and enhance positive outcomes and addresses episodes of mania and hypomania. Psychoeducation educates patients about their illness to improve long term outcomes. It empowers the patient by being active in their own health (Bond & Anderson, 2015). Pat Solitano can benefit from psychoeducation in addition with pharmacotherapy because he will have a further understanding of his condition as well as maintaining stability through medication. Pat will be in control of his health and goals. Both psychoeducation and pharmacotherapy can also be effective for preventing relapse, one of the important concerns that the Solitano family has for Pat.
Medical adherence Patients with bipolar disorder have been found to be frequently noncompliant with their medication regimen, almost 50% of people with bipolar disorder have been found to be non-adherent. Reasons for not following treatment include problems with side effects, lack of efficacy in controlling symptoms, or feeling well enough to stop continuing taking medication (Gibson, Brand, Burt, Boden, & Benson, 2013). As with Pat, he had stopped taking his medications for a while because the side effects he was experiencing were not making him feel well. To improve medical adherence, motivational interviewing can be done to discuss personal values and the pros and cons of continuing a specific behavior. A series of open-ended questions guides both the health provider and patient in identifying their values and ways their behavior, such as not taking their medications, are not helping them meet their goals. Motivational interviewing get Pat to to think logically about his behavior and realize that medication noncompliance interferes with achieving his goals and stability (McKenzie & Change, 2015).
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Family focused therapy
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Based on our assessment on the Solitano family, Pat’s bipolar disorder causes a heavy strain on his family members. There is emotional distress and burden relating to the severity of Pat’s bipolar disorder symptoms and having other family members with their own history of mood disorder adds even more distress and burden. Therapy is available for both patients and their families with interventions specialized to a family unit. These types of therapies are similar to psychoeducation, providing family members enhanced skills for managing their loved one’s illness, accepting the limitations caused by the illness, and resolving barriers to providing care (Perlick, Miklowitz, Lopez, Chou, Kalvin, Adzhiashvili, & Aronson, 2010). Family focused therapy will include all members of Pat’s family in his care and management of his bipolar disorder. This will allow for relationships among the family members to improve and create an appropriate support system.
References Bipolar Disorder. (n.d.). Retrieved March 01, 2016, from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml. Bond, K & Anderson, I. (2015). Psychoeducation for relapse prevention in bipolar disorder: A systematic review of efficacy in randomized controlled trials. Bipolar Disorders: An International Journal of Psychiatry and
Neurosciences, 17, 349-362. doi: 10.1111/bdi.12287. Gibson, S., Brand, S., Burt, S., Boden, Z., & Benson, O. (2013). Understanding treatment non-adherence in schoziphrenia and bipolar disorder. BMC Psychiatry 13(153). Retrieved from http://www.medscape. com/viewarticle/808437_5. Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015) Family Health
Care Nursing: Theory, practice and research (5th ed.). F.A. Davis: Philadelphia. McKenzie, K., & Chang, Y. (2015). The effect of nurse-led motivational interviewing on medication adherence in patients with bipolar disorder.
Perspectives In Psychiatric Care, 51(1), 36-44. doi:10.1111/ppc.12060. Mischke, K. B., & Hanson, S. M. ((n.d.)). Family Systems-Strength Inventory. In Midwestern State University. Retrieved March 2, 2016, from http: //faculty.mwsu.edu/nursing/marty.gibson/pdf/familysystemsstressors. pdf Movie Screencaps. (2012). SIlver Linings Playbook. Retrieved from http://movie-screencaps.com/silver-linings-playbook-2012/1/ Perlick, D. A., Miklowitz, D. J., Lopez, N., Chou, J., Kalvin, C., Adzhiashvili, V., & Aronson, A. (2010). Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disorders, 12(6), 627-637. doi:10.1111/j. 1399-5618.2010.00852. Townsend, M. C. (2014). Psychiatric mental health nursing: Concepts of
care in evidence-based practice. Philadelphia, PA: F.A. Davis.