Visual Report - Bipolar Disorder

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Visual Report: Bipolar Disorder

Simone Khalil, Chloe Parsons, Xuan Dao Tran Pham, Jessica Wood, Eric Wyatt


Introduction


BIPOLAR DISORDER A.K.A. MANIC-DEPRESSIVE ILLNESS According to the National Institute of Mental Health (2012), Bipolar Disorder ●

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is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks often appears in the late teens or early adult years (At least half of all cases start before age 25) is not easy to spot when it starts. Some people suffer for years before they are properly diagnosed and treated is a long-term illness that must be carefully managed throughout life People with bipolar disorder experience unusually intense emotional states that are drastic from the person’s usual mood and behavior Manic episodes are the overly joyful or overexcited state Depressive episodes are states of extreme sadness or hopelessness. An effective treatment plan usually incorporates medication and psychotherapy The psychotherapy component can include family focused therapy, which helps enhance coping strategies recognize new episodes early and help their loved one. It also helps improve communication and problem solving among family members

(2015) Retrieved from: http://media.giphy.com/media/l41lHG5OkwrbjXGM0/giphy.gif


Symptoms of mania or a manic episode include:

Symptoms of depression or a depressive episode include:

Mood Changes ● An overly long period of

Mood Changes ● An overly long period of

feeling "high," or an overly happy or outgoing ●

feeling sad or hopeless ●

mood

activities once enjoyed,

Extreme irritability.

including sex

Behavioral Changes ● Talking very fast,

Behavioral Changes ● Feeling overly tired or

jumping from one idea to another, having racing ● ●

"slowed down" ●

concentrating,

Being unusually

remembering, and making

distracted

decisions

Increasing activities, multiple new projects

Being overly restless

Sleeping little or not

Being restless or irritable

Changing eating, sleeping, or other habits

Thinking of death or

being tired

suicide, or attempting

Having an unrealistic

suicide.

belief in your abilities ●

Having problems

thoughts

such as taking on

Loss of interest in

Behaving impulsively and engaging in pleasurable, high-risk behaviors.

National Institute of Mental Health (2012)


Andre Lyon Andre is the eldest son of the Lyon family and CFO of Empire Entertainment. He is Wharton educated, power hungry and suffers from bipolar disorder. He is also married to his college sweetheart, Rhonda. He plans to run Empire, but is in a battle for the head chair with his younger brothers. Function - Andre has always been extremely loyal to his father. From a young age, Andre, as the eldest child, covered for his father’s illegal activities and continues to do so without questioning him. Andre’s function is being his father right hand man in the family and the business as acting CFO. He is ivy league educated and chose a different path than the rest of his brothers. He sometimes feels separated from the rest of the family because they all bond over making music. His father refused to acknowledge his mental illness when he had his first manic episode in his 20s and acts as if it doesn’t exist. Andre has always worked extremely hard and feels like he should be the son taking over the family business. Some factors that led to his manic episode in the show is lack of medical adherence (to his appointments and bipolar medications), high stress work environment, pressure and manipulation from his father, and some conflict with his wife.

Hodes, C./ FOX (2015, January). Trai Byers as Andre . Retrieved from: http: //www.screenspy.com/articles/tv/images-empire-1x05-dangerousbonds/nggallery/image/105empire_ep105_sc41-42_101414_0245_f_hires1/#gallery


Rhonda Lyon Eldest Son’s Wife - Andre's power-hungry wife Function- Rhonda is Andre’s wife and is not accepted by Lucious. She is always pushing Andre to do what he needs to do to secure his part of the family business. She is one of Andre’s only support systems in regards to his career as well as his bipolar disorder. Rhonda always reminds Andre to stay on his medications and keep his appointments reminding him that “if a normal person misses their appointments, it's laziness. If a person with bipolar misses their appointment it's life threatening”

FOX (2015, January) Retrieved from: http://www.eurweb.com/2015/05/empirekaitlin-doubleday-engaged-serayah-mcneill-in-taylor-swift-circle/


Lucious Lyon Lucious is a former drug dealer turned hip hop mogul and the CEO of Empire Entertainment, whose life begins to cave in around him after his past sins come back to haunt him following his being diagnosed with ALS. Lucious has a fiancée, Anika, but his ex-wife, Cookie, intends to tear them apart Function - Lucious is extremely motivated by money and power and has bred his children to live the same way. All goals are oriented towards the growth of the company at expense for the family dynamic. He is willing to sacrifice the cohesion among his family for the progression of his Empire. Lucious does whatever it takes to secure the business, even if it means taking lives, lying, and risking his family’s wellbeing. He is unaccepting of his sons as they are. He denies Andre’s bipolar illness and tells Jamal his homosexuality is a choice and that it is going to ruin his career. Lucious is also ok with hurting people in his love life, although claims to have an enduring love for the mother of his children, Cookie. He is the head figure of his family and the company, and has trouble connecting in a real way with those closest to him.

Hodes, C./ FOX (2015, January). Terrence Howard as Lucious . Retrieved from: http://www.screenspy.com/articles/tv/images-empire-1x05-dangerous-


Loretha “Cookie” Lyon Lucious' outspoken ex-wife and mother of his three sons, who served a 17-year stretch in prison for drug dealing. She sees herself as the sacrificial lamb for Empire Entertainment, which she built with Lucious, but then took the fall for when she was arrested for running the drugs that financed Lucious' early career. Upon her return from prison she is determined to bring the Lyon family back together and reclaim her share of Empire Entertainment. Function - Cookie is motivated and loyal, sacrificing her life in prison to see her husband and children move forward. She is also extremely motivated about the growth of the family business, but not at the expense of the family ties. She’s constantly pushing her children to further their careers, but not at the expense of one another. She wants to see her children getting along and have good relationships with one another. Her relationship with her ex. husband is extremely complicated.

Hodes, C./ FOX (2015, January). Taraji P. Henson as Cookie . Retrieved from: http://www.screenspy.com/articles/tv/images-empire-1x05-dangerousbonds/nggallery/image/105empire_ep105_sc41-42_101414_0245_f_hires1/#gallery


Jamal Lyon The middle son and "black sheep" of the Lyon family, a talented, gay singer-songwriter who despises the corporate aspect of the music industry and is estranged from his homophobic father. Jamal is considered Cookie's favorite and has a strong relationship with his brother Hakeem. Function - Jamal has been abused by his father in the past due to his homosexual orientation that has been apparent since a young age. He is faced with the decision to come out to the world. He also wants his father’s acceptance more than anything, yet his father will not accept his homosexuality as a part of him and fears it will harm his career as a young African American man in the Hip Hop arena. Jamal is close to his brother Hakeem and is loving to all the members of his family. Jamal rejects his father’s financial support in order to maintain his homosexual lifestyle.

Dinnerstein, M. /FOX. (2015, February) Retrieved from: https://www.pinterest. com/pin/508977195363584292/


Hakeem Lyon The fame-obsessed youngest son and Lucious' favorite child, who is a hip hop star on the rise. Hakeem starts to find feelings for his mother, Cookie, and has a great relationship with Jamal. Function - Hakeem is his father’s favorite son and is bred to become a star. Hakeem lacks an individual identity and is distracted by drugs, alcohol, fame and women. He is his father’s son in many ways. With the presence of his mom and a building of a relationship with her, he starts to develop more of his identity even to the point where he stands up to his father. Jamal also grows in love for his brothers.

Brown, F. (2015, October) Empire TV series cast Bryshere Gray. Retrieved from:http://www.franchiseherald.com/articles/21332/20150131/empiretv-series-cast.htm


Developmental Stages Duvall’s Family Development Stage Theory, Stage 6 and 7 The Lyon Family is in Stage 6, “family launching young adults”. The oldest child, Andre, is married and lives with his wife, and also acts as CFO for his father’s hip hop music company.The middle child, Jamal, was being supported by his father, and in an act of standing up for who he is, decides to not deny who he is as a homosexual against his father’s wishes, leaving him cut off financially. Jamal has his own apartment where he writes and produces his music and talent. The youngest child, Hakeem, is living with his father and is completely molded by him. As the favorite child, Hakeem enjoys his father’s support, gifts, and drive to fame. The father’s music empire has enabled the family to have a lot of great opportunities, but it has an disadvantage to the children. At the beginning, Jamal’s loft is paid for with his father’s money. This action does not promote Jamal’s independence to become his own person who work and support himself. The family’s income has enable Andre to goes to graduate school of business and have a position in the company. Lucious’ own ambition blinds him from seeing his son Andre’s bipolar condition. He used Andre’s business talent to make the company public and increase profit. This hindered Andre from exploring any other career option and be independent of those choices. Andre wishes to please his father so much that he does not consider what choices will make himself happy. The father uses the company to pit his children against each other to drive them to accomplish the tasks needed to drive the Empire into further success. Although two of the children are able to live on their own, their lives are still hindered by the family’s great wealth and they have not yet establish their own identity or independent as an adult. The identity of the family and the empire are so intertwined and indistinguishable which leads to a lack of personal identity and family problems. The Lyon family is also in Stage 7, a family with “middle aged parents”. The Lyon family builds a music empire from nothing. Lucious and Cookie are reaching an age where they trying to maintain relationship ties and ensure retirement and legacy. Lucious is focusing more on which one of his sons will become the next head of the company to ensure that the empire he build will continue to flourish. On the other hand, Cookie’s priority is to bring her family back together and build a relationship with all her sons. Lucious’ priority is his company, although he frames it as a family company. In his eyes, the family and the company are one in the same. Cookie has been in jail for the past 17 years, leaving her to have minimal to no relationship with her family. The boys lack a parental figure that helps guide them through life. Therefore, the relationship among the family is fragile.


Developmental Stages cont. Andre has a condition called bipolar disorder. In one episode, the doctor told Lucious that his son has a mental disorder. Lucious’ reaction to the news was anger and denial; he felt like if he can goes through anything, so can his sons. Everyone in the family knows that Andre has the mental disorder, but they are not educated on the matter or how to properly help Andre. They allow Andre to continue his high stress job and ignore his condition all together. Everyone is so consumed with their own life that they do not have the time to reach out to help Andre until he had a manic episode in the office putting everyone at risk of being physically hurt. The Lyon family members are too focused on the company that they fail to help their brother and son with bipolar. Andre’s true support system is his wife of 10 years, who has stood by his side and supported him in order for him to keep his mental disorder under control. The company enables the family to come together as one to promote the success of the business. On the other hand, it has hindered their relationships by consuming much of their time on work and not focus on developing the relationship among each member of the family.


Culture & Religious traditions


2.6% According to the National Institute of Mental Health (NIMH), bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year (2013). However, while the rate of bipolar disorder is the same among African Americans as it is among other Americans, African Americans are less likely to receive a diagnosis and, therefore, treatment for this illness (“Bipolar Disorder and African Americans�, 2015).


stigma


According to Kaakinen, Coehlo, Steele, Tabacco, and Hanson (2015): Stigma has been defined as labeling, stereotyping, separation, status loss, and discrimination‌The media are responsible for perpetuating misconceptions about persons with an MHC [mental health condition], often by sensationalizing crimes in which persons with an MHC are involved and using pejorative terms to describe the individual with the MHC.


stigma Empire may be changing the culture around bipolar disorder

Andre Lyon is a rare TV or movie character with a chronic mental illness who is shown managing his illness by taking his medication and managing his symptoms (with the support of his wife) while functioning at a very high level‌ In showing a high achiever who is successful at managing bipolar disorder, the show takes some steps to destigmatizing bipolar disorder specifically, and brain disorders in general. In doing so, Empire may inspire people to seek treatment and pursue dreams they may have otherwise not thought possible. - Ruth C. White, Ph.D., M. S.W., and M.P.H.


culture


Culture: Mental Illness

From a cultural perspective, mental health has not been prioritized amongst members of the African-American community. For many different reasons, African-American patients have been reluctant to seek treatment using a biomedical approach when confronted with a mental illness. In an article written in the Huffington Post, Ruth C. White (2011), a professor at University of Southern California, elucidates the culture surrounding mental illness among the African-American community through the lens of her own experience with being an African-American with bipolar disorder: According to the mythology that surrounds the strength of African Americans, "falling apart" is just not something we do. We survived the Middle Passage, slavery, racial oppression and economic deprivation. We know how to "handle our business," "be a man" or "be a woman." We see therapy as the domain of "weak," neurotic people who don't know what "real problems" are. Instead, to deal with our psychic pain we eat our way into life-threatening obesity, excessively use alcohol and drugs and act out violently through word and deed, but we do not go crazy.


Culture: stigma

The stigma associated with mental illness in general, and especially amongst the African-American community, is not the only factor to consider when trying to understand the culture surrounding these delicate issues. One compounding element is the fact that medicine and corresponding research substantively trail behind when it comes to the viewpoint of the African-American community. In an interview with NPR (2012), William Lawson, a psychiatrist and professor at Harvard University, took the opportunity to delve into the stigma associated with mental illness amongst members of the African-American community:

The stigma problem comes from two directions. One is comes from the profession, the field in of itself. When I was in medical school, I was told that black people didn't get depressed…And then the other direction is that AfricanAmerican men have a lot of pressures to not only to be successful, to be competent, but to reacting as a larger society that says that African-American men are less confident, less able to do things and have - and are mentally weak.


culture: treatment

Faith and religion is often an important resource for members of the African-American community. As such, when someone is dealing with a mental illness, patients and family members have a strong tendency to seek out that resource as a foundation for obtaining more information on how best to cope. While the church may provide a good starting point for understanding mental illness, religion can only do so much in the treatment of any one brain disorder. William Lawson (2012) took the time to provide insight as to why the African-American community typically seeks treatment and advice about mental health illness from the church:

African-Americans tend to like to seek treatment or help from those institutions that they're familiar with and trust. Unfortunately, in the past, the church, while it has been very helpful in terms of general medical conditions and putting on health fairs and other support organizations, many times some of the members simply aren't aware that mental disorders of some types are in fact medical problems and need the kind of support and help that can come.


Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) In 2005, the NIMH initiated a study to provide more insight into bipolar disorder, called Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

More analysis by other researchers has been conducted on the data from STEP-BD to clarify the results of the original study. Gonzales et al, (2010) investigated one-year treatment outcomes for AfricanAmerican and Hispanic patients in STEP-BD. They found some very interesting insights with regards to the culture of the treatment given to the AfricanAmerican population living with bipolar disorder. Treatment approaches that are inaccurate as well as the suboptimal outcomes related to management of bipolar disorder in AfricanAmericans may be due to inaccurate assessment of the psychotic symptoms. For example: A clinician may misinterpret depressive symptoms as negative symptoms associated with schizophrenia. What is labeled a “lack of insight” resulting from psychosis might be more accurately seen as a lack of familiarity with illness terminology and with mental health service systems. Some African-American patients’ mistrust of mental health providers may be interpreted as paranoia instead of as culturally consistent and perhaps reasonable.


strengths & challenges for the lyon family Strengths

Challenges

Andre’s supportive spouse, Rhonda Lyon, reminds him to take medication

Mother, Cookie Lyon, was just released from 17 years in prison for dealing drugs

Andre is the current CEO of Empire Entertainment, and has goals of taking over the business after his father steps down

Father, Lucious Lyon, was recently diagnosed with ALS

Andre has an education, he graduated from the Wharton School of Business

Discord in the family surrounding who will take over the family business, with Lucious Lyon pitting his three sons against each other

After Andre consistently displays erratic behavior, his father Lucious calls the paramedics to escort him to the hospital

Andre flush his medication down the toilet when his father refuses to acknowledge his hard work

In a moment of despair, Andre attempts suicide


communication practices ●

In order to establish an effective therapeutic relationship with the family, it is critical that nurses use nonblaming and nonjudgmental communication interactions with families who have a member with bipolar disorder, or any mental health condition.

Psychoeducation and health promotion interventions serve both the care providers as well as the family member who has bipolar disorder. Kaakinen et al. (2015) state that care providers “have significantly less depression, improved health, and less subjective burden of care and role dysfunction” and family members with bipolar disorder “may demonstrate a decrease in mania and depression, due in part to the improved health of the provider of care” (p. 539).

It is important that professionals acknowledge the distinctive qualities inherent in both the providers of care and the recipient of care, when communicating support.

Kaakinen et al. (2015) goes on to explain that valuable communication practices surrounding educational interventions for family members living with a person who has bipolar disorder helps to “reduce stress for the family members, increase family members’ understanding of the condition, and enhance family members’ ability to remain socially functional” (p. 539).


application of family theory


Friedman Family Assessment Identifying Data Family Name. Lyon family Cultural Background. Luscious and Cookie both come from the streets. They used to sell drugs and do other illegal activities. Cookie was arrested and went to jail for 17

years. While Cookie was in Jail, Luscious did everything

he could to create the music label, Empire. Religious Identification. Family religion is unknown Social Class Status. Upper class Social Class Mobility. Throughout the years, Luscious helped the family go from lower class to upper class through the creation of Empire. Developmental Stage and History of Family Family’s Present Developmental Stage. The family is in Erikson’s stage of Generativity vs. Stagnation. Luscious is trying to decide which son to pass his legacy onto. Extent of Family Development Tasks Fulfillment. The family development is hindered right now. Luscious has a hard time letting go of the reigns and passing his legacy off to one of his sons. He does not believe any of his sons are ready to take over his legacy. He refuses to consider Andre a candidate for succession since Andre lacks the musical element. Luscious also has a hard time considering Jamal for his replacement since Luscious does not support Jamal’s lifestyle of being a gay man.


Friedman Family Assessment Environmental Data Characteristics of Home. The Lyon family has a huge home in New York City. The home is very lavish and elegant with expensive paintings, chandeliers, and a grand piano. Technically, the family home belongs to Luscious. Andre lives in a townhome with his wife Rhonda but most of the family interaction happens in Lucious’ home. Characteristics of Neighborhood and Larger Community. The family lives in New York City. The community they live in is very wealthy and overall it is a safe neighborhood. Family’s Geographical Mobility. Since the family is very wealthy geographical mobility is not a problem for the family. The family has drivers on hand when they need them. The family members also have their own cars. If any family member needed to get somewhere fast, they could easily use a private jet. Family’s Associations and Transactions With Community.The family associates with the community through their company, Empire. Through Empire they share their music with the community and the world. The family interacts with the community by going to big events to promote their music. Family Structure Communication Patterns. The communication between the family members is severely dysfunctional. There are a lot of heated arguments and lies among the family members since they are all looking out for themselves. The conversations among the family members typically consist of business and music strategies. The family does not communicate on a personal level; in fact the three sons never questioned as to why Luscious is seeking a successor to run the company.


Friedman Family Assessment Power Structure. It is evident this family is driven by power. Each family member is motivated to gain as much power from the company. Luscious is the decision-maker in regards to running Empire and family matters. Luscious has most, if not all of the power in this family dynamic. But Cookie, being newly released from prison is on a mission to take power back from Luscious and claim what’s hers. Role Structure. Each family member has their own unique role in the family structure. Luscious takes the role of the leader. He built Empire and continues to run day to day operations for the company. Andre takes responsibility for the business side of Empire. He is a smart man, who graduated from Wharton Business School. Andre and Luscious are responsible for the financial strength of Empire. The other two sons, Jamal and Hakeem, take on the role of creativity in the family. Both sons are musically inclined and contribute to the success of Empire through their musicianship. One variable that affects the role structure of this family is Empire. The success of Empire shapes each family member's role. Family Values: This family values power, money, and success. Each family member is driven to claim power of Empire. There is a great disconnect among the family members. Families that have strong connections tend to hold family values of compromise, reason, and civility. Those values are not seen much at all in the Lyon family. Each family member is out for themselves and will do whatever to gain power, money, and success.


Friedman Family Assessment Family Functions Affective function. Much of the family suffers from a lack of connectedness. Because the mother, Cookie, was in incarcerated for 17 years of Jamal’s, Hakeem’s, and Andre’s childhood the maternal relationships that she shares with her respective children are strained. The resentment between Lucious and Cookie over her incarceration leads to a tension that causes nurturance between parents and children to be divided. The family’s needresponse pattern is convoluted and complicated by everyone’s desire to contribute to the family company, Empire Entertainment; individual needs are sacrificed and/or neglected for the sake of energy directed to that endeavor. Because of this dynamic the needs of Andre to manage his bipolar disorder are largely his own to handle. In this respect, the family is reactionary instead of preventative. Socialization function. The family’s child-rearing practices are largely in the past considering that the children are all adults, though it should be noted that because of Cookie’s incarceration, Lucious was the head of a singlefamily household. His child-rearing practices were adapted to handle the attention that the family company required. The dynamic has since shifted with Lucious’ diagnosis of ALS and his desire to have one his sons take control of the family company. Andre’s bipolar disorder leaves Lucious hesitant to let him take control of the family company, even though his business experience and education would otherwise offer the standing required. The rise in the social class of the family as they became more affluent and successful has lead to greater resources available to the family. However, Andre largely disregards his mental illness in hopes of focusing on proving he can take over Empire Entertainment.


Friedman Family Assessment Health care function. As it relates to his mental illness, Andre has poor medication adherence. Rather than seeking medical care as a preventative measure to maintain Andre’s health, his family only shows a willingness to seek medical care in moments of distress, such as when Andre is in a manic state. Lucious’ recent diagnosis of ALS is the main focus of the family’s perceived health and illness concern. However, Lucious is in a state of denial about how serious his illness is and how to properly grapple with its consequences. Because the dietary practices of the family are not well understood, a 3-day food history may prove to be illustrative. Andre’s behavior suggests that he has not yet managed his tendency to deviate to a manic state where his high energy and abundance of selfconfidence lead to an inability to maintain proper sleep habits. The family has a rich history of recreational drug use and Andre’s wife reports that he often chooses to drink alcohol instead of regularly taking his medications. It appears that everyone in the family completely lacks any regular undertaking of medically based preventative measures. The family does not partake in any complementary or alternative therapies. The family’ s health history is not well recalled upon request and it is unclear if there is a familial basis of either ALS or bipolar disorder. Because of the family’s wealthy social class, health insurance and services are abundantly available to them. Because of Andre’s unwillingness to grapple with his bipolar disorder, the logistics of receiving care is often in the form of emergency treatment and his perceptions and feelings of health services is shaped by this dynamic and is recognized as adversarial.


Friedman Family Assessment Family Stress, Coping, and Adaptation Family stressors, strengths, and perceptions. The main stressor that the family faces is the demands of the family entertainment company. Many of the stresses that the family faces are inspired by and derive from the family company. Their strengths include a willingness to help one another when they perceive that there is a problem and a desire to keep the family unit intact. As it relates to Andre’s mental illness, the family does not define the situation as one that deserves a great deal of attention. Family coping strategies. The family tends to resort to drug and alcohol use as a reaction to stressors. In this respect, external coping strategies have been and continue to be the main source of the dysfunctional coping strategies utilized by the family. Recreational drug and alcohol use by virtually all of the immediate family members serves as a distraction from and an aggravation of the health problems that deserve greater awareness. Family adaptation. The family appears to be in a crisis state when considering the overall health of the family. The patriarch of the family, Lucious, is suffering from a major health condition, ALS, and yet there appears to be no legitimate attention devoted to this reality. And yet, the family appears to focus a greater attention to Lucious’ health than on Andre’s health. There appears to be no defined manner in which the family deals with Andre’s bipolar disorder and the only symptom management comes in the form of a moderate adherence


Friedman Family Assessment to medication for which the only family member that assists Andre in this manner is his wife, Rhonda. Tracking stressors. It is difficult to assess how the family has coped and adapted over time to the stressors that they face as a family. However, it appears that as the family company has succeeded and the family has rose to a higher social class their stressors have increased with no suggestion of a greater ability to manage these stressors.


Nursing Process Area of The Friedman Family Assessment Model

Communication Patterns

Health Care Function

Family Coping Strategies

Problem in this Area

Suggested Intervention

Supportive Research

The lack of proper communication skills among the family members is a serious problem. The lack of communication skills leads to frustration not only for AL but for everyone else as well.

All family members participate in communication skills training. The training will incorporate behavioral rehearsal of effective speaking and listening strategies.

Miklowitz, D., Goodwin, G., Bauer, M., & Geddes, J. (2008). Common and specific elements of psychosocial treatments for bipolar disorder: a survey of clinicians participating in randomized trials. Journal Of Psychiatric Practice, 14(2), 77-85

The deficit of family knowledge about bipolar disorder and its treatment leads to a poor emotional environment that helps to inspire the low quality of AL’s medication adherence.

Educate all members of the family on the importance of AL’s medication and how it can help manage his illness. Encourage them to promote an environment that will allow AL to seek a more consistent and therapeutic pursuit of medically based preventative measures.

Scott, J., Colom, F., Pope, M., Reinares, M., & Vieta, E. (2012). The prognostic role of perceived criticism, medication adherence and family knowledge in bipolar disorders. Journal Of Affective Disorders, 142(1-3), 72-76.

There appears to be no coping mechanism that the family employs to handle the stress associated with their lifestyle and health. The dysfunction of the family fosters an atmosphere that influences AL’s turn to an abuse of and alcohol.

Host a reflective educational family discussion that discusses the symptoms and manifestations of bipolar disorder. Discuss feelings, behavior, and thoughts as they relate to how the family manages stress and anxiety.

Jonsson, P., Wijk, H., Danielson, E., & Skarsater, I. (2010). Outcomes of an educational intervention for the family of a person with bipolar disorder: a 2year follow-up study. Journal Of Psychiatric And Mental Health Nursing, 18(4), 333341.


References Behind Mental Health Stigmas In Black Communities [Radio series episode]. (2012, August 20). In Talk of the Nation. John Donovan.

Bipolar Disorder and African Americans. (n.d.). Retrieved October 5, 2015, from http://www.mentalhealthamerica.net/conditions/bipolar-disorder-andafric an-americans

Brown, F. (2015, October) Empire TV series cast Bryshere Gray. Retrieved from http://www.franchiseherald.com/articles/21332/20150131/empire-tvseriescast.html

Daniels, L., Strong, D., Grazer, B., Calfo, F., Chaiken, I.

(2015)

Empire. Chicago, IL: 20th Century Fox Television.

Dinnerstein, M. /FOX. (2015, February) Retrieved from: https://www.pinterest.com/pin/508977195363584292/

FOX (2015, January) Retrieved from: http://www.eurweb.com/2015/05/empire-kaitlin-doubleday-engagedserayah-m cneill-in-taylor-swift-circle/


References Gonzalez, J. M., Bowden, C. L., Berman, N., Frank, E., Bauer, M. S., Kogan, J. N., ‌ Miklowitz, D. J. (2010). One-Year Treatment Outcomes of African-American and Hispanic Patients With Bipolar I or II Disorder in STEP-BD. Psychiatric Services (Washington, D.C.),

61(2), 164–172. http://doi.org/10.1176/appi.ps.61.2.164

Hodes, C./ FOX

(2015, January). Taraji P. Henson as Cookie . Retrieved

from:http://www.screenspy.com/articles/tv/images-empire-1x05-danger ous-bonds/nggallery/image/105empire_ep105_sc41-42_101414_0245_f_hir es1/#gallery

Hodes, C./ FOX

(2015, January). Terrence Howard as Lucious . Retrieved

from:http://www.screenspy.com/articles/tv/images-empire-1x05-danger ous-bonds/nggallery/image/105empire_ep105_sc41-42_101414_0245_f_hir es1/#gallery

Hodes, C./ FOX

(2015, January). Trai Byers as Andre . Retrieved from:

http://www.screenspy.com/articles/tv/images-empire-1x05-dangerous-b onds/nggallery/image/105empire_ep105_sc41-42_101414_0245_f_hires1/# gallery

Jonsson, P., Wijk, H., Danielson, E., & Skarsater, I. (2010). Outcomes of an educational intervention for the family of a person with bipolar disorder: a 2-year follow-up study. Journal Of Psychiatric

And Mental Health Nursing, 18(4), 333-341.


References Kaakinen, J., Coehlo, D., Steele, R., Tabacco, A., & Hanson, S. (2015). Family Mental Health Nursing. In Family health care nursing theory,

practice and research (5th ed.). Philadelphia, Pennsylvania: F.A. Davis. Miklowitz, D., Goodwin, G., Bauer, M., & Geddes, J. (2008). Common and specific elements of psychosocial treatments for bipolar disorder: a survey of clinicians participating in randomized trials. Journal

Of Psychiatric Practice, 14(2), 77-85

National Institute of Mental Health (2012). Bipolar Disorder in Adults. Retrieved from: http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adu lts/index.shtml

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(2015) Empire (2015 TV Series). Retrieved from: https://en.wikipedia.org/wiki/Empire_%282015_TV_series%29#Premise



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