A case study of a patient with bipolar disorder and intellectual disability in a residential context: Aggressive behaviour, theft, quality of life and pharmacological therapy. A cognitive behavioural approach.

Journal title RIVISTA SPERIMENTALE DI FRENIATRIA
Author/s Mirko Dai Prà
Publishing Year 2020 Issue 2020/2
Language Italian Pages 26 P. 115-140 File size 302 KB
DOI 10.3280/RSF2020-002007
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The Author presents a case study of a 41 year old patient - with bipolar disorder and cognitive disability - and assesses the outcomes of the intervention examining: aggression, theft, medication and the patient’s perceived quality of life. Methodology: The rehabilitation team, after having completed the functional evaluation of the patient with the ABC Behavioral Model (Antecedent Behavior Consequences), utilized a cognitive behavioral approach to set up an integrated intervention. The team was trained to use operant conditioning. After the first intervention, token economy was introduced to reinforce the newly learnt behavior. Ultimately, a cognitive psycho-educative intervention was added. The contents of the various interventions was adapted to meet the patient's comprehension skills. The outcomes of this study are: type and dosage of medication, the number of aggressive or theft episodes and the patient’s perceived quality of life. Results: Aggressiveness and theft episodes decreased, after having reduced the dosage of the drugs - benzodiazepine, antipsychotic - and having also reduced the restrictive mechanical therapies such as Intra Muscle pro re nata medication and room isolation. The patient’s quality of life - health, vitality, social activities and emotional states - improved. Conclusion: The intervention was effective in decreasing the patient’s problematic behaviour, it helped to reduce medication and increased the patient’s perceived Quality of Life. This case study offers insight on team and individual work with a bipolar and cognitive disabled patient.

Keywords: Aggression, Quality of Life, Bipolar, Disability, Behavioural, Cognitive.

  1. Mead S & Copeland ME. What recovery means to us: consumers' perspectives. Community Ment Health Journal 2000. 36,3:315-28. DOI: 10.1023/a:1001917516869.
  2. King E, Okodogbe T, Burke E, McCarron M, McCallion P & O’Donovan MA. Activities of daily living and transition to community living for adults with intellectual disabilities. Scandinavian Journal of Occupational Therapy 2017; 4, 5:357-365. DOI: 10.1080/11038128.2016.1227369.
  3. Hilberink SR, Van der Slot WMA & Klem M. Health and participation problems in older adults with long-term disability. Disability Health Journal 2016; 10, 2:361-366. DOI 10.1016/j.dhjo.2016.12.004.
  4. Grande I, Berk M, Birmaher B & Vieta E. Bipolar disorder. Lancet 2016. 387, 10027:1561–1572. DOI: 10.1016/S0140-6736(15)00241-X.
  5. Arlington VA. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.), American Psychiatric Publishing, 2013. Edizione italiana: Manuale diagnostico e statistico dei disturbi mentali. Milano: Raffaello Cortina; 2014.
  6. Colom F & Vieta E. Manuale di psicoeducazione per il disturbo bipolare. Giovanni Fioriti Editore, Roma 2016.
  7. Dols A, Kupka RW, van Lammeren A, Beekman AT, Sajatovic M & Stek ML The prevalence of late-life mania: a review. Bipolar Disord 2014. 16,2:113-118.
  8. Yatham L, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O'Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA & Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update. Bipolar Disord. 2013;15,1:1-44.
  9. Greene M, Paladini L, Lemmer T, Piedade A, Touya M & Clark O Systematic literature review on patterns of pharmacological treatment and adherence among patients with bipolar disorder type I in the USA. Neuropsychiatric Disease and Treatment 2018. 14: 1545-1559 DOI: 10.2147/NDT.S166730
  10. De la Fuente - Tomás L, Sierra P, Sanchez-Autet M, García-Blanco A, Safont G, Arranz B, García-Portilla MP. Sleep disturbances, functioning, and quality of life in euthymic patients with bipolar disorder. Psychiatry Research 2018. 269:501-507. DOI: 10.1016/J.PSYCHRES.2018.08.104
  11. Takaesu Y. Circadian rhythm in bipolar disorder: A reviewof the literature. Psychiatry and Clinical Neurosciences 2018. 72: 673-682.
  12. Oliveira SE, Carvalho H & Esteves F. Internalized stigma and quality of life domains among people with mental illness: the mediating role of self-esteem. Journal Menthal Health 2016. 25,1:55-61. DOI: 10.3109/09638237.2015.1124387
  13. Hofer A, Mizuno Y, Wartelsteiner F, Wolfgang Fleischhacker W, Frajo-Apor B, Kemmler G, Mimura M, Pardeller S, Sondermann C, Suzuki T, Welte A & Uchida H. Quality of life in schizophrenia and bipolar disorder: The impact of symptomatic remission and resilience. Eurpean Psychiatry 2017. 46:42-47.
  14. Michalak EE, Yatham LN & Lam RW Quality of life in bipolar disorder: A review of the literature. Health Quality Life Outcomes 2005. 3, 72.
  15. Herman H, Metelko Z, Szabo S & al. (World Health Organization Quality Of Life Group WHOQOL) Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument, 1993. Quality Life Research, 2: 153-159. DOI: 10.1007/BF00435734
  16. Gaynes BN, Brown CL, Lux LJ, Brownley KA, Van Dorn RA, Edlund MJ, Coker-Schwimmer E, Palmieri Weber R, Sheitman B, Zarzar T, Viswanathan M, Lohr KN. Preventing and De-escalating Aggressive Behavior Among Adult Psychiatric Patients: A Systematic Review of the Evidence. Psychiatric Services 2017. 68,8: 819-831.
  17. Services 2017. 68,8: 819-831.
  18. Swanson JW, Holzer CDE, Ganju VK & Jonio RT. Violence and psychiatric disorder in community: evidence from epidemiologic catchment area surveys. Hospital & Community Psychiatry 1989. 40: 605-608.
  19. Hodgins S, Kratzer L & McNeil TF. Obstetrical complications, parenting practices and risk of criminal behaviour among persons who develop major mental disorders. Acta Psychiatrica Scandinavica 2002. 105, 3: 179-188.
  20. Antony, WA. Recovery from mental illness: The guiding vision of the mental health system in the 1990s. Psychosocial Rehabilitation Journal 1993. 16: 521-538.
  21. Barber ME. Recovery as the New Medical Model for Psychiatry. Psychiatr Service 2012. 63,3:277-9.
  22. Corrigan PW. Recovery from Schizophrenia and the role of evidence-based psychosocial interventions. Expert Review Neurotherapeutics 2006. 6,7: 993-1004. DOI: 10.1586/14737175.6.7.993
  23. Guyatt, G., Sackett, D., Taylor, D. W., Ghong, J., Roberts, R. & Pugsley, S. Determining Optimal Therapy – Randomized Trials in Individual Patients. New England Journal of Medicine, 1986. 314, 14, 889-892. DOI: 10.1056/NEJM198604033141406
  24. Larson, E.B. N-of-1 Clinical Trials A Technique for Improving Medical Therapeutics [Specialty Conference]. West J Med 1990, 152:52-56.
  25. Mee J, Sumsion T & Craik C. Mental Health Clients Confirm the Value of Occupation in Building Competence and Self-Identity. British Journal of Occupational Therapy, 2004. 67,5: 225-233. DOI: 10.1177/030802260406700506
  26. Waller H, Garety PA, Jolley S, Fornells – Ambrojo M, Kuipers E, Onwumere J, Woodall A, Emsley R & Craiga T. Low intensity cognitive behavioural therapy for psychosis: A pilot study. Journal Behavioral Therapy & Experimental Psychiatry 2013. 44 98-104.
  27. Leufstadius C & Eklund M. Time use among individuals with persistent mental illness: identifying risk factors for imbalance in daily activities. Scandinavian Journal of Occupational Therapy 2014. 21:53-63. DOI: 10.3109/11038128.2014.952905
  28. Skinner B F. Science and human behavior. New York: Macmillan;1953.
  29. Hanley GP, Iwata BA & McCord BE L’analisi funzionale dei comportamenti problema: una rassegna. Handicap Grave 2004. 5, 2: 135-189.
  30. Zeller SL & Rhoades RW. Systematic reviews of assessment measures and pharmacologic treatments for agitation. Clinical Therapeutics 2010. 32:403-425.
  31. Richmond JS, Berlin JS, Fishkind AB, Holloman GH, Zeller SL, Wilson MP, Aly Rifai MA & Ng AT Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA de-escalation workgroup. Western Journal of Emergency Medicine 2012. 13:17-25.
  32. Ashcraft L & Anthony WA. Crisis services in the living room. Behavioral Healthcare 2006. 26:12-14.
  33. Loucks J, Rutledge DN, Hatch B & Morrison V. Rapid response team for behavioral emergencies. Journal of the American Psychiatric Nurses Association 2010. 16:93-100. DOI: 10.1177/1078390310363023
  34. CMS Manual System. Baltimore, Centers for Medicare & Medicaid Services, (2008). -- https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/dowloads/R37SOMA.pdf.
  35. Dollard J, Doob L, Miller N, Mowrer O & Sears R. Frustration and aggression, New Haven CT, Yale University Press. 1939.
  36. Martin G & Pear J (2000). Strategie e tecniche per il cambiamento. La via Comportamentale. (Tr It. Moderato P & Rovetto F.) N York: McGraw – Hill. (Opera originale pubblicata nel 1999).
  37. The WHOQOL Group. The World Health Organization Quality of Life Assessment 315 (WHOQOL): position paper from The World Health Organization. Soc Sci Med 316 1995. 41(10):1403-9.
  38. Apolone G & Mosconi P. The Italian SF-36 Health Survey: translation, validation and norming. Journal Clinical Epidemiology 1998. 51, 11: 1025-36.
  39. Gabler N B, Duan N, Vohra S & Kravitz. N – of – 1 Trials in the Medical Literature: A Systematic Review. Medical Care, 2011.49,8 761-768.
  40. Kravitz, R. L., Duan, N., & Braslow, J. Evidence-Based Medicine, Heterogeneity of Treatment Effects, and the Trouble with Averages. The Milbank Quarterly, 2004, 82(4), 661-687.

Mirko Dai Prà, Uno studio di caso di paziente con Disabilità Intellettiva e disturbo Bipolare in contesto residenziale: comportamenti aggressivi, furto, Qualità della Vita e terapia farmacologica. Un intervento Comportamentale e Cognitivo. in "RIVISTA SPERIMENTALE DI FRENIATRIA" 2/2020, pp 115-140, DOI: 10.3280/RSF2020-002007