Case conseptualization: Description of Problem

Case Conceptualization
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Description of Problem
The issue in question is that of Bill, a 25-year old male with a history of bipolar disorder first diagnosed at 15 years, and he has been hospitalized once before. Lately, he has extremely irritable toward his mother, siblings, and friends. He is also socially withdrawn, and when he goes out, it is mostly drinking. He reports experiencing insomnia and appetite loss for the past 1 month and appears to be anxious. However, there are instances where he seems to show increased energy, and in these cases, he has partied hard with some of his friends but then goes back to drinking alone. He is concerned that he lacks positive job prospects, and Bill has worked in various construction jobs and been dismissed from the last one. Despite this, he now claims to be a rich man who is not struggling financially. His mother brought him to the hospital, and his father died when he was 20 years old. Bill has not suffered serious behavioral disorders to require other mental hospital admissions. In the past, when he was hospitalized, there were no psychotic symptoms. 
Bipolar is a common and chronic psychiatric disorder, which mostly starts during adolescence or early adulthood. The mental disorder is characterized by drastic mood changes when there are recurrent episodes of mania and/or hypomania and episodes of depression. Detecting bipolar disorder in children and adolescents is challenging as the disorder has symptoms similar to other disorders. For instance, bipolar often has similar symptoms to other disorders such as attention deficit hyperactivity disorder (ADHD), unipolar depression, borderline personality disorder, and schizoaffective disorder. Among some adults living with bipolar disorder, the first manifestations of bipolar are during teenage years and sometimes this remains undiagnosed. Thus, proper diagnosis in childhood and adolescence is necessary to improve the long-term mental health outcomes. Bill openly admits to smoking marijuana for the past three years, and use has increased the past 6 months.
Among people living with bipolar disorder, the mood swings are intense and the changes extreme. In the manic episode, an individual will be very excited, irritable, and anxious, with moments of euphoria and hyperactivity. There may also be alterations in sleep and in the ability to concentrate. Bipolar and anxiety affect sleep patterns, and in turn, daily functioning as the patient is left feeling lethargic during the day. There is a tendency to act impulsively without assessing the risks or consequences of one’s actions. During a depressive episode, the bipolar client will feel very depressed, empty, have low motivation or self-esteem, and be inattentive. In extreme cases, there is a high risk of self-harm and suicide. The changes from one episode to another can occur during the same week or across several months. There are different types of bipolar disorder, where people can suffer from episodes of the depressive type, while other people suffer both episodes alternately. 
The client's vulnerabilities
Bill lives alone near his family and works in construction, but his work history is sporadic. He has been dismissed twice for being late to work without explanation. While he has a small circle of friends, he is more distant than ever before and is mostly staying indoors. Considering his health history, environment, and current symptoms, it is likely that Bill's mental health will deteriorate. Additionally, he is at high risk of other mental health issues stress, substance abuse disorder, and depression if there is no good social support. The lack of a stable job and strong relations places him in a vulnerable position, especially now that he is more socially withdrawn. At the moment, his family is the main source of social support, but his unwillingness to talk to them more often makes it more challenging for the family members to offer emotional support.
There is no known cause for bipolar disorder, but it is believed that the combination of genetics, chemical imbalance, and environmental factors explain the development of the disorder. Identifying environmental factors among people with bipolar disorder and living in different environments, presents challenges as there are various ways in which the environment affects mental health. Some of the factors are beyond the patient’s control, such as neurodevelopment and genetics. However, environmental stressors trigger bipolar disorder can be modified to improve one’s mental health.
Alcohol and substance abuse are some of the vulnerabilities that are associated with deteriorating mental health. Drug or alcohol use is risky for people diagnosed with bipolar, and it can also trigger the development of the disorder. Additionally, marijuana and alcohol increase the risk of the disorder among those who are predisposed to bipolar disorder. Bill has become withdrawn, he drinks and smokes marijuana, and Bill may experience anxiety if he does not seek mental health attention and does not get social support.
The client's triggers
Drinking and marijuana are not only sources of vulnerabilities as they are triggers. Recreational drug use increases the risk of dependence on the drug and, combined with insomnia, will likely trigger the condition and worsen his symptoms. Yet, until recently his mental health status has not been an issue of concern. Alcohol and drugs are associated with worsening the symptoms of bipolar in some people and especially those vulnerable to mental health problems. THC, the main psychoactive element in marijuana, has been linked to unusual thought patterns, unlike cannabidiol (CBD) (Elms et al., 2019). When mental health issues are already present, the prolonged use of marijuana is associated with worsening mental health outcomes (Lowe et al., 2019). This is a concern for adolescents and young adults already diagnosed with bipolar and other mental health disorders. Marijuana is at times used for self-medication among those with mental health problems, placing them at a higher risk of being heavy users.
Considering Bill’s medical history, mental health, previous problems with substance abuse, family history, and family support help to evaluate the client's psychological profile and risk of deterioration. Mental health deterioration has mostly been noticeable over the past two months. Considering the individual's life and mental health condition can offer clues on the triggers likely to worsen his condition. The lack of sleep is a precipitant of the disorder, and it is also a symptom of bipolar episodes. Thus, sleep deprivation is a trigger, but there is a tendency for there to be insomnia with bipolar than when living without the disorder. Dealing with different symptoms, including sleep deprivation, will help improve Bill's moods, but there is no guarantee that he will adhere to the medication.
Core Beliefs
Bill seems to believe that nothing is wrong with him, and others are misjudging him rather than let him live his life as he pleases as an adult who makes independent decisions. He states that he is a responsible drinker and drinking has not interfered with daily activities or functioning. He is also be reluctant to seek treatment. Bill is mostly drinking alone and does not go out for social drinking while living alone means fewer people know about his mental health struggles. However, he believes that there is no issue with having less contact with close family members and friends as he is just fine. He has expressed frustrations at suggestions that he seems to ignore others, making it more difficult to reestablish connections. He is also angry when there are suggestions that he needs to make changes in his life, as it appears to him that he is deemed unfit to make choices that affect him, and yet, he does not interfere with other people's lives. 
The most central thoughts client is avoiding.
The client's situation is partly linked to his circumstances, as he is bouncing from job to job and lacks strong relations with his family members and friends. He is also growing more anxious as he has not yet achieved stability. Stressful life events such as job dismissal are risk factors associated with the disorder and depression. The client has poor job prospects and lacks a concrete plan on how to improve his financial situation, and he keeps saying he is a rich man ...