The focus of this case study is a 28-year man Ahmad diagnosed with bipolar disorder. First, his condition will be defined and then all the components of his performance and occupational engagement will be considered and assessed in terms of his condition. It is essential to assist Ahmad in achieving his occupational goals by recommending him certain inventions in occupational therapy. Identifying the issues of occupational performance is done on the basis of the model of human occupation. Ahmad is introduced through Person environment-occupation model.
A single 28-year-old male, Ahmad, is diagnosed with bipolar disorder that affects the brain functioning and makes a person unstable in moods. Extreme moods can even worsen to the psychosis symptoms when a person does not distinguish between the imaginary and real events. According to Sajatovic et al., there are numerous bipolar disorder types, in particular Bipolar I, Bipolar II, Cyclothymic Disorder, BP-NOS (Bipolar Disorder Not Otherwise Specified), and others. Those who suffer from bipolar disorder have “mood episodes” with emotional states of extreme intensity when the typical behavior and mood of a person changes drastically. For instance, a manic episode is characterized with excessive excitement; a depressive episode implies hopelessness, while a mixed state has the symptoms of both. Other symptoms of a mood episode are explosiveness, irritation and drastic changes in sleep and activity patterns. The factors, which cause bipolar disorder, include brain chemicals, genetics, diseases, or environmental issues, although the major cause is still not discovered. Ahmad’s grandmother was diagnosed with bipolar disorder seven years before death. Ahmad’s psychiatrist recommended him to undergo occupational therapy assessment and intervention to facilitate his engagement and occupational performance.
Environment and Occupation:
Being a Latrobe University art student from Emirates, Ahmad is currently doing his bachelor degree. He lives alone in a one-bedroom apartment and has a part-time job in a café. He has few friends in Australia and spends time watching TV, working out at the gym and studying.
Occupational Performance Issues:
The impact of the bipolar disorder on Ahmad’s engagement and occupational performance is demonstrated via the MOHO model. All aspects of occupation are taken into consideration, in particular capacity, habituation and volition. Ahmad’s engagement can also be facilitated or hindered with different environmental factors. Being at the depressive bipolar stage, Ahmad experiences the following impacts on his daily life:
- Sleep disorder
Plante and Winkelman point out sleep disturbance as a feature of depressive bipolar stage. Having modification at the low level, Ahmad can stay in bed the whole day. He used to be able to do sleep habitation, but he lost that ability. He used to wake up at 7 a.m., work part-time and study at the university. His usual time for going to bed used to be 11 p.m. However, currently Ahmad cannot get out of his bed, being affected with bipolar disorder.
- Eating disorder
Jen et al. emphasize the impact of bipolar on the eating habits. Ahmad used to like going to Middle Eastern restaurants in Coubrg every weekend. His volition to do that was good and he really enjoyed eating Arabic traditional food. Having been diagnosed with the bipolar disorder, he lost his motivation and habits. Eating does not please him, so he has only some bread, chips and soft drinks every day.
- Studying at the University
Studying is not interesting for Ahmad any more. He has no desire or volition to go to university or do his assignments. The bipolar disorder has also affected his performance capacity; so, it is challenging for him to listen carefully in class, understand the contents of the units or remember the date when the assignments are due. Ahmad misses important group meetings because of the issues with his memory.
- Self Care and Hygiene
Ahmad used to have a habit of taking a shower every morning. He also used to shave his face once a week. However, the bipolar disorder influenced his motivation to follow the rules of self care and hygiene. Currently, he is not taking care of his body.
Occupational Therapy Assessment
Ahmad’s poor motivation can be an impediment to adaptive functioning. According to De las Heras et at., the consequences of Ahmad’s motivation problems can be his suboptimization, making wrong choices while engagement in occupation, and avoiding occupational performance. The occupational therapist can use the collected data about Ahmad’s motivation via Volitional Questioner assessment. Then he identifies which motivational barriers hinder the man’s functioning. The data are helpful in planning the intervention measures for Ahmad. Using VQ, the therapist can assess the volition of those clients who have limited verbal, physical or cognitive abilities and cannot communicate.
MOHO or model of human occupation is the VQ theoretical basis. The concept of volition implies occupational motivation expressed in feelings and thoughts regarding the values, interests and capacities (personal causation). The ongoing process of volition implies dynamic interaction with people and environment, making choices, getting experience and reflecting over occupations. The motivation cannot be the same in different environments. Kielhofner points out that volition is affected with the salient features of the administered environments.
There are fourteen VQ items that show the characteristics of Ahmad’s volition through his observable behavior. It is recommended that 15-30 minute observations of Ahmad should be done in different environments and situations. Having completed the observation, an occupational therapist rates every item according to 1-4 rating scale. Thus, it is possible to analyze the degree of Ahmad’s spontaneous motivation versus the one that requires encouragement, structure or support to be engaged in the types of behavior which indicate volition. All characteristics of social and physical environment that impact the volition are also observed and recorded.
- Shows curiosity
- Initiates action/tasks
- Tries new things
- Shows pride
- Seeks challenges
- Seeks additional responsibilities
- Tries to correct mistakes/failures
- Tries to solve problems
- Shows preferences
- Pursues an activity to completion/accomplishment
- Stays engaged
- Invests additional energy/emotion/attention
- Indicates goals
- Shows that an activity is special or significant
Ahmad’s long-term goal (in 8-10 weeks) is to get back to university. He will be able to focus on his studies and communicate with his peers.
Ahmad’s short-term goals (in 4 – 6 weeks):
- to increase the concentration level;
- to improve and develop communication abilities.
Occupational therapy innervations strategies include the following:
- CBT or Cognitive Behavior Therapy
Occupational therapists apply CBT techniques to impact the dysfunctional relation between the emotions and thoughts of a client with the behavior. Parikh singles out the following approaches to people with bipolar disorder: teaching them regulation and self-control, and development of coping skills for depressive and maniac episodes. Thus, concentration of Ahmad can be improved with Cognitive Behavior Therapy.
- OT Run Groups
A large variety of leisure groups are organized and run by occupational therapists both in the community and within a clinic. The groups are engaged in activities chosen by the participants; they are music, outdoor walking, watching movies, playing badminton, doing pottery, painting, etc. Swartz also points out the possible focus of the groups on learning skills of social interaction, problem solving and communication; afterwards, those skills can be applied. The OT run group is suitable for Ahmad with bipolar disorder as he needs to work on improving his communication skills.
In the present case report I used the condition of a bipolar disorder, introduced the client, presented the issues related to his occupational performance and developed a case study. Furthermore, I provided thorough explanation of the suitable occupational therapy assessment approach. Finally, I presented the long-term and short-terms goals along with two strategies of intervention.