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Expressed Emotion in a Woman with Bipolar Disorder: a Case Report from Deli Serdang

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Expressed Emotion in a Woman with Bipolar Disorder: a Case Report from Deli Serdang Open Access Maced J Med Sci electronic publication ahead of print, published on August 28, 2019 as https://doi.org/10.3889/oamjms.2019.400 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. https://doi.org/10.3889/oamjms.2019.400 eISSN: 1857-9655 Neuroscience, Neurology and Psychiatry Expressed Emotion in a Woman with Bipolar Disorder: A Case Report from Deli Serdang Indah V. Putri*, Elmeida Effendy Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia Abstract Citation: Putri IV, Effendy E. Expressed Emotion in a BACKGROUND: Aretaeus of Cappadocia first described the bipolar disorder in 30 Masehi. Falret separated this Woman with Bipolar Disorder: A Case Report from Deli disorder and called it folie circulaire in 1854. A bipolar patient had a change in mood from depression to mania Serdang. Open Access Maced J Med Sci. https://doi.org/10.3889/oamjms.2019.400 and vice versa while having normal (euthymic) mood period in between. She experienced mood fluctuations that Keywords: Case Report; Bipolar Disorder; Expressed were typical of bipolar disorder. This case report was aimed to understand the personal experience of a bipolar Emotion patient confronting her mood changes and expressing their emotions. *Correspondence: Indah V. Putri. Department of Psychiatry, Faculty of Medicine, Universitas Sumatera CASE REPORT: We presented a case of a 25year-old bipolar woman, makeup artist, unmarried, from Batak Utara, Medan, Indonesia. E-mail: tribe. She came alone to seek treatment from a psychiatrist for her mood changes that she could not comprehend. [email protected] Received: 11-Jul-2019; Revised: 13-Aug-2019; CONCLUSION: We provided psychoeducation to help her recognise her bipolar disorder and direct her emotional Accepted: 14-Aug-2019; Online first: 28-Aug-2019 expression to more positive things, in her case, makeup and writing. Copyright: © 2019 Indah V. Putri, Elmeida Effendy. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) Funding: This research did not receive any financial support Competing Interests: The authors have declared that no competing interests exist Introduction occur unexpectedly and lasts between 2 weeks to four-five months. People with bipolar disorder experience these phases of feeling in their lives [3], The bipolar disorder is well known as the [4], [5]. manic-depressive disorder. It is a mood disorder Bipolar disorder is a significant mental health identified by extreme mood fluctuations ranging from problem in 2-4% of the population. This may be due to euphoria to severe depression and having a normal frequent recurrence and many adverse effects. It has (euthymic) mood period in between [1]. Bipolar comes a severe impact on patients, families, and society [6]. from two words: bi and polar. Bi means two and polar Bipolar disorder is difficult to be established, means pole. Bipolar literal means as a disturbance of considering its overlapping symptoms with other feeling with two opposite poles, depression and mania psychiatric disorders like schizophrenia and [2]. Depression defines as an emotional state schizoaffective. This overlapping leads to the different characterised by intense sadness, feeling of prevalence of the schizoaffective disorder, worthlessness and a sense of guilt, self-withdrawing, schizophrenia, and bipolar disorder in each study [7]. and losing interest in usual daily activities. Depressive episodes tend to last longer (around six months) but The essential difference between bipolar and rarely exceed a year. non-bipolar people is that bipolar patients have excessive sadness or elevated mood without a logical Mania defines as an emotional state with reason. A simple trigger could cause extreme grandiosity, irritability, hyperactivity, excessive talking, sadness, and prolonged depression and the patients and thought and attention distractibility. Mania can find it difficult to escape those feelings [2]. _______________________________________________________________________________________________________________________________ Open Access Maced J Med Sci. 1 Neuroscience, Neurology and Psychiatry _______________________________________________________________________________________________________________________________ Mood changes experienced by bipolar work. Writing books was another hobby of hers to patients create personal suffering. Their emotion pour her mind and perspective of life. She felt more explodes in manic episodes. This causes some comfortable writing her feeling into books than problem to maintain their relationships. They have discussing it directly with others. She intended markedly diminished interest, including in social publishing the book in the future. activities during the depressive period. Bipolar people The patient stated she never told her family were uncertain about how to overcome the mood about her current condition and the need to seek the changes they cannot comprehend. Life of bipolar help of a psychiatrist. She felt her family would hate patients with fluctuating mood attracted author to have her if they knew her current condition and overburden a better understanding of how the person with bipolar her even more. The patient confined herself in her disorder accepts her condition and diagnosis and their room and chose not to go anywhere, including work, attempts to direct her emotional expression to more whenever she experienced extreme sadness. This positive things [2], [7], [8]. condition could happen for several days. Her boss would worry about her for not call in sick. When the boss confronted her, she only apologised without telling her actual condition. She would gain back her Case Report confidence after her boss told her some customers were asking her specifically to do their make-up. The patient was evaluated at 11 AM, and she A 25-year-old female unmarried makeup artist was well-oriented of place, time and person. She had from Batak tribe presented herself to the Psychiatric expansive with appropriate effect. No hallucination Department of Lubuk Pakam Hospital. Her face was and illusion were found. Grandiose ideas were found. appropriate for her age, with neatly-combed-black Nevertheless, they did not fulfil the criteria of delusion. hair. During the interview, the patient appeared calm, Long-, medium-, short-term and immediate memories her verbal and visual contact was sufficient, and she were good. There was a minor miscalculation. The was cooperative. examiner found no deja vu, jamais vu, or other She could correctly mention her name, paramnesia disorders, and no nightmare was found. address, age, and current whereabouts. Her chief She provided honest insight into her condition (level complaint has been difficult to sleep at night since last V). She denied any history of using psychoactive month. Her usual sleep routine was from 9 PM till the substances and alcohol, confirmed by a urine morning. Nowadays, she would wake up around 11 examination. There was no prior head trauma. PM because her head was full of fast-changing ideas, After a discussion, she was diagnosed with making her difficult to go back to sleep. The idea was bipolar affective disorder, current episode manic to set up a large cosmetics company recruiting many without psychotic symptoms (F31.1). We employees and collaborate with other companies. recommended her to have daily routine light exercise Another idea was that she wanted to be an active and and pray and provided psychoeducation. dominant spokesperson in her community and Psychoeducation was aimed to help her recognise the became a chief executive officer. She identified this disorder and direct her emotion to the more positive overflowing feeling for at least a year, but the last things, in this case, makeup and writing. month was so disturbing, she had difficulty sleeping. On the other hand, she had a prior feeling of intense sadness when she was nostalgic or failing to get to university and growing up in a dysfunctional family. She had those feelings of sadness throughout the Discussion year and confessed that she had several suicidal thoughts on multiple occasions. The concept of mental disorders cited from Parents raised her with a modest International Statistical Classification of Disease and socioeconomic life. The patient said her family was Related Health Problems 10th Revision (ICD-10) dysfunctional. Her father assaulted her mother and referring to the DSM-IV is a syndrome characterised repeatedly said disrespectful words when scolding her by clinically significant disturbance in an individual's and her siblings. The patient lived with her parents cognition, emotion regulation, or behaviour that until she graduated from junior high school. She did reflects a dysfunction in the psychological, biological, not complete her education because of her low or developmental processes underlying mental income. She moved to the city to earn some money functioning [5], [8]. and maintained several jobs, including; a restaurant waiter, a household assistant, a cleaning staff at a Bipolar disorder, based on the International publishing company, and currently a makeup artist in Statistical Classification of Disease and Related a beauty salon. She enjoyed her current job because Health Problems 10th Revision (ICD-10), had she could express herself eloquently. Both her boss repetition on how patients show how they feel. There
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