Solution
Azra S answered on
Nov 09 2021
Medical Refe
al Lette
Date: November 8, 2020
TO,
[ATTN]
[ADDRESS]
[POSTAL CODE]
[COUNTRY]
Subject: Letter of Medical Necessity
To Whom It May Concern/Dear Dr.,
I am refe
ing Mr. Arthur Bright for evaluation and consideration for Bipolar II medication.
I have been providing therapy to Mr. Bright for 5 sessions now.I have used CBT to manage his symptoms and reduce dissociation. However, the symptoms seem to be increasing and he reports suicidal thoughts lately.
Medications will definitely assist him to deal with depression and dissociation. This will help with his symptoms so he can continue his studies and improve his quality of life.
Regards
Yojana Khatiwada
Case formulation
Personal Details: The name of the patient is Arthur Bright. He is 21 years of age and is cu
ently pursuing higher studies.
Presenting problem: The patient has been showing persistent signs of severe depression, insomnia and mood swings. He has even reported having suicidal thoughts.
Case Presentation: The patient is a college student in his early twenties. He lives alone in a shared apartment. He has a younger
other and father who live together in another city. His mother who suffered from Bipolar 2 Disorder, is deceased.
Symptoms and Diagnosis: Arthur has been complaining of his inability to sleep at night and poor concentration and mood swings. His symptoms began after his mother passed away 3 years ago. He moved out of his family home and started to live in a shared apartment. His symptoms gained momentum after he joined college and was unable to score well in exams, even though the subject he pursued was one he was quite committed to.
He has experienced hypo manic episodes around two times in the past year which lasted for four days each. He slept for hardly 3-4 hours in those days and had a constant feeling of being high.
This was followed by a day of extreme depression where he lacked any energy or motivation to do anything and unpredictable mood changes. He was also unable to sleep properly for several days.
Arthur has very low self-esteem and blames himself for his inability to perform well in his studies or find a job. His mother was a severe Bipolar patient. She was hospitalized on several occasions. In addition to this, she was physically abusive to him and his
other. She eventually died of a heart attack 3 years ago. She also constantly abused him emotionally by declaring that he was good for nothing. His father was very strict and distant. Being bullied at college makes things even worse for him. Arthur keeps away from his younger
other because he fears that he will negatively affect his
other or cause him harm. He has no social life at all.
His roommate is a very social person and generally has college students come over which makes Arthur really uncomfortable and he feels out of place around them. He feels that he doesn’t belong anywhere and that he should not exist.
Arthur has reported increasing loss of interest in day to day activities. He finds it difficult to attend regular college classes, and doesn’t find the will or the ability to find a job. As a result of this, his father who was financing his studies till now, is threatening to pull away his financial support.
Arthur also complains of feelings of detachment from his su
oundings.
He faces difficulty in studies as he sometimes phases out during lectures/classes. He is bullied by his college mates due to being extremely reserved and awkward. Sometimes, he is even ridiculed by his teachers and all of this has had a strong negative impact on him regarding himself, the society and his life in its entirety. Based on his symptoms, Arthur is showing signs of bipolar 2 disorder (Judd, 2003)
Diagnosis: Bipolar 2 Disorders
Predisposing factors (contributed over lifetime): Mother had bipolar 2 disorder and was physically abusive. He has no deep connection with family.
Precipitating factors (trigger onset of illness): Death of mother, Bullying at college.
Perpetuating (maintain negative symptoms): Severed contact with family, lack of job, father threatening to stop financial aid, low grade at college, lack of friends.
Protective factors: Will to complete studies, art, enjoys painting, way of expressing himself.
Treatment Plan:
CBT is a form of psychotherapy that aims at changing emotions and feelings by changing thoughts and behavior. It is a form of talk therapy that focusses on the present and the future.
According to CBT approach emotions, behaviors and thoughts affect each other therefore negative thinking/cognitive distortions cause negative emotions and lead to depression and unwanted behavior and mood changes.
We see several cognitive distortions in Arthur’s way of thinking, for example:
Labeling: He labels himself as a failure
Jumping to the conclusion: He concludes that he will never be able to land a job or finish his studies and that he will be a negative example for his younger
other. We also find him mentally filtering out all the positive thoughts and disregarding the many skills that he has.
For Arthur’s treatment, I propose using a combination therapy i.e. we apply both CBT as well as medication to improve his symptoms (Gonzalez‐Pinto et al, 2004). Cognitive behavior therapy will help him improve his condition gradually and medication will help control the symptoms and provide immediate relief to his troubled mind and nerves.
As a part of CBT, the first step of Arthur’s treatment plan will focus on building a positive trusting therapeutic relationship with him. He needs to feel safe and heard. He needs to trust me so that he will be willing to do what I ask...