Vignette 4

Isabella has the knowledge and skills to maintain her self-care activities. She can cook, clean, manage caring for a home and herself when she is feeling "normal". When she is "down" she does not bathe, wash her hair, dress, cook, shop or collect her mail or pay bills because she is "so tired" and has no energy. At other times she is feeling "too upbeat " and is "too busy" to maintain her home, clean, cook or pay bills but she does maintain her personal appearance- bathing and washing her hair, applying make-up and wearing jewelry. Isabella's recent depression has put her at risk for losing her housing for "not paying the rent, not removing trash and having smelly food in the house" when her frig went off due to not paying her electrical bill. Isabella puts herself at risk during both her recent manic phase when she was engaged in unprotected sex with several partners and when she was depressed and walked around her apartment complex late at night in an unsafe area. This walking has increased her "Soldier Hallucinations" which has decreased her ability to sleep and feel rested and increased her anxiety and her rapid heartbeat and palpations.

Isabella does not maintain her ADLs when she is either in her manic or depressive phase. She appeared today as unkempt and with poor personal hygiene having not bathed or washed her hair for several days to a week. Her movements and speech are markedly slow and she is tearful and fidgeting and picking at her clothes and hair. Isabella's irresponsible behavior has resulted in her electricity being turned off and her ex-husband had it turned back on and cleaned her home. This continued "rescuing" behavior on the part of her ex-husband is co-dependent and results in Isabella not having to take responsibility for herself and her behaviors. She was behind on her bills because she spent her money on gambling when she was in a manic phase. During this manic phase, Isabella does not apply limits to her life and becomes too self-involved to maintain her finances. This has put her at increased risk of losing her housing. Isabella's drinking continues to put her at risk when she engages in sexual activities that recently resulted in a "pregnancy scare". She is taking safety risks and has potential for self harm, although she denies it at this point. However, her walking in the park late at night may be an attempt for self-harm without hurting herself and being responsible to her family for her actions.