Vignette 4

Choose the best narrative for the domain, Medical Health

Narrative A:  Medical Health
Narrative B:  Medical Health

Axis III- Hyperthyroidism. Non-compliant with medications- including psychotropic. Does not test as needed. Fails to keep scheduled appointments and does not follow through on recommended medical interventions. Has trouble scheduling appointments due to limited resources.

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.