6090 Week 6 - Discussion: Applying Differential Diagnosis to Depressive and Bipolar Disorders
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CASE OF ANGEL
INTAKE DATE: May 2019
DEMOGRAPHIC DATA:
This is a voluntary intake for this 53-year-old Hispanic male. Angel had one psychiatric hospitalization in the past. Angel has been married for 19 years and has been separated from his wife for the past four months. His wife, daughter, and two sons live two blocks from him. Angel is employed as a car salesman manager and is very successful at his career.
CHIEF COMPLAINT:
"I miss my family and do not want to live without them. My wife said if I attend treatment we can get back together."
HISTORY OF ILLNESS:
Angel reports first seeking psychiatric treatment when he was twenty-four-years-old. He sought treatment by the encouragement of his girlfriend at the time because she described him as strange. He was always excited and was “on top of the world.” He would buy her a lot of gifts, which she appreciated, but she later found out he charged everything and did not have the money to pay for the gifts. He was employed at a car dealership and was washing cars at the time. Sometimes he would become very irritable when he saw the credit card bills months later. His focus was on advancing his career and he believed he could be in charge of the entire car dealership in a short period of time. He always was a fast talker but during this period his girlfriend could not get a word in edgewise. She hated how he would be up most of the night. She needed to sleep to get to work but a few hours of sleep did not seem to affect Angel. This behavior seemed to settle down after a while, and Angel did not continue psychiatric help.
At thirty-four-years-old he attempted suicide after his wife of one year left him. He was hospitalized in a psychiatric unit for twelve days. Angel showed signs of feeling down, fearful, and suicidal. His wife indicated he would become very agitated and would sometimes punch the wall. She feared she would be the victim of some of his acting out. For a few weeks, he would not get out of bed or go to work because he said he could not concentrate on work he was feeling so bad.
PSYCHOSOCIAL HISTORY:
Angel grew up in an average household with both parents working in a factory. His dad was eventually promoted to foreman. Mom and Dad would have different shifts so it was rare that they would have dinner together. Angel has nice memories about Sundays since the family would go to church and have a nice dinner. Many of the relatives would gather each week at a different house. Angel has 6 siblings. Angel was initially considered an underachiever in the early years of school. He chose not to attend college because he wanted to get out in the work force for money.
SUBSTANCE USE HISTORY:
Angel indicates he is a social drinker. Through collaborative contact from his wife, she confirms he is a social drinker. One worry she has is recently when he had reported feeling down, she believed his alcohol intake increased slightly which was very different than his normal behavior.
MEDICAL HISTORY:
Angel has no significant medical history.
FAMILY ISSUES AND DYNAMICS:
Angel is currently married with three children, one daughter and two sons. This is his only marriage. Through collaborative discussion with his wife, she indicates Angel is a great dad and good provider. There was that one incident when he was hospitalized but overall, their relationship has been good.
More recently, Angel has been feeling depressed again. This feeling has been on and off but has been more consistent these past few months. He then would have angry outbursts and act out and punch the wall. His wife believed this was due to his lack of sleep. He says he is always tired but has difficulty sleeping, and she noticed he would play video games most of the night. He would then have a difficult time to go to work in the morning.
MENTAL STATUS EXAM:
Angel presents as a neatly dressed male who appears younger than his stated age. His nails are neatly groomed. Facial expressions are appropriate to thought content. Motor activity is appropriate. Thoughts are logical and organized. There is no evidence of hallucinations. Angel admitted to a history of suicidal ideation. During the interview, Angel talked slowly. Angel is oriented to time, place, and person. His intelligence appears above average.