SAM CASE STUDY #2
1
Sam Case Study
Rocio Vega Arriaga
School of Behavioral Science, Liberty University
Author Note
Rocio Arriaga
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Rocio Arriaga.
Email: [email protected]
SAM CASE STUDY #2
2
Client Concerns
Symptoms
Behaviors
Stressors
Mood swings
Suicidal thoughts & poor
school performance
high & depressive episodes
Suicidal ideation
Thoughts of being dead
Mood shifts
Depression
Sadness, lack of enjoyment,
fatigue, sleeping 10 hours per
day, no appetite and difficulty
concentrating
Mother struggled long-term
depression. Sister struggles
with some depression.
Hallucinations
Hysterical & crying
uncontrollably
The voices she would hear
Manic Episode
1-2 hours of sleep, talking
nonstop, lots of energy
hallucinations
Assessment
Sam’s symptoms and behaviors along with the manic and depressive episodes she’s been
experiencing suggest a form of mood disorder. The most appropriate assessment for her would
be the Mood Disorders Questionnaire (MDQ) is a widely-used screening tool for Bipolar
spectrum disorders (BSD) with established sensitivity and specificity in detecting bipolar
disorder (BD) (Dumont et al, 2020). The MDQ is a self-administered screening instrument for
BD composed of three parts. The first part consists of 13 yes-or-no statements to identify
previous hypomanic or manic episodes; the second part consists of one yes-or-no question
regarding the simultaneous occurrence of symptoms; and the third part comprises one question
concerning the influence of the above symptoms (Wang et al, 2015).
SAM CASE STUDY #2
3
The assessment used to clarify diagnosis for the client was the Mood Disorder Questionnaire (MDQ), which is often used in the diagnosis of Bipolar I disorder. It is comprised of 13 items on a checklist that clients can easily answer and can be quickly scored by a clinician (Hirschfeld, 2002). Wang et al. (2019) found through metaanalysis that the MDQ was an effective screening tool for Bipolar disorders.The assessment used to clarify diagnosis for the client was the Mood Disorder Questionnaire (MDQ), which is often used in the diagnosis of Bipolar I disorder. It is comprised of 13 items on a checklist that clients can easily answer and can be quickly scored by a clinician (Hirschfeld, 2002). Wang et al. (2019) found through metaanalysis that the MDQ was an effective screening tool for Bipolar disorders. The assessment used to clarify diagnosis for the client was the Mood Disorder Questionnaire (MDQ), which is often used in the diagnosis of Bipolar I disorder. It is comprised of 13 items on a checklist that clients can easily answer and can be quickly scored by a clinician (Hirschfeld, 2002). Wang et al. (2019) found through metaanalysis that the MDQ was an effective screening tool for Bipolar disorders.
Diagnostic Impression
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Bipolar 1
disorder (F31)
All of the following information was taken from
the Diagnostic and Statistical Manual 5th Edition,
Text Revision (American Psychiatric Association,
2022) unless otherwise noted.
Client’s Signs/Reported Symptoms:
Criterion A: A distinct period of abnormally
and persistently elevated, expansive, or
irritable mood and abnormally and
persistently increased goal-directed activity or
energy lasting at least a week and present
most of the day, nearly every day (or any
duration if hospitalization is necessary)
Had a “high” episode that lasted 10 days.
Had “a manic episode” that lasted 12 days
Criterion B: During the period of mood
disturbance and increased energy or activity,
three (or more) of the following symptoms
(four if the mood is only irritable) are present
to a significant degree and represent a
noticeable change from usual behavior.
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual
6. Increase in goal directed activity
1. Expressed she saw herself as the most
significant author ever lived.
2. Reported sleeping 1-2 hours per night
during her manic episode.
3. Reported talking nonstop about what a
phenomenal she was & how she would not
forget her roommate when she was famous.
6. due to her energy she started writing her
novel and screenplay again.
Criterion C: The mood disturbance is
sufficiently severe to cause marked
impairment in social or occupational
functioning or to necessities hospitalization to
prevent harm to self or others, or there are
psychotic features.
She is placed in academic probation due to her
academic performance.
She received good evaluations until her last
depressive episode in her practical practice.
Taken to the hospital due to her manic
episode.
SAM CASE STUDY #2
4
Criterion D: The episode is not attributable
to the physiological effects of a substance
(e.g., a drug of abuse, a medication, other
treatment) or to another medical condition.
She reported no history of medical problems
and has never been on medication.
She reported never taken any kind of illegal
drugs or prescription medication that was not
prescribed for her.
Other DSM-5-TR Conditions Considered
There were symptoms and behaviors that suggest Major Depressive Disorder to be
considered due to her four-month episode of depression. Sam experienced feelings of
sadness, a lack of enjoyment, fatigue that led to her sleeping 10 hours per day, no
appetite and difficulty concentrating. For two weeks she experienced feelings of
overwhelming sadness followed by three months of feeling worthless and thought she
might be better off dead. Her manic episodes were the reason why I would dismiss
MDD.
Developmental Theories and/or Systemic Factors
Sam reported that her mother struggled long-term with depression. She also stated that
this was the primary reason for her parents’ divorce. This may be the reason why she has a closer
relationship with her mother than her father. I believe she can relate more with her mother
because they both have struggled with the same thing. She reported that her stepfather is more
tolerant of her mother’s ongoing sadness compared to her father that could not manage her
moods, this may be the reason why she has a “decent” relationship with this his of the family as
she expressed. Sam so also reported that her sister has some struggles with depression but
doesn’t think is paired with manic episodes. Technological advances have allowed for genome-
wide association studies that have pooled data and identified multiple genetic loci associated
SAM CASE STUDY #2
5
with bipolar patients (Rowland & Marwaha, 2018). Based on this information it is safe to say,
that Sam’s genetics play a big role with her mental health.
Multicultural and/or Social Justice Considerations
Sam is a 25-year-old single Caucasian female. She is the oldest of three children. Mother
and sister have also struggled with depression. Due to this problem her parents divorced because
her father could not manage her mother’s moods. She has not lived with any of her parents since
she was 23 years old, they both live in a neighboring state with their new families. Sam reported
that she grew up Catholic and attended mass every week until she started graduate school. She
stated that even though she doesn’t attend mass anymore, her faith in God is very important to
her and would like to integrate it into the therapy process. She is currently in matters of social
work program at a local university along with many of her friends, her roommate being her
closest friend. Her friendship is very important to Sam and doesn’t want for her mental health to
ruin it.
Key Issues for Treatment
●Suicidal recurrent thoughts
●Manic & depressive episodes
●Hallucination
Recommendations for Individual Counseling
I believe that for Sam CBT is the best treatment during individual counseling. Based on
my research “CBT for bipolar disorder rests on the premise that thoughts, feelings, and behaviors
are interconnected and that shifts in mood and cognitive processes during affective episodes
SAM CASE STUDY #2
6
influence behavior, all of which can lead to a vicious cycle that contributes to illness burden”
(Novick & Swartz, 2019). Eliminating and modifying these thoughts can help with the vicious
cycle. Sam seems to be in a cycle of manic and depressive episodes that lead to shifts in mood
and problematic behaviors. During the CBT process, the counselor helps the client link mood
and thoughts, recognize and monitor symptoms and prodromes, develop behavioral strategies for
symptoms, learn basic CBT techniques, improve sleep and activity routines, improve medication
adherence, and resolve psychosocial problems (Novick & Swartz, 2019). This kind of counseling
can be administered individually or in a small group and can include other strategies, such as
MBCT.
I would refer Sam for a medical evaluation because of her rapid mood shifts and
thoughts. Especially since she reported that some of her family members also struggle with their
mental health. She could benefit from mood stabilizers. Medication can help improve or reduce
the mood swings and improve her manic and depressive symptoms. If these symptoms are
controlled, it can benefit therapy.
Specific Considerations
Sam has been experiencing depressive and manic episodes that has led to a problematic
cycle. Since her manic and depressive cycles are not consistent and each cycle comes with
different symptoms this can impact the diagnosis and treatment. Females are more likely to
experience rapid cycling and mixed states, and to have patterns of comorbidity that differ from
those of males. I am afraid that she might not carry through an entire treatment. This is
something to keep in mind as the counselor works with Sam.
SAM CASE STUDY #2
7
References
DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. (2022). Arlington,
VA: American Psychiatric Association.
Dumont, C. M., Sheridan, L. M., Besancon, E. K., Blattner, M., Lopes, F., Kassem, L.,&
McMahon, F. J. (2020). Validity of the mood disorder questionnaire (MDQ) as a
screening tool for bipolar spectrum disorders in anabaptist populations. Journal of
Psychiatric Research, 123, 159-163. https://doi.org/10.1016/j.jpsychires.2020.01.011
Novick, D. M., & Swartz, H. A. (2019). Evidence-Based Psychotherapies for Bipolar Disorder.
FOCUS, 17(3), 238–248. https://doi.org/10.1176/appi.focus.20190004
Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar
disorder. Therapeutic advances in psychopharmacology, 8(9), 251–269.
https://doi.org/10.1177/2045125318769235
Wang, H.R., Woo, Y.S., Ahn, H.S., Ahn, I.M., Kim, H.J. and Bahk, W.-M. (2015), THE
VALIDITY OF
THE MOOD DISORDER QUESTIONNAIRE FOR SCREENING BIPOLAR
DISORDER: A META-ANALYSIS. Depress Anxiety, 32: 527-
538. https://doi.org/10.1002/da.22374
