CASE STUDY ASSIGNMENT #2
Case Study Assignment #2
Author Note
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to
Cathy De Freitas
Email: cbdefreitas@liberty.edu
School of Behavioral Sciences, Liberty University
Criterion A: A distinct period of abnormally
and persistently elevated, expansive, or
CASE STUDY ASSIGNMENT #2
Case Study Assignment #2
Client Concerns
Assessment
The Structured Clinical Interview for DSM-IV (SCID) is a semi-structured interview that
is regarded the gold standard for psychiatric diagnosis accuracy and reliability (Brodey et al.,
2018b). I’ll be using the SCID to determine if Sam is suffering from Bipolar disorder I.
Diagnostic Impression
My primary diagnostic impression is Bipolar Disorder I 296.43 (F31.13). The secondary
disorder impression I had was PTSD 313.89 (F94.1) but, in the end, I came to only one diagnosis
for the case of Sam because reported symptoms fall perfectly into the Bipolar Disorder I
category.
Signs and Symptoms
DSM-5 Diagnostic Criteria: Bipolar Disorder I Client’s Signs/Reported Symptoms:
296.43 (F31.13) Manic Episodes
Mood swings
Symptoms
Mood swings
Trouble sleeping
Manic episode
Depressive episode
Excessive sleep
No appetite
Difficulty concentrating
Suicidal thoughts
Behaviors
Extreme behavioral
changes Hallucination
Hyperactive
Lethargic
Fatigued
Not eating appropriately
Slacking with schoolwork
Overthinking
Stressors
Bipolar disorder
BD
BD
BD
BD
BD
BD
BD
CASE STUDY ASSIGNMENT #2
irritable mood and abnormally and
persistently increased activity or energy,
lasting at least 1 week and present most of the
day, nearly every day (or any duration if
hospitalization is necessary).
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:
Inflated self-esteem or grandiosity.
Decreased need for sleep (e.g., feels rested
after only 3 hours of sleep).
More talkative than usual or pressure to keep
talking.
Flight of ideas or subjective experience that
thoughts are racing.
Distractibility (i.e., attention too easily drawn
to unimportant or irrelevant external stimuli),
as reported or observed.
Increase in goal-directed activity (either
socially, at work or school, or sexually) or
psychomotor agitation (i.e., purposeless non-
goal-directed activity).
Excessive involvement in activities that have
a high potential for painful consequences
(e.g., engaging in unrestrained buying sprees,
sexual indiscretions, or foolish business
investments).
Sam reported needing to sleep only one to two
hours per night for the 12 days and that she had a
lot of energy. Sam added that her roommate
reported that she was terrible to live with during
those 12 days, talking incessantly about what a
fantastic author she was and how she would
remember her roommate when she became
famous.
CASE STUDY ASSIGNMENT #2
Criterion C: The mood disturbance is
sufficiently severe to cause marked
impairment in social or occupational
functioning or to necessitate hospitalization to
prevent harm to self or others, or there are
psychotic features.
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 another medical condition.
Sam reported having suicidal ideation without
specific plans. She also experienced sadness,
a lack of enthusiasm in any of her typical
activities, weariness, low appetite, and
difficulties concentrating.
She found little pleasure in her daily tasks,
sleeps 12-13 hours a day, felt worthless, and
had difficulty concentrating.
Depressive Episodes Criterion A: Five (or more)
of the following symptoms have been present
during the same 2-week period and represent a
change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2)
loss of interest or pleasure.
Depressed mood most of the day, nearly every
day, as indicated by either subjective report (e.g.,
feels sad, empty, or hopeless) or observation
made by others (e.g., appears tearful).
Markedly diminished interest or pleasure in all, or
almost all, activities most of the day, nearly every
day (as indicated by either subjective account or
observation).
Significant weight loss when not dieting or weight
gain (e.g., a change of more than 5% of body
weight in a month) or decrease or increase in
appetite nearly every day.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every
day (observable by others; not merely subjective
feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or
Sam hallucinated, she was hospitalized because
she began to hear voices telling her she was a bad
writer, causing her to become upset and cry
uncontrollably.
CASE STUDY ASSIGNMENT #2
Criterion B: The symptoms cause clinically Sam was not going to be able to begin her
significant distress or impairment in social,
internship because she had not been attending
occupational, or other important areas of
functioning.class and had completed very few homework.
Her grades were poor, and she had been
placed on academic probation. She expected
to be kicked out of the program at the
conclusion of the semester.
Criterion C: The episode is not attributable to Sam had never been on medicine and had no
the physiological effects of a substance or
history of medical concerns. Social alcoholic
another medical condition.
consumption.
Other DSM-5 Conditions Considered
The client reported symptoms of PTSD 313.89 (F94.1) such as agitation, difficulty
thinking and concentrating, and difficulty falling asleep, while she experienced a manic episode.
However more symptoms were reported that best fit into the bipolar disorder category.
Developmental Theories and/or Systemic Factors
Sam’s family history seems to play a part on her current mental health condition. She
reported that her mother suffered from depression and that was the main reason her parents
divorced when she was a teenager. She also reported that her sister suffers from depression just
inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or
guilt about being sick).
Diminished ability to think or concentrate, or
indecisiveness, nearly every day (either by
subjective account or as observed by others).
Recurrent thoughts of death (not just fear of
dying), recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific
plan for committing suicide.
CASE STUDY ASSIGNMENT #2
like her mother. Even though she did not report that her mother had been diagnosed with bipolar
disorder specifically, there is a possibility that her mother’s mental illness passed down to Sam
with a different diagnosis. According to numerous research, people with bipolar disorder
frequently have at least one close relative who suffers from depression or bipolar disorder
(American Psychiatric Association et al., 2013).
Multicultural and/or Social Justice Considerations
The DSM-5 states that environmental factors such as stress, sleep disruption, and drugs
and alcohol can induce mood episodes in vulnerable people (American Psychiatric Association et
al., 2013). Sam is experiencing a lot of school related stress trying to finish her master’s
program. Also, even though she reported that her relationship with her parents is ok, she doesn’t
seem to have a lot of emotional support and presence from family because they live far apart.
Treatment Recommendations
Key Issues for Treatment
Depressed mood episodes
Sleeping dysregulation
Manic episodes
Recommendations for Individual Counseling
I would recommend cognitive behavioral therapy for Sam’s case. CBT can effectively
identify unfavorable assumptions and thought processes and push the client to practice more
adaptive thinking. CBT can ensure the client keeps engaged with rewarding components of their
environment when they're depressed, and when they're manic, it ensures they're not overworked
(Different Types of Therapy for Bipolar Disorder, NAMI, 2019).
CASE STUDY ASSIGNMENT #2
Interpersonal and Social Rhythm Therapy (IPSRT) is another treatment I would
recommend for Sam. IPSRT is a psychotherapy with a focus on the client’s social rhythms or
daily routines. The client notes their bedtimes, waking hours, and activities on a daily basis, as
well as the consequences of changes in these patterns on their moods (Douglas et al., 2022).
Specific Considerations
A client being in crisis changes the focus of my assessment to the immediate need of the
client, I need to able to assess the client’s problem as quickly and effectively as possible. I need
to be able to meet the client where she/he is and have efficient strategies to stabilize the crisis
and improve functioning. If the client is seeking treatment because of a crisis, it means that
he/she is probably desperate and is making a last-ditch heroic effort to get well. This also means
that they could be more open and willing to receive the treatment, suggested goals and working
alliance with me.
CASE STUDY ASSIGNMENT #2
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Brodey, B., Purcell, S. E., Rhea, K., Maier, P., First, M., Zweede, L., Sinisterra, M., Nunn, M. B.,
Austin, M. P., & Brodey, I. S. (2018b). Rapid and Accurate Behavioral Health Diagnostic
Screening: Initial Validation Study of a Web-Based, Self-Report Tool (the SAGE-
SR). Journal of Medical Internet Research, 20(3), e108. https://doi.org/10.2196/jmir.9428
Different Types of Therapy for Bipolar Disorder | NAMI: National Alliance on Mental Illness.
(2019). Nami. https://nami.org/Blogs/NAMI-Blog/April-2019/Different-Types-of-
Therapy-for-Bipolar-Disorder
Douglas, K. M., Inder, M. L., Crowe, M. T., Jordan, J., Carlye, D., Lacey, C., Beaglehole, B.,
Mulder, R., Eggleston, K., Donovan, K. A., Frampton, C. M. A., Bowie, C. R., & Porter,
R. J. (2022). Randomised controlled trial of Interpersonal and Social Rhythm Therapy
and group-based Cognitive Remediation versus Interpersonal and Social Rhythm Therapy
alone for mood disorders: study protocol. BMC Psychiatry, 22(1).
https://doi.org/10.1186/s12888-022-03747-z
