CASE STUDY 1
Case Study: Sam
Hannah Wood
School of Behavioral Sciences, Liberty University
Client Concerns
Symptoms Behaviors Stressors
Mood Swings Suicidal ideation School, schoolwork load,
Manic Episodes Productive, Lasted more than 12 days,
Hallucinating Hear voices Lack of sleep,
Sadness Depression, crying
uncontrollably, felt sad
daily, tearful
Relationships, schoolwork
CASE STUDY 2
Fatigue Lethargic, no appetite,
difficulty concentrating
Sleeping only 1-2 hours a
night
Depression Depressive episodes Friendships, relationships
Assessment.
One assessment that could be used is the mood disorder questionnaire (MDQ). The
mood disorder questionnaire is a common assessment tool for bipolar disorders (Mundy et al.,
2023). The MDQ is used worldwide, and it involves 13 aspects of mania, symptom duration,
functional impairment, and family history of bipolar (Mandy et al., 2023).
Diagnostic Impression
Based on the DSMR-5-TR Sams symptoms closely align with F31 bipolar I Disorder
(American Psychiatric Association, 2022). Sam is experiencing mood swings and is experiencing
“high” episodes. Sam reported she is experiencing increased self-esteem and a decreased need
for sleep.
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Bipolar I
Disorder (F31)
Client’s Signs/Reported Symptoms:
Criterion A: Consistent heightened or
irritability and increased energy that lasts one
week for most of the day everyday (American
Sam reported that one of her episodes lasted
for 12 days. Sam reported her sleep
decreased and she had lots of energy.
Psychiatric Association, 2022).
Criterion B: During a mood disturbance and
increased energy three or more symptoms
must be presence
1. Increased self esteem
2. Reduction of sleep
3. Talkative
4. Racing thoughts
5. Easily distracted
6. Heightened goal directed activity
7. Involvement in activities with painful
consequences
(American Psychiatric Association, 2022).
Sam reported she thought she was writing
the world’s greatest book and movie. Sam
also reported she only slept for one to two
hours a night resulting in her having lots of
energy. Her roommate reported that she was
very talkative
CASE STUDY 3
Criterion C: The mood disturbance is severe
enough to cause impairment in social and
occupational functioning and the need for
hospitalization due to harm of self or others.
(American Psychiatric Association, 2022).
Sam reported many occurrences of suicidal
ideation. Sam reported her roommate took
her to the ER when Sam reported she was
hearing voices and was crying uncontrollably.
Criterion D: Not caused due to the effects of a
substance or medical condition. (American
Psychiatric Association, 2022).
She was given medication and took for about
a week. Sam reported she was able to rest,
and the episode ended.
Other DSM-5-TR Conditions Considered
Some of the symptoms that Sam reported lead to other possible diagnosis. Sam reported
hallucinating and said she was hearing voices. This aligns with brief psychotic disorder although
Sam experienced hallucinations her symptoms more closely algin with bipolar disorder which is
why brief psychotic disorder was ruled out. Another DSM-5-TR diagnosis that was looked at was
major depressive disorder. Sam experienced most symptoms, but it did not align with her
increased energy and self-esteem. This is why major depressive disorder was ruled out.
Developmental Theories and/or Systemic Factors
Sam is a 25-year-old female who is currently going to college to pursue her master’s in
social work. Sam currently works as a case manager for a local mental health clinic. She
currently lives with her roommate. Her roommate and two other girls are Sam’s close friends in
which she can confide with. According to Maree (2021) Sam is in Erikson stage of intimacy vs
isolation. In this stage adolescents are seeking intimate relationships with others that they can
maintain to establish trust (Maree, 2021). By establishing relationships, it allows an individual to
understand their vulnerability (Maree, 2021). Sam has at least three relationships where she is
trusting. Sam reported that when her roommate found out about her suicidal ideation, she
became upset. When Sam was discussing this, she became tearful and spoke on how important
her friendship is.
CASE STUDY 4
Multicultural and/or Social Justice Considerations
Same is the oldest of her sibling and her parents divorced when she was 14 years old.
Sam reported that she had an easy relationship with one another. When parents and children go
through divorce experience discomfort and pain the leads to intense stress (Obeid et al., 2021).
Sam reported that she struggles to be fully honest with her family as to not worry them. Sam
also communicated that her mother struggled with long-term depression, and she could not
mange her moods. She also reported that her sister struggles with depression.
Treatment Recommendations
Key Issues for Treatment
•Suicidal Ideation
•Mood Swings
Recommendations for Individual Counseling
One of Sam’s key issues is suicidal ideation. An article by Sienaer et al. (2022) discussed
the use of Electroconvulsive therapy (ECT) reduces suicidal ideation. The study found that three
quarter of the patients who experienced suicidal ideation did not report any experience at the
end of the study (Sienaer et al., 2022). Electroconvulsive therapy is the primary treatment of
individuals who suffer with depression and suicidal ideation (Sienaer et al., 2022).
Another treatment that could be recommended is for mood swings. According to Qiu et
al. (2023) looked at repetitive transcranial magnetic stimulation (rTMS). Repetitive transcranial
magnetic stimulation is non-invasive therapy for depression (Qiu et al., 2023). The stimulation
that rTMS does is produced by a magnetic coil that resets cortical oscillatory activity and restarts
cerebral rhythms (Qiu et al., 2023).
Sam reported that while at the ER the doctor did give her medication to help if she
became anxious. Sam reported taking the medication for one week. She also reported that she
was able to get sleep and her episode stopped. Sam did not go to the follow up appointment
CASE STUDY 5
with the psychiatrist. For Same I would refer her to medical evaluation. Sam continuously has
high episodes with mood swings and suicidal ideation. An article I found by Mills (2022)
discussed a medication that does not require clinical monitoring. The medication is called
lamotrigine that is used for treatment of bipolar disorder (Mills, 2022). Since Sam did not follow
through with her follow up appointment, I feel that having a medication that does not need
clinical monitoring could be beneficial.
Specific Considerations
Sam is a current graduate student pursuing her degree in social work. She identified as
growing up catholic and attended mass ever Sunday until she started graduate school. She
would like to include her faith in God into her therapy sessions. Since Sam discussed her suicidal
ideation and how it is impacting her relationships it does change the focus of her assessment.
Counseling approaches of helping individuals in frequent crisis situations normalizes the mental
state (Demchenko et al., 2022). Counseling clients in crisis requires the counselor to listen and
understand the situation, identifying the key issues and problems (Demchenko et al., 2022).
With a client being in crisis requires a more attentive and quick approach.
CASE STUDY 6
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders
(5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Demchenko, I., Sımko, R., Hudyma, O., Levchuk, N., Shportun, O., & Samara, O. (2022).
Psychological counseling of clients in crisis situations. Brain. Broad Research in
Artificial Intelligence and Neuroscience, 13(3), 104-
118. https://doi.org/10.18662/brain/13.3/356
Maree, J. G. (2021). The psychosocial development theory of Erik Erickson: Critical overview.
Early Child Development and Care, 191(7–8), 1107–1121.
https://doi.org/10.1080/03004430.2020.1845163
Mills, J. (2022). What's going on with lamotrigine (lamictal)? an updated look at the popular
medication for bipolar disorder. Issues in Mental Health Nursing, 43(9), 887-
889. https://doi.org/10.1080/01612840.2022.2104042
Mundy, J., Hübel, C., Adey, B. N., Davies, H. L., Davies, M. R., Coleman, J. R. I., Hotopf, M.,
Kalsi, G., Lee, S. H., McIntosh, A. M., Rogers, H. C., Eley, T. C., Murray, R. M.,
Vassos, E., & Breen, G. (2023). Genetic examination of the Mood Disorder
Questionnaire and its relationship with bipolar disorder. American Journal of Medical
Genetics., 192(7–8), 147–160. https://doi.org/10.1002/ajmg.b.32938
Obeid, S., Al Karaki, G., Haddad, C., Sacre, H., Soufia, M., Hallit, R., Salameh, P., & Hallit, S.
(2021). Association between parental divorce and mental health outcomes among
lebanese adolescents: Results of a national study. BMC Pediatrics, 21(1), 1-
455. https://doi.org/10.1186/s12887-021-02926-3
Qiu, H., Liang, K., Lu, L., Gao, Y., Li, H., Hu, X., Xing, H., Huang, X., & Gong, Q. (2023). Efficacy and
safety of repetitive transcranial magnetic stimulation in children and adolescents with
depression: A systematic review and preliminary meta-analysis. Journal of Affective
Disorders., 320, 305–312. https://doi.org/10.1016/j.jad.2022.09.060
CASE STUDY 7
Sienaert, P., Brus, O., Lambrichts, S., Lundberg, J., Nordanskog, P., Obbels, J., Verspecht, S.,
Vansteelandt, K., & Nordenskjöld, A. (2022). Suicidal ideation and ECT, ECT and
suicidal ideation: A register study. Acta Psychiatrica Scandinavica, 146(1), 7484.
https://doi.org/10.1111/acps.13425
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