CASE STUDY: SAM 1
Case Study: Sam
Frank B. Hill
School of Behavioral Sciences, Liberty University
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CASE STUDY: SAM
Client Concerns
Symptoms Behaviors Stressors
Mood swings Poor school work School
Suicidal ideation Drinking (occasional) Relationship with
roommate
Manic episodes
characterized by flight of
thoughts
Sharing worries with
children
Possible removal from
program
Fatigue Inability to sleep Inability to work through
episodes
Loss of appetite Sleeping long periods of
time
Inability to discuss issues
with family
Anxiety
Feelings of worthlessness Uncontrollable crying Family hx of depression
Hallucinations
Assessment
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 Diagnostic Criteria: Bipolar disorder,
current episode depressed, severe, with
psychotic features. F31.5 (APA, 2013)
Client’s Signs/Reported Symptoms:
Criterion A: One manic episode preceded or
followed by hypomanic of major depressive
episodes
Manic episode (lasting 7+ days) followed by
major depressive episode
Criterion B: Not better explained by
schizoaffective disorder, schizophreniform
disorder, delusional disorder or unspecified
schizophrenia spectrum and other psychotic
disorder
R/O due to hallucinations being very short-
term and not meeting time requirements for
any schizo-disorder.
Manic Episode Criteria
Lasts one week or any length if
hospitalized.
Three or more sx present (inflated
self-esteem, decrease in need for
sleep, more talkative, flight of ideas,
distractibility, increase in goal-
Lasts 7+ days
Believes she will be best author in
world with greatest book in the world
Talks constantly about novel
Sleeping less than 5 hours per night,
sometimes significantly less,
Flight of ideas regarding novel
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CASE STUDY: SAM
directed activity, excessive
engagement in high risk activity).
Mood disturbance severity (causes
makred impairment
socially/occupationally, requires
hospitalization, psychotic traits_
R/O substance use/medical cause
Constant focus on novel
Distracted fron studies
Causing issues with friends/roommate
Psychotic features of hallucinations
“hearing voices”
No substance/medical issues
Major Depressive Criteria
Five or more symptoms during two
week period (depressed mood most of
day every day, decreased
interest/pleasure in most activities,
weight loss/gain, insomnia or
hypersomnia, fatigue/loss of energy,
movements that serve no purpose as
reported by others, feelings of
worthlessness/guilt nearly every day,
inability to think/concentrate nearly
every day, recurrent thoughts of
death/suicidal ideation with or without
plan
Sx cause distress or impairment in
important areas (social/occupational)
R/O substance use/medical issues
Lasts 2+ weeks
Depressed
Sleeping 10+ hours a day
Fatigue
Inability to concentrate on school
work
Inability to work at job
Strained relationship with roommate
Suicidal ideation
Feelings of worthlessness
No substance/medical issues
Other DSM-5 Conditions Considered
The other DSM-5 conditions that I considered were Cyclothymia and Schizoaffective
disorder. However, cyclothymia was ruled out due to the length of time Sam is experiencing
manic and depressive symptoms. Schizoaffective disorder was ruled out because hallucinationas
and delusions are not consistently being experienced for weeks at a time.
Developmental Theories and/or Systemic Factors
Bipolar disorder is best explained by heredity. According to Faedda et al. (2014), risk
factors of bipolar disorder include genetics, as well as early onset anxiety or behavioral issues.
The client, Sam, reports that her mother and sister have dealt with untreated long-term
depression. Sam also reports that her mother’s depression led to divorce, a life event that
occurred when Sam was 14-years old.
Multicultural and/or Social Justice Considerations
Sam is a Caucasian female who is also a college student working through a social work
program. Considerations should be taken regarding the stigma attached to those who aspire to be
in any helping field, but also struggle with mental health issues. At least one third of graduate
students in a program such as this struggle with mental health problems, and also struggle with
disclosing those issues and asking for help due to the possibility of being ousted from their
program (Willyard, 2012). Many go into the field to better understand their own issues, however
there is still an assumption present that if one struggles with mental health they are likely to
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CASE STUDY: SAM
perform poorly in terms of helping others. This assumption causes many to hide their issues
rather than ask for help.
Treatment Recommendations
Key Issues for Treatment
Managing manic and major depressive episodes
Suicidal ideation during major depressive episodes
Medication management
Recommendations for Individual Counseling
Interpersonal and Social Rhythm Therpay (IPSR)
oIndividual therapy related to recording and tracking sleep/wake cycles as well as
activities and how those activities trigger different moods.
oRegulation of routines and cycles help client in stabilizing moods.
oAssessing problem areas that trigger moods and possible solutions to those problems
as prevention for future triggers.
oResearch completed by Steardo et al. (2020) shows IPSRT as an effective treatment
modality in improving bipolar disorder symptoms and reducing the rate of morbidity
related to these disorders.
Dialectical Behavioral Therapy
oTo treat Sam’s suicidal ideation related to bipolar disorder, dialectical behavioral
therpay, a form of CBT, is also an option.
oIncludes training in mindfulness, emotion regulation, distress tolerance and healthy
ways in coping with stress.
oDBT has been shown to reduce suicidal behavior and suicidal outcomes (DeCou,
Comtois and Landes, 2019).
Cultural Considerations
Culture plays an important role in this case. Because Sam is a college student pursuing a
career in social work there is a stigma associated with admitting that you have an issue, due to
the fear related to losing a position as a student in a program. This can turn into a fear of asking
for help due to the possibility of losing a job as a counselor. However, Sam is realizing that her
mental health is directly affecting her ability to perform in school and is escalating into the
possibility of morbidity. Due to this, utilizing techniques related to DBT and IPSR can help
reduce the risk of suicide and help Sam to live a more functional life, and hopefully keep her
position in her social work program. I would feel comfortable working with Sam, as I have
experience as a college student in a field related to a helping profession. I do not think I would
have value conflicts with this client and her culture. I would appreciate her spiritual perspective
and be able to meet her needs incorporating spirituality into the counseling arena.
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CASE STUDY: SAM
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.).
DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical behavior therapy is effective
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CASE STUDY: SAM
for the treatment of suicidal behavior: A meta-analysis. , (1), 60-72.Behavior therapy 50
Faedda, G., Serra, G., Marangoni, C., Salvatore, P., Sani, G., Vazquez, G., Tondo, L., Girardi, P.,
Badessarini, R., Koukopoulos, A. (2014). Clinical risk factors for bipolar disorders: A
systematic review of prospective studies. Journal of Affective Disorders, 168. doi:
10.1016/j.jad.2014.07.013.
Hirschfeld, R. (2002). The mood disorder questionnaire: A simple, patient-rated screening i
instrument for bipolar disorder. Journal of Clinical Psychiatry, 4(1): 9-11. doi:
10.4088/pcc.v04n0104.
Steardo, L., Luciano, M., Sampogna, G., Zinno, F., Saviano, P., Staltari, F., Garcia, C., DeFazio,
P., Fiorillo, A. (2020). Efficacy of the interpersonal and social rhythm therapy (IPSRT) in
patients with bipolar disorder: results from a real-world, controlled trial. Annals of
General Psychiatry, 19(1), 1-7.
Wang, Y. Y., Xu, D. D., Liu, R., Yang, Y., Grover, S., Ungvari, G. S., ... & Xiang, Y. T. (2019).
Comparison of the screening ability between the 32-item Hypomania Checklist (HCL-32)
and the Mood Disorder Questionnaire (MDQ) for bipolar disorder: a meta-analysis and
systematic review. Psychiatry Research, 273, 461-466.
Willyard, C. (2012). American Psychological Association. Retrieved July Need to heal thyself?
9, 2022, from https://www.apa.org/gradpsych/2012/01/heal
