Case Study 1
Diagnosis: Bipolar II Disorder– F31.81
Rationale:
Hypomanic Episode:
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood
and abnormally and persistently increased activity or energy, lasting at least 4
consecutive days and present most of the day, nearly every day.
Client reported excess of energy to the point where he did not sleep much. Client also
reported more than usual activity as if they had “things to do and places to go”.
B. During the period of mood disturbance and increased energy and activity, three (or more)
of the following symptoms have persisted (four if the mood is only irritable), represent a
noticeable change from usual behavior, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
Client does not present an Inflated self-esteem.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
Client reported that he did not need to sleep much during this period of high energy.
3. More talkative than usual or pressure to keep talking.
Client reported that they were more talkative during this period.
4. Flight of ideas or subjective experience that thoughts are racing.
Client stated that their thoughts seemed random and would jump from one thought to the
other.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external
stimuli), as reported or observed.
Client reported that they were easily distracted during this time.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation.
Client reported inability to sit still during periods of excess energy.
7. 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).
Client does not present this symptom.
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of
the individual when not symptomatic.
Client’s mother stated change in functioning and that client had not “been the same”.
D. The disturbance in mood and the change in functioning are observable by others.
Client’s mother can observe change in functioning.
E. The episode is not severe enough to cause marked impairment in social or occupational
functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by
definition, manic.
Client has never been hospitalized.
F. 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.
Client has denied drug or alcohol use.
Major Depressive Episode
1. 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). (Note: In children and adolescents, can be irritable mood.)
Client reported feelings of worthlessness and decreased motivation.
2. 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).
Client reported disinterest and motivation in school, barely passing classes.
Reports of also not wishing to leave his room.
3. Insomnia or hypersomnia nearly every day.
Client reported difficulty falling asleep and chronic tiredness.
4. Psychomotor agitation or retardation nearly every day (observable by others, not merely
subjective feelings of restlessness or being slowed down).
Client reported feelings of “Blah”
5. Fatigue or loss of energy nearly every day.
Client reported feelings of tiredness most of the time.
6. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or guilt about being sick).
Client reported feelings of worthlessness
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others).
Client reported being unable to sit still & control random thoughts
8. Recurrent thoughts of death (not just fear of dying); recurrent suicidal ideation without a
specific plan; a specific suicide plan; or a suicide attempt.
Client did report chronic thoughts of suicide as well as a mentioned suicide attempt.
Differential Diagnosis/Rule Out:
● It is not Bipolar I.
(Not Bipolar 1 because Simon has never been hospitalized)
● It is not Cyclothymic Disorder.
(Not Cyclothymic because Simon appears to have major depressive episodes and criteria
for hypomanic episodes has been met)
Treatment:
1) Treatment option 1
a. Mood stabilizing drugs, a psychotropic drug that helps stabilize moods and helps
other bipolar symptoms from developing. (lithium, lamictal, Tegretol, and
valproate)
2) Treatment option 2
a. Adjunctive psychotherapy, therapy has an emphasis on the importance of taking
medication, improving life skills, relationships, educating patients and families,
and helping solve problems from family, school and occupation.
3) Treatment option 3
a. A combination of both Mood stabilizing drugs with adjunctive psychotherapy
reduces the possibilities of hospitalization, and increases the likelihood that
individuals with bipolar disorder will take their medications.
Powered by TCPDF (www.tcpdf.org)
