Ariel Lopez
2/16/23, 5:47 AM
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Wendy, a 30-year-old white female, has a history of erratic and unpredictable behavior. She has a history of depression, occasional periods of high energy, decreased need for sleep, and excessive engagement in pleasurable activities. She also has a history of quitting her job due to anger issues. Wendy sees a man with addiction, describing her behavior as “addictive and dysfunctional.” She was recently arrested for disorderly conduct and writing bad checks. Her family has a history of depression, and her grandfather was diagnosed with manic depression.
Patient’s problems (in order of priority)
1. BipolarDisorder with manic and depressive episodes
2. Substanceuse disorder
3. Angermanagement issues
4. Impulsivityand risky behavior
5. Financialproblems
Diagnosis
Bipolar Disorder should be considered as a diagnosis for Wendy
Rationale
Wendy has a history of depressive and manic symptoms, and her behavior during her arrest is consistent with manic symptoms. Additionally, her family history of manic depression increases the likelihood of a bipolar disorder diagnosis.
Differential Diagnosis
Other differential diagnoses that could be considered include major depressive disorder, borderline personality disorder, and substance-induced mood disorder.
Testing and screening
The Mood Disorder Questionnaire (MDQ) and the Bipolar Spectrum Diagnostic Scale (BSDS) can be used to help identify the correct diagnosis. A comprehensive medical and psychiatric evaluation is also necessary to rule out other possible causes of her symptoms.
Treatment
A combination of psychopharmacology, psychotherapy, and psychoeducation should be considered for Wendy’s treatment. Mood stabilizers such as lithium, valproate, or lamotrigine can help manage her manic and depressive symptoms. Antipsychotic medications may also be helpful in treating acute manic symptoms (McIntyre et al., 2020). Wendy should be referred to a substance abuse treatment program to address her addiction issues. Cognitive-behavioral therapy (CBT) can help her manage her anger and impulsivity. Psychoeducation is also important to help Wendy and her family understand her diagnosis and treatment options.
Standard guidelines
The American Psychiatric Association (APA) provides guidelines for the assessment and treatment of bipolar disorder, including the use of mood stabilizers and psychotherapy. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides guidelines for the treatment of substance use disorders (Keepers et al., 2020). A multidisciplinary team approach is recommended to provide comprehensive care for patients with complex mental health issues.
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Alianne Maria Liens
2/16/23, 5:35 AM
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Wendy is a 30-year-old unemployed female with a long history of therapy. Her behavior is erratic and unpredictable, and her parents have urged her to seek treatment. She has had various jobs but usually quits because she gets angry with her boss or coworkers. She has a boyfriend who also has addiction issues, and she describes the relationship as addictive and dysfunctional. Wendy has had several episodes of depression in the last five years, where she did not eat or leave the house. Recently, she was arrested for disorderly conduct, and she wrote terrible checks exceeding $7,000. The police report that she was hyperverbal and hyperactive, solicited them for sex and was combative. Wendy’s father has also experienced periods of depression, and her grandfather was diagnosed with manic depression and hospitalized in the 1950s and 1960s. Wendy’s brother died in a car accident several years ago and had a long history of depression.
List of patient’s problems and prioritization
· Impulsivebehavior, including quitting jobs and engaging in dysfunctional relationshipsand criminal activities
· Moodinstability, including periods of depression and hyperactivity
· Familyhistory of mental illness, including depression and manic depression
· Substanceabuse by the patient’s partner, which could be exacerbating her symptoms
Diagnosis and rationale
The patient’s symptoms are consistent with a diagnosis of bipolar disorder. She experiences periods of depression, irritability, and hyperactivity and has a family history of manic depression. Her impulsive behavior and criminal activities could be related to manic episodes, while her periods of depression could be depressive episodes (O’Donovan et al., 2020). The patient’s hypersexuality and substance abuse are also consistent with bipolar disorder.
Differential diagnosis and screening tools
Other possible diagnoses include borderline personality disorder and attention deficit/hyperactivity disorder (ADHD). A screening tool for bipolar disorder, such as the Mood Disorder Questionnaire (MDQ), could help identify the correct diagnosis. Additional assessments for personality disorders and ADHD could also be considered.
Treatment and rationale
The patient should receive a comprehensive treatment plan that includes medication, psychotherapy, and psychoeducation. Mood stabilizing agents, such as lithium or valproate, could help stabilize her moods and reduce impulsivity. Antidepressants may be prescribed to manage depressive episodes, but caution should be taken to avoid inducing manic episodes. (McIntyre et al., 2020) Psychotherapy, such as cognitive-behavioral therapy, could help the patient manage her impulsive behavior and develop coping skills. Psychoeducation could help the patient and her family understand the nature of the bipolar disorder and the importance of medication adherence and monitoring for side effects.
Standard guidelines
The American Psychiatric Association Practice Guideline for the Treatment of Patients with Bipolar Disorder could be used to guide the assessment and treatment of this patient. The guideline recommends a multimodal approach that includes medication, psychotherapy, and psychoeducation. The guideline also emphasizes the importance of monitoring for side effects, assessing suicide risk, and addressing comorbid conditions such as substance abuse.
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Osvady Argudin
Case Discussion on Bipolar Disorder
Wendy, a 30-year-old white woman, has a history of alcohol and drug misuse, dysfunctional relationships, erratic and unpredictable conduct, depression, and suicidal thoughts. Recently, she was detained for unruly behavior, writing bad checks, and asking police officers for sex. Wendy should be considered for a diagnosis of Bipolar Disorder 1 due to her family history of Bipolar Disorder, her periods of intense depression, her difficulty managing her emotions, and her impulsive behaviors such as excessive spending and substance use. (Mousavi et al., 2021). However, other potential diagnoses, such as Major Depressive Disorder, and Substance Abuse, should also be considered, as they can present similar symptoms that require a careful assessment to differentiate between them.
When attempting to diagnose Wendy accurately, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Beck Depression Inventory (BDI), and the Hamilton Rating Scale for Depression (HRSD) should be considered as potential tests and screening tools to assist in the process. These tools can provide valuable insight into Wendy’s mental health status and help to determine the correct diagnosis (Ayub et al., 2022). Based on the diagnosis of Bipolar Disorder, the treatment prescribed for Wendy would involve psychopharmacology. Psychopharmacology would involve using mood stabilizers such as lithium, which should be provided to boost her mood and lessen mania symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria would be used to assess and treat Wendy for her Bipolar Disorder by evaluating the presence of manic and hypomanic episodes and depressive episodes. (Bredström, 2019). Furthermore, the DSM-5 criteria would be used to develop a comprehensive treatment plan including psychotherapy, medications, lifestyle changes, and other supportive interventions such as social support, family therapy, and crisis management.
Yordanis Santana Soayero
2/15/23, 11:09 PM
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Clinical Case Summary
Wendy is a 30-year-old unemployed female with a long history of therapy. She has difficulty holding onto a job and has had a string of unstable relationships. Her family reports erratic behavior, including periods of hyperactivity, depression, and substance abuse. She was recently arrested for disorderly conduct, solicitation of sex, and writing bad checks. Wendy’s father has also reported periods of depression, and her grandfather had been hospitalized for manic depression.
List of Patient’s Problems and Prioritization
1. Erratic behavior, including hyperactivity, depression, and substance abuse
2. Difficulty holding onto a job
3. Unstable relationships
4. Criminal behavior, including writing bad checks and solicitation of sex
Diagnosis
Bipolar Disorder Type I should be considered due to Wendy’s periods of hyperactivity and depression, family history of mood disorders, and the potential for substance abuse. The diagnostic criteria for bipolar I include at least one manic episode and/or mixed episode as supported by McIntyre et al. (2020), and Wendy’s behavior during the arrest suggests the presence of a manic episode.
Differential Diagnosis
Other potential diagnoses that should be considered include BPD, ADHD, and Substance Use Disorder. Borderline Personality Disorder can cause unstable relationships and erratic behavior, while ADHD can cause hyperactivity and impulsivity. Substance Use Disorder can also cause periods of depression and erratic behavior.
Test or Screening Tools
According to McIntyre et al. (2020) MDQ and BSDS are screening tools that can help identify the correct diagnosis of bipolar disorder.
Treatment
According to McIntyre et al. (2020) the treatment for bipolar disorder includes psychoeducation, psychotherapy, pharmacotherapy, and referrals to specialists as needed. Wendy should receive a thorough diagnostic evaluation, which may include laboratory tests, physical examination, and mental health assessments. If she is diagnosed with bipolar disorder, she should receive a combination of pharmacotherapy and psychotherapy. Lithium, valproate, and atypical antipsychotics are commonly used medications for bipolar disorder, while CBT and DBT can be effective psychotherapeutic interventions.
Standard Guidelines
The American Psychiatric Association Practice Guidelines for the Treatment of Patients with Bipolar Disorder can provide guidance for the assessment and treatment of Wendy’s condition. APA, (2011) guidelines recommend a collaborative approach to treatment, involving a team of mental health professionals, physicians, and other specialists as needed. Regular follow-up appointments, monitoring of symptoms, and ongoing assessment of medication efficacy and side effects are also important aspects of treatment.
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Yolanda Morgado
2/15/23, 11:08 PM
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Wendy is a 30-year-old woman with a history of seeing therapists since her teen years. She has held various jobs, but she quits because of anger issues. She has been in a relationship with an unemployed man with an alcohol and methamphetamine problem for a year. Wendy’s parents have urged her to seek treatment because of her erratic and unpredictable behavior. Wendy has had periods of depression and has been arrested for disorderly conduct while being drunk and hyperverbal. She has also written bad checks in excess of $7,000.
List of Patient Problems
and Prioritization
Wendy’s problems include anger issues, a dysfunctional relationship, erratic and unpredictable behavior, depression, hyperverbal and hyperactive behavior, and financial problems. Among these problems, her erratic and unpredictable behavior and hyperverbal and hyperactive behavior seem to be the most critical.
Diagnosis and rationale
Bipolar disorder should be considered for Wendy. She has a family history of manic depression, which increases her risk for the disorder. Wendy has had periods of depression, followed by hyperverbal and hyperactive behavior, which are characteristic of bipolar disorder. Wendy has a family history of manic depression, which is a risk factor for the disorder (Miklowitz et al., 2021). She has exhibited both depressive and manic symptoms, such as periods of depression followed by hyperverbal and hyperactive behavior, which are characteristic of bipolar disorder.
Differential Diagnosis
They include attention-deficit/hyperactivity disorder (ADHD), substance use disorder, and borderline personality disorder. ADHD could be considered due to Wendy’s hyperverbal and hyperactive behavior. Substance use disorder could be considered because Wendy’s partner has an alcohol and methamphetamine problem. Borderline personality disorder could also be considered due to Wendy’s erratic and unpredictable behavior.
Test or Screening Tools
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for bipolar disorder could be used to help identify the correct diagnosis. Wendy could also be assessed using rating scales, such as the Mood Disorder Questionnaire (MDQ), which is a screening tool for bipolar disorder.
Treatment
Psychopharmacology treatment could include mood-stabilizing agents, such as lithium, valproic acid, or carbamazepine. Referral to a psychiatrist for medication management could also be considered (Rantala et al., 2021). Psychotherapy could include cognitive-behavioral therapy (CBT) and family therapy. Psychoeducation could also be provided to Wendy and her family to help them understand bipolar disorder and how to manage it.
Standard Guidelines
The American Psychiatric Association’s (APA) Practice Guideline for the Treatment of Patients with Bipolar Disorder could be used to assess and treat Wendy. The guideline provides evidence-based recommendations for managing bipolar disorder, including pharmacological and psychotherapeutic treatments.
Clinical case.
Wendy is a 30-year-old unemployed white female with an alcohol and methamphetamine problem. She has had a string of boyfriends over the years but has been seeing one man for the last year or so. She is back in treatment at the urging of her parents, who describe her behavior as erratic and unpredictable. Recently, she was arrested for disorderly conduct at a friend’s party and solicited them for sex. She was also investigated for bad checks she wrote in excess of $7,000.
List the patient’s problems and prioritize them.
There is a history of depression in the patient’s family.
She is 30 years old and currently unemployed because she hardly has a job.
In the past five years, she has experienced depressive episodes.
She currently gets less sleep and goes out more.
Wendy is erratic, talkative, and hyperactive.
Diagnosis and rationale
For Wendy, bipolar disorder should be taken into account. She is more likely to get the condition because her family has a history of the condition. Wendy has had depressive episodes followed by the hyperverbal and hyperactive behavior that bipolar disorder is known for. A risk factor for the illness is Wendy’s family history of manic depression). She has demonstrated both manic and depressive symptoms, including depressive episodes followed by hyperverbal and impulsive conduct, which are signs of bipolar illness.
Differential diagnosis
The first differential diagnosis is a borderline personality disorder, due to the patient’s unstable relationships and impulsive behaviors. The second diagnosis is attention deficit hyperactivity disorder (ADHD). The third differential diagnosis is Major Depressive Disorder (MDD). The rationale for the differential diagnosis is that the patient’s history of seeing counselors suggests that she may struggle to regulate emotions and interpersonal relationships. The patient’s periods of depression, including not eating or leaving the house, and her family history of depression suggest a potential diagnosis of MDD.
What test or screening tools should be considered to help identify the correct diagnosis?
The Mood Disorder Questionnaire (MDQ) and the Young Mania Rating Scale (YMRS), which rate manic symptoms, are screening instruments that may aid in determining the proper diagnosis. The Beck Depression Inventory (BDI) and the Patient Health Questionnaire-9 (PHQ-9) can both be used to evaluate depressive symptoms.
What treatment would you prescribe and what is the rationale (consider psychopharmacology, diagnostics tests, referrals, psychotherapy, psychoeducation)
Psychotherapy and medication are frequently used in the treatment of bipolar illness. Lithium and valproic acid, two mood stabilizers, may be administered to assist maintain mood and prevent manic and depressive episodes. In order to manage Wendy’s medication and provide continuous counseling to address her behavioral and emotional concerns, a referral to a psychiatrist and psychotherapist would be appropriate. Wendy and her family would benefit from psychoeducation to better comprehend bipolar disorder and create symptom management plans.
Obdelis Dominguez
2/15/23, 11:07 PM
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Wendy is a 30-year-old unemployed woman with a history of therapy. She has a pattern of quitting her part-time jobs due to conflicts with her coworkers or bosses. Her current boyfriend has substance abuse problems, and she describes their relationship as addictive and dysfunctional. She has periods of depression and hyperactivity, and her father has a history of depression. She was recently arrested for disorderly conduct, and storeowners reported bad checks written for over $7,000.
List of Patient Problems
1. Substanceabuse issues with her boyfriend
2. Hyperactivityand impulsivity
3. Periodsof depression and lethargy
4. Financialissues due to writing bad checks
5. Riskysexual behavior and combative behavior
6. Historyof depression and family history of bipolar disorder
Diagnosis
The primary diagnosis that should be considered is bipolar disorder, specifically bipolar disorder type 1 with mixed features.
Rationale
Wendy has a history of depression and periods of hyperactivity and impulsivity. Her father also has a history of depression, and her grandfather had manic depression. Her recent behavior, including hyperverbal and hyperactive behavior, risky sexual behavior, and combative behavior, is consistent with manic or hypomanic episodes. The periods of depression she has experienced in the past suggest the possibility of a mood disorder as supported by Kato (2019).
Differential Diagnosis
Differential diagnoses should include substance-induced mood disorder, BPD, and ADHD.
Test or Screening Tools
A screening tool that can be used is the MDQ, which is a brief self-report questionnaire that can assist in the assessment of bipolar disorder as recommended by Kato (2019).
Treatment
A combination of medication and psychotherapy is recommended Kato (2019). Medication options include mood stabilizers such as lithium or antipsychotics. Psychotherapy options include CBT and IPSRT. Additionally, substance abuse treatment for Wendy’s boyfriend is crucial, as it may exacerbate her symptoms.
Standard Guidelines
SAMHSA (2022), offers guidelines for the treatment of substance abuse disorders that can be followed.
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Marta Garcia Diaz
2/15/23, 11:05 PM
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Wendy is a 30-year-old unemployed white female with a history of therapy for erratic and unpredictable behavior. She has a pattern of quitting part-time jobs due to anger issues, and is currently in a dysfunctional, addictive relationship with a man who has drug and alcohol problems. Wendy also experiences periods of depression, has a family history of bipolar disorder and depression, and has been arrested for disorderly conduct and bad checks.
Problem List (prioritized):
1. Substance abuse and addiction
2. Mood instability and depression
3. Impulsive and reckless behavior
4. Relationship dysfunction
5. Employment instability
Diagnosis:
Bipolar Disorder, specifically Bipolar I Disorder
Rationale:
Wendy has a family history of bipolar disorder and exhibits symptoms consistent with manic and depressive episodes. She has periods of depression where she isolates herself and has no appetite, as well as episodes of hypomania or mania where she engages in risky and impulsive behavior, such as staying up for 24 hours and writing bad checks. Wendy’s history of substance abuse and addiction, as well as her pattern of unstable employment and dysfunctional relationships, are also common in individuals with bipolar disorder as highlighted by Rhee et al. (2020).
Differential Diagnosis:
· BPD
· Substance-induced mood disorder
· ADHD
Test or Screening Tools as per Rhee et al. (2020):
· Mood Disorder Questionnaire
· The Young Mania Rating Scale (YMRS)
· ADHD Self-Report Scale (ASRS)
Treatment:
Wendy would benefit from a comprehensive treatment plan that includes medication, psychotherapy, and psychoeducation as supported by Rhee et al. (2020). Specifically, she should be prescribed a mood stabilizer, such as lithium or valproate, to manage her manic and depressive episodes. Wendy would also benefit from psychotherapy, such as cognitive-behavioral therapy, to address her impulsivity, relationship dysfunction, and substance abuse. Psychoeducation is also important to help Wendy and her family understand the nature of bipolar disorder, as well as how to recognize and manage her symptoms.
Standard Guidelines:
The American Psychiatric Association’s Practice Guidelines can be used. APA (2022) guidelines emphasize the importance of a comprehensive and individualized treatment plan that addresses the unique needs and preferences of the patient.
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Leodan Diaz
2/15/23, 11:05 PM
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Bipolar
Disorder
Case
Study
Create a list of the patient’s problems and prioritize them.
1. Bipolar Disorder
2. Depression
3. Alcohol addiction
Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
Pharmacological treatment is the use of drugs to suppress the depressant thoughts in a patient. This treatment method has side effects; hence it is advised not to overdose the patient and harm them rather than treat them. Depression in adults can be treated using effective antidepressants, and due to this, many patients use pharmacologic treatment. Most patients using antidepressants respond favorably. However, there are always side effects for using antidepressants (Villa, et al., 2018). Trisha would use these drugs but with a strict follow-up due to her history of alcohol abuse and erratic behavior. Antidepressants would be efficient in Trisha’s case because the patient uses the medication for a while, and the doses are increased or regulated according to the patient’s response.
Which non-pharmacological treatment would you prescribe? Include the rationale for this treatment.
The non-pharmacological treatment uses the systematic review of the patient’s response to therapy without drugs. For Trisha’s case (Farah et al., 2016), I would recommend Cognitive behavioral therapy (CBT) to help her have a different view in life and have positive thoughts. Evidence shows that CBT works well as antidepressants, and the lessons learned can be used beyond depression time. Therefore, CBT would most likely help her once and for all to leave depression behind with no side effects whatsoever.
Include an assessment of treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence.
The use of pharmacological treatment is very effective for the majority of patients. The only drawback is the side effects of using antidepressants for a long time. Non-pharmacological treatment in mental illness is by far the most recommended mode of treatment because there is no use of drugs; therefore, no side effects to the patient.
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