Mood Stabilizing Agents
Mood Stabilizing Agents
Instructions: Case Discussion on Bipolar Disorder:
Wendy is a 30-year-old, unemployed white female. She is no stranger to therapy, having seen counselors for most of her teen and adult years. Her friends would describe her as a “wild woman” who takes no crap from anyone. She has held various part-time jobs for the last few years because she usually gets angry at her boss or coworkers and quits. While she has had a string of boyfriends over the years, she has been seeing one man for the last year or so. He too is unemployed and has both an alcohol and methamphetamine problem. She describes the relationship as “addictive and dysfunctional, yet exciting and hot.” Wendy is back in treatment at the urging of her parents, who describe her behavior as erratic and unpredictable. They also claim that she has periods where she “sleeps little and parties lots.” There were also several occasions in the last five years when she was so depressed she didn’t eat or want to leave the house. Her father also admits to periods of depression, and Trisha’s grandfather was diagnosed with manic depression, resulting in numerous hospitalizations in the 1950s and 1960s. Wendy’s only brother died in a car accident several years ago. He was drunk at the time, but she claims he had a long history of depression. Recently Trisha was arrested for disorderly conduct at a friend’s party. She had not slept for nearly 24 hours and was drunk and combative. When she was first approached by police, she solicited them for sex. They report that she was rather hyperverbal and hyperactive. They later had to investigate a complaint from local storeowners for bad checks she wrote in excess of $7,000.
- Summarize the clinical case.
- Create a list of the patient’s problems and prioritize them.
- Which diagnosis should be considered
- What is your rationale for the diagnosis
- What differential diagnosis should be considered
- What test or screening tools should be considered to help identify the correct diagnosis
- What treatment would you prescribe and what is the rationale (consider psychopharmacology, diagnostics tests, referrals, psychotherapy, psychoeducation)
- What standard guidelines would you use to assess or treat this patient
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Answers:
Clinical Case Summary:
Wendy is a 30-year-old unemployed female with a history of being in therapy for most of her teen and adult years. Her behavior is described as erratic and unpredictable, and her friends consider her a “wild woman” who does not take any crap from anyone. She has had various part-time jobs but usually quits due to anger issues. She is currently in a dysfunctional and addictive relationship with a man who has drug and alcohol addiction. Her parents urged her to go to treatment because of her recent erratic behavior, including periods of depression and mania. She was arrested for disorderly conduct, which was triggered by her being hyperverbal and hyperactive. Wendy’s father has also experienced depression, and her grandfather was diagnosed with manic depression resulting in several hospitalizations.
List of Patient’s Problems and Prioritization:
- Manic and Depressive Episodes – Wendy’s behavior includes periods of depression and mania, which can be harmful to herself and others. This should be the top priority.
- Substance Abuse – Wendy is in a dysfunctional and addictive relationship with a man who has drug and alcohol addiction. This can worsen her mental health and lead to other problems.
- Anger Issues – Wendy has a history of quitting jobs due to anger issues, which can affect her employability and personal relationships.
- Impulsivity – Wendy wrote bad checks for over $7,000, which is a result of her impulsivity and can lead to legal problems.
Diagnosis:
Based on Wendy’s symptoms, the diagnosis of bipolar disorder should be considered. Bipolar disorder is a mental illness characterized by mood swings between mania and depression. The symptoms of mania include elevated mood, grandiosity, decreased need for sleep, racing thoughts, and impulsive behavior. The symptoms of depression include a persistent low mood, loss of interest in activities, and fatigue.
Rationale for Diagnosis:
Wendy has a family history of bipolar disorder, which increases her risk of developing the condition. She experiences periods of mania and depression, which are characteristic symptoms of bipolar disorder. Her hyperverbal and hyperactive behavior during the arrest indicates mania, and her periods of depression support the diagnosis.
Differential Diagnosis:
The differential diagnosis for Wendy’s symptoms should include major depressive disorder, borderline personality disorder, and substance-induced mood disorder.
Test or Screening Tools:
To help identify the correct diagnosis, a psychiatric evaluation is necessary, which should include a detailed history and a mental status exam. Mood disorder questionnaires, such as the Mood Disorder Questionnaire (MDQ), can be helpful in screening for bipolar disorder. A drug screening test can also be useful in identifying any substance-induced mood disorders.
Treatment:
The treatment for Wendy’s condition should include psychopharmacology, psychotherapy, psychoeducation, and referrals. Medications such as mood stabilizers, antipsychotics, and antidepressants can be used to manage symptoms. Psychotherapy, including cognitive-behavioral therapy and interpersonal therapy, can help Wendy manage her mood swings and improve her coping skills. Psychoeducation can help Wendy and her family understand the condition and its management. Referrals for substance abuse treatment and legal counseling should be considered.
Standard Guidelines:
The American Psychiatric Association’s Practice Guideline for the Treatment of Patients with Bipolar Disorder provides evidence-based recommendations for the management of bipolar disorder. The guideline recommends the use of mood stabilizers as first-line treatment for mania and bipolar depression. The guideline also recommends the use of psychotherapy, such as cognitive-behavioral therapy, in combination with pharmacotherapy.
