Diagnosing Mood Disorders

 

Directions: In each scenario please include (a) the symptoms you are using to make a diagnosis, (b) duration of the symptoms and (c) any questions you might ask to clarify information that might help to differentiate between two different diagnoses and (d) provide your most educated guess about a diagnosis for each scenario. Use the following diagnoses for your answers. Some diagnoses may be used more than once. Use the mood chart at the bottom of the activity for help.    

 

 

• Major Depressive Disorder
• Bipolar I Disorder
• Bipolar II Disorder
• Major Depressive Disorder with peripartum onset
• Cyclothymia
• Persistent Depressive Disorder
• Rule Out *(The person doesn't meet full criteria for a diagnosis. Rule Out means to watch symptomology as treatment progresses to Rule In / Rule Out a disorder).

 

 

1.    Jessica is a 28 year-old married female. She has a very demanding, high stress job as a second year medical resident in a large hospital. Jessica has always been a high achiever. She graduated with top honors in both college and medical school. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past.

For the past three weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her coworkers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping.

At home, Jessica's husband has noticed changes as well. She's shown little interest in sex and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an hour or two after they go to bed. He's overheard her having frequent tearful phone conversations with her closest friend, which have him worried. When he tries to get her to open up about what's bothering her, she pushes him away with an abrupt "everything's fine".

Although she hasn't ever considered suicide, Jessica has found herself increasingly dissatisfied with her life. She's been having frequent thoughts of wishing she was dead. She gets frustrated with herself because she feels like she has every reason to be happy, yet can't seem to shake the sense of doom and gloom that has been clouding each day as of late.

 

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2.    Susie is a 20-year-old sophomore at a small Midwestern college.  For the past eight days she has gone without any sleep and has been in a heightened state of activity which she describes as "out of control." For the most part, her behavior is characterized by strange and grandiose ideas that often take on a mystical or sexual tone.  For example, she recently proclaimed to a group of friends that she did not menstruate because she was a "of a third sex, a gender above the human sexes." Also, some of Susie's bizarre thinking centers on politics, such as believing that she had somehow switched souls with the senior senator from her state. She feels that her recent experiences with switching souls would make her particularly well suited for a high position in government; perhaps even the presidency.

 

Susie often worries that she will forget some of her thoughts and has begun writing notes to herself everywhere; in her notebooks, on her computer---even on the walls of her dormitory.  Susie's family and friends, who have always known her to be extremely tidy and organized, have been shocked to find her room in total disarray with frantic and incoherent messages written all over the walls and furniture.  These messages reflect her disorganized, grandiose thinking about spiritual and sexual themes. 

 

Susie has experienced two previous episodes of wild and bizarre behavior similar to what she is experiencing now; both alternated with periods of intense depression.  When she was in the depressed state, she could not bring herself to attend classes or any campus activities; she suffered from insomnia, poor appetite, and difficulty concentrating.  At the lowest points of the depressive side of her disorder, Susie contemplated suicide. 

 

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3.    Cody is a 29-year old, married, father of two children. He has gone to see a psychologist about the following concerns. Four weeks ago Cody states that he was "super depressed." He had no energy, was sleeping all day long, missing work because he couldn't concentrate during tasks, noticed an increase in his appetite, was thinking about death a lot, didn't feel like hanging out with his friends, and feeling "totally worthless." Cody made today's appointment because his friends say he seems "off." He says that over the last four days he's been feeling much better and is "up and happy." He also has been rushing around doing home-improvement projects, talking more than usual and not needing to sleep at night.   Cody indicates that his grandmother was once hospitalized for depression. 

 

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4.    Rosemary Chambers is a 29-year-old mother of two. Rosemary gave birth to her second child, Kelly, two weeks ago. She had a protracted labor. After 35 hours the obstetrician decided to perform a forceps delivery. The birth was difficult, resulting in Rosemary requiring internal and external sutures. From the time of Kelly's birth, Rosemary experienced a lack of interest and "feeling" for her new baby, only agreeing to hold the baby following encouragement from nurses and pressure from her husband Rob. Rob states that Rosemary's lack of interest and affection for the new baby is worrisome.   

 

Rosemary was referred to a psychologist by her GP for assessment of her mental state following a deterioration in her mood, increased stress and anxiety, loss of appetite with resulting weight decrease, increased feelings of worthlessness, feelings of guilt that accompany thoughts of her children dying, poor sleep and general fatigue. 

 

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5.    When Peter goes to see his doctor for a work physical he decides to mention a concern he has about his mood. Peter states that his partner has mentioned feeling concerned about his mood swings.  Peter says that over the last five years his mood fluctuates between pretty good or "kind of bad." When he's feeling good, his mood is happy, he seems to need less sleep and gets a lot of work done. When his mood is lower he feels sad for a few weeks, experiences difficulty sleeping and feels fatigued during the day. These cycles seem to repeat endlessly year in and year out.

 

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6.    Today Janet called the mental health center to ask if someone could help her 16-year-old son, Adam. He has been having trouble sleeping for the past week, and Janet is becoming concerned about his health. Adam is waking up at irregular intervals throughout the night. She also states that his overall happiness seems to have taken a huge dip. Adam's teacher called her today and commented that Adam drew a picture of a grave during class. 

 

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7.    Eddie is a 48-year-old nurse. He's been successful in his job but he's known as the floor "Debbie downer." His work friends describe him as "pessimistic, gloomy and apathetic about life." One day a co-worker asks him why he's so sad. Eddie, thinks about it and says, "I don't know, I'm not really super sad but it just seems like I've been in a slump for the last four or five years. I'm not really depressed but I'm not all that happy either." Eddie decides to see a therapist about this issue. During the clinical interview, Eddie states that his mood is generally low, he doesn't find a lot of joy in many of the things he used to like and sometimes he feels pretty worthless.   

 

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8.    When I was 23, I left my job, joined the army, and life really went well for a while. But after I got back from the Middle East about six months ago, I started feeling really down. I don't even know why - the deployment wasn't difficult. I wasn't really in danger and I didn't see anything too awful or upsetting. But I just felt worse and worse, and all the things I used to enjoy seemed stupid and pointless. I couldn't be bothered doing anything, not even eating. I didn't have any energy but I couldn't sleep either. I managed to talk the Doc on the base into giving me a few weeks off sick, but that didn't do any good, I continued to feel completely worthless. I just stayed in bed and cried. Once I even thought about killing myself, but then I thought about what it would do to mom and dad. 

 

ENTER ANSWER

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Status NEW Posted 21 Jun 2017 12:06 AM My Price 20.00

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