Health & Medical Bipolar Disorder II Eve Case Study

Make sure to fully respond to each question and to use the rubric to guide your writing (the rubric is used to determine your grade). Your assignments should be written in accordance with APA 6^th edition guidelines and contain two professional sources (your text-book may count as one of your resources). Although there is no minimum page length requirement for this assignment, you will likely write a minimum of four pages to full address all of the prompts.

Case Scenario

The Case of Eve

 

Eve is a thirty-two-year-old woman who comes to the therapist for treatment of depression. Her current symptoms include the following: depressed mood, apathy, anhedonia, hypersomnia, significant daytime fatigue, suicidal ideations, and low frustration tolerance. She has experienced five prior episodes of depression. The symptom picture was much the same during each episode, though in this most recent episode she reports that her suicidal thoughts have increased. She also is increasingly pessimistic about psychiatric treatment being helpful for her.

Eve’s first episode occurred at the age of twenty-one and the second at age twenty-five. During these first two episodes of depression, each of which lasted approximately eight to nine months, she was functional but seriously depressed. She did not seek treatment; apparently in both cases she eventually experienced spontaneous remissions. In the next episode (her third, at age 27), she did see a psychotherapist and reports that it was somewhat helpful, but the treatment (psychotherapy alone) did not resolve her depression. Again she eventually recovered after twelve months. Again, it was likely a spontaneous remission.

Episode number four (age 29): Eve was treated by her primary care physician with Zoloft. She started this medication at a dose of 50 mg qd and she did tolerate it. After one month on this dose the dose was increased at first to 100 mg and then to 150 mg. After 3 months during which she did not show any improvement she was switched to Wellbutrin. Again she started with a low dose and was eventually increased to a dose of 300 mg qd. On both the Zoloft and the Wellbutrin, there was no significant improvement, but she remembers that she did experience increased irritability. Since the medication was not effective, she simply stopped taking it (four months into treatment). Eve continued to be depressed but somehow tolerated it and never talked to her doctor about it again. By twelve months her depression lifted.

Episode number five (age 30): This time Eve saw a psychiatrist and was tried on a number of different drugs: Effexor (up to 300 mg); Wellbutrin added to Effexor (doses in the therapeutic range). On Wellbutrin and Effexor she showed a 10% reduction in symptoms on the Hamilton Depression Rating Scale, but her slight improvement was accompanied by increased irritability, and that was the reason she stopped this medication combination after six weeks. The next medication she was prescribed was Remeron (which she stopped after five days due to excessive daytime sedation). Next she was tried on Effexor and lithium (she discontinued the lithium after three weeks due to sedation and nausea). Before stopping she had attained a blood level of 0.6 and no noticeable improvement. Finally, she was prescribed Cymbalta; again, not successful. Her psychiatrist diagnosed her as having treatment-resistant major depression without psychotic symptoms.

She now seeks treatment for her sixth episode of depression, which began three months ago and has gotten increasingly more severe.

Eve denies any history of psychotic symptoms, mania or hypomania, suicide attempts, or significant abuse of alcohol or other recreational drugs. She does drink four cups of coffee a day, attempting to stay alert and combat her constant fatigue. She takes a low dose of Inderal to treat a “mild case of hypertension.” She was started on this medication about three months prior to her current episode of depression. She says that she has no other medical problems.

 

In her first episode the break-up of a romantic relationship seems to have triggered the depressive episode. This was the case again in her second episode. However, in all later episodes there were no noticeable psychosocial stressors occurring prior to the depression. The depressions seemed to “come out of the blue.” She is currently married, in a stable and supportive relationship with her husband, and works as a university librarian.

Family history is significant. Her maternal grandmother (someone she never met) had had a number of psychiatric hospitalizations and she killed herself when she was twenty-nine years old. One cousin has had a “nervous breakdown.” Eve does not know any details about this. A great aunt was a severe alcoholic, and mother suffers from moderately severe chronic depression.

Eve says that now she feels desperate and is plagued by recurring and intense suicidal impulses.

Directions: Please respond to the following questions. All papers should be written in APA format.

Questions

1. Make a diagnosis (and mention possible diagnoses/diagnoses to rule out), and explain the rationale for the diagnosis.
2. What are the points in favor of a bipolar II diagnosis?

3.What might account for the failure to respond to any of the prior treatments?

4. Given the diagnosis you have made, describe your medication treatment strategies. Discuss not only initial choices of medications but also your next-step strategy and why you’ve chosen it. (In doing so, be sure to provide a rationale for your choices.) What questions should be addressed about the class of medications that is chosen (e.g., mood stabilizers)?

 

 

• This assignment is worth 100 points.
• All assignments should be written in APA format. Please include a title page, the body of your paper, and a reference page. All papers should include an introduction and conclusion.
• Submit the assignment by 11:59 CST on Day 7 of the week.

 

Assignment Rubric

 

Criteria	Well Developed (A to High A)	Developed (B to Low A)	Emerging (C to Low B)	Undeveloped (Less than a C)
Question 1: 15 pts a.       Make a diagnosis (and mention possible diagnoses/diagnoses to rule out), b.      Explain the rationale for the diagnosis.	15 points The correct diagnosis was clearly identified. Possible diagnoses to rule out were identified. Rationale for diagnosis was explained and pointed to the diagnosis.	13-14 points The correct diagnosis was clearly identified. Diagnoses to rule out were identified Rationale for diagnosis was explained.	11-12 points A diagnosis was identified. Diagnoses to rule out may or may not have been present. Rationale for diagnosis was present.	0-10 points A diagnosis was present but diagnoses to rule out may or may not have been present. Diagnostic rationale may not point to diagnosis or is missing.
Question 2: 15 pts a.       What are the points in favor of a bipolar II diagnosis?	15 points Hypomanic episode and depressive episodes are identified and not explained by ruling out disorders. Clinical distress is present. No manic episodes identified.	13-14 points Hypomanic episode and depressive episodes are identified and not explained by ruling out disorders. Clinical distress is present.	11-12 points Hypomanic episode and depressive episodes are identified. Clinical distress is present.	0-10 points Hypomanic episode and depressive episodes are vaguely identified or missing. Clinical distress may or may not be noted.
Question 3: 15pts a.       What might account for the failure to respond to any of the prior treatments?	15 points Previous treatments are all identified and discussed. Rationale for treatment is multi-factorial and direct links applied to previous treatments.	13-14 points Previous treatments are all identified and discussed. Rationale is present with direct links applied to previous treatments.	11-12 points Some previous treatments are identified and discussed. Rationale for treatment failure is discussed.	0-10 points Some previous treatments are discussed. Rationale for treatment failure may or may not be present.
Question 4: 30 pts a.   Given the diagnosis you have made, describe your medication treatment strategies. Discuss not only initial choices of medications but also your next-step strategy and why you’ve chosen it. (In doing so, be sure to provide a rationale for your choices.) b.   What questions should be addressed about the class of medications that is chosen (e.g., mood stabilizers)?	29-30 points Diagnosis is stated and medication treatment strategies are fully discussed. Medications are identified and rationale for next-step use presented and linked to therapeutic interventions. At least five medication questions are thoroughly addressed.	25-28 points Diagnosis is stated and medication treatment strategies are discussed. Medications and rationale for next-step use presented with suggestions for accompanying therapeutic interventions. Two to four medication questions are thoroughly addressed.	22-24 points Diagnosis and medication treatment strategies are incompletely addressed. Rationale for next-step use is incomplete and may not be associated with any suggestions for therapeutic interventions. One or more medication questions are incompletely addressed.	0-21 points Medication treatment strategies are present. Rationale for next-step use is vague or is missing. Accompanying therapeutic interventions may or may not be present. Medication questions are incomplete or absent.
Writing Mechanics and APA Format: 15 points	15 points No more than three grammatical, spelling, punctuation, and/or APA errors. Clarity of paper not influenced by errors.	13-14 points More than three grammatical, spelling, punctuation, or APA errors. Clarity of paper was not strongly influenced by the errors.	11-12 points More than three grammatical, spelling, punctuation, or APA errors that had a negative influence on the clarity of the paper.	0-10 points More than three grammatical, spelling, punctuation, or APA errors that had a strong negative influence on the clarity of the paper.
Sources: 10 points	10 points 2 professional sources or more are used throughout the paper as appropriate to thoroughly support ideas, and are documented in the references list.	9 points 1-2 professional sources are used to adequately support ideas and are documented in the reference list.	7 points 1 professional source is used to partially support ideas and is documented in the reference list.	0-6 points 1 source or less was used. Ideas were insufficiently supported.
Total: 100 points