Lesson 1: Clinical Disorders – Part B
PART B
Bipolar Disorder - Case Study 12
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Description Abigale, a 24 year-old copy editor who had just moved to a new city, sought help from a psychiatrist regarding her on-going treatment with lithium, a mood stabilizer. She told the doctor that three years ago, while attending college in her senior year, she began to experience depression and a loss of appetite that resulted in a weight loss of about ten pounds. Abigale explained that she had trouble falling asleep and often awakened too early - unable to sleep any longer. Before the onset of these symptoms, Abigale described herself as a happy person who did well at school and had many friends.
Abigale’s friends became alarmed at her change in behaviour and so took her to a hospital emergency room where she was admitted to the psychiatric ward after an evaluation. Further assessment of After about six weeks Abigale displayed none of the symptoms she had at the time of her admission, but she did note that she was sleeping a bit longer than normal (ten hours) and had a decrease in appetite. She was, however, found well enough to be discharged from the hospital to live with some friends. Unfortunately, after about eight months, Abigale was taken off of the lithium carbonate by the college psychiatrist only to have her symptoms reappear after a few months. She was admitted to the hospital again with almost identical symptoms of her first visit. She was placed back on her medication and has been doing well ever since. Her move to a new city because of a job promotion necessitated finding another psychiatrist to manage her treatment. As for Abigale’s familial history, her father had severe depression in his 40s. The depression was characterized by hypersomnia (sleeping too much), anorexia, a slowing of body movements, and suicidal thoughts. Her father’s mother (Abigale’s grandmother) also suffered from depression and had committed suicide during a major depressive episode. |
Diagnosis Abigale was functioning quite well before the onset of her unusual behaviour. Starting with the development of a depressive episode (depression, loss of appetite) and changing to a period of mania (elation, irritability, low sleep requirements, delusions-radar messages, auditory hallucinations), it became evident that Abigale was suffering from a mood disorder. Many of Abigale’s symptoms also characterize schizophrenia (delusions and hallucinations), but because they occurred only in the manic phase, schizophrenia was ruled out. A diagnosis of bipolar disorder was made because no organic cause was found and Abigale did not abuse any stimulants or other drugs that may produce similar symptoms. Because Abigale was symptom-free for over six months (still taking her medication) and functioned well in her day-to-day life, she was considered to be in “full remission” with a high GAF. Please see below for her full DSM diagnosis. Axis I: Bipolar Disorder, Manic, in Full Remission Axis II: No diagnosis or condition Axis III: None Axis IV: Psychosocial stressors: none Axis V: Current GAF: 80 Axis V: Current GAF: 80 |
She told the psychiatrist that the above symptoms lasted about two months only to be replaced by feelings of increased energy and a reduced need for sleep – from two to five hours per night. She noted that her thoughts would race during these “energetic” phases and that she would see symbolic meaning (especially sexual) in ordinary things. She began to imagine that comments on television shows were directed to her personally and she became increasingly ecstatic, irritable, and verbose (talkative). Abigale began to believe that radar messages were being sent to her through a hole in her head. The messages, from other people, were believed to be beyond her control and had power over her emotions and thoughts. She also believed that other people could read her thoughts at will. Abigale also heard voices that sometimes spoke to her in the third person. 
Abigale on the following day resulted in her being placed on three drugs (an antipsychotic, chlorpromazine, and lithium carbonate). Over the next month Abigale’s symptoms decreased rapidly and her medication was modified to consist of only lithium carbonate.