A 24-year-old woman presented with nervousness, headache, and insomnia. She expe

Question

A 24-year-old woman presented with nervousness, headache, and insomnia. She experienced periods of sadness, often unexplained, as well as difficulty controlling her temper and dealing with stressful situations. Her sadness would occasionally last as long as a week and, when present, was intense, occurring all day every day, but she reported that she would then “bounce back” to her usual self. At times, her sadness would be accompanied by a restless energy and irritability that precipitated arguments with her husband and his ex-wife, among others. These periods of restless and boundless energy would then switch abruptly back to a state of intense, depressed mood. When depressed, she would sleep excessively and tended to overeat. She would isolate herself, let the housework go, and found it hard to get things done. She was also particularly sensitive to feelings of rejection by others, but her mood could be temporarily brightened, if she were occupied by activities she enjoyed.

      The patient had a 9-month-old child (her first) and a 1-year marriage to a law enforcement officer (her first; his third).

      The patient smoked 2 or 3 packs of cigarettes per day, drank no alcohol, and never used marijuana, cocaine, or other illicit substances. She drank 4 caffeinated soft drinks per day. She took birth control pills and had been generally healthy except for migraine headaches without aura. She had been moderately successful at treating the headaches with ibuprofen and rest. Her pregnancy and delivery were uncomplicated, but her headaches had been increasing in frequency and duration since giving birth. Only since the delivery of the child had she been experiencing these brief, but intense, periods of depressed mood. She described herself before this time as cheerful and outgoing, and she had sought no prior treatment for mood or anxiety problems. By contrast, many of her relatives experienced anxiety and/or depression. Her paternal grandfather was diagnosed with manic depression and hospitalized in a state mental health facility on 1 occasion. Several other male relatives abused alcohol or cocaine. Her father was an alcoholic. She described him as mercurial and impulsive, prone to outbursts and violent behaviors even during extended periods of sobriety.

     At the initial interview, the patient was animated and dramatic. Her response to the first question—“What brings you here to see us today?”—lasted 7 minutes without interruption. She switched topics a number of times, and her speech was moderately pressured. She was affectively labile, alternately laughing and crying. Her mood contained elements of depression and hypomania. She related frenzied activity into the early morning hours that was often accompanied by talking with friends on the phone and planning social outings. She would then rest for 3 or 4 hours and awaken with the same pressured desire to “get things done.” During the day, however, she was often tearful and irritable. Her judgment was not seriously impaired, and beyond arguments with her husband and his ex-wife, she was not involved in any self-damaging activities. There were no impairments in reality testing.

Using the DSM-V, what is your initial diagnosis (based only on the information given above):

Explanation / Answer

Answer. Using the dsm 5, initial diagnosis can be of Bipolar disorder - CYCLOTHYMIA.

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