CASE STUDY: Miss B is a 20 year old Caucasian female of Irish heritage who was a

Question

CASE STUDY: Miss B is a 20 year old Caucasian female of Irish heritage who was arrested for walking along the roadway on her college campus shouting obscenities at oncoming traffic. She is agitated states"leave me alone. I am in perfect health and know my own mind." Her mother and boyfriend arrive and state that she has been taking lithium carbonate 600mg t.i.d. for Bipolar Disorder II for the past 5 years, with good results until several weeks ago. Her boyfriend states that she has been 'up all night' for the past few days and has a "harebrained scheme to become a Rhodes Scholar". Miss B's mother states that she suffers from chronic depression and that she is worried since Miss B is pregnant. She says, "I have bad genes, but is there anything that we can do to keep my grandchild from having a mental disorder?" 1. Identify additional information/history that should be elicited in relation to this case. 2. Identify the pattern of inheritance for the disease/condition, and discuss the reason for your answer. 3. Identify family members that may be at risk for this disease, explain your answers. 4. Discuss any other alternative explanations for the disease/condition pattern noted in the Pedigree. Please refer to the book: Genetics and Genomics in Nursing and Health Care(2012)

Explanation / Answer

Bipolar II is a mental illness which is characterised by symptoms of major episodes of depression and at least one episode of hypomania. During an episode of hypomania, the person affected feels a certain kind of high or euphoric and may also be quite irritable. Miss B, suffered from a depressive period lasting for weeks. She was having one of her hypomanic episodes when she was out on the streets and cussing at the oncoming traffic.

She having a "harebrained scheme to become a Rhodes Scholar" and being up all night for the same exhibits symptoms that a person going through a hypomaniac episode exhibits, which includes not being able to sleep all night, and still continuing to feel active and entusiastic, being an over achiever, having ridiculous thoughts of accomplishing the unachievable.

The additional information required in relation to the above case is to know for how long did Miss B's hypomaniac episode last for. There could be a possibilty that if Miss B's hypomania lasted for a longer period of time then there are chances of her being diagnosed with Bipolar I. However, before we arrive to that conclusion, the following criteria needs to be met in accordance with The Diagnostic and Statistical Manual of Mental Disorders (DSM) which is published by the American Psychiatric Association (APA). DSM is a manual that all psychologists use to make any diagnosis as it is a standardised classification for mental disorders.

(The following criteria are from DSM-V)

Diagnostic Criteria for Bipolar Disorder-I:

1. Criteria have been met for at least one Manic or Mixed Episode.

2. The symptoms cause social/occupational distress or impairment.

3. The symptoms are not better accounted for by Schizoaffective Disorder, and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Diagnostic Criteria for a Manic Episode

1. Persistent elevated, expansive, or irritable mood for at least one week
(unless hospitalization is required).

At least three of the following symptoms are present during mood disturbance

(four if mood is irritable):

• inflated self-esteem or grandiosity
• decreased need for sleep
• increased talkativeness
• flight of ideas or racing thoughts
• distractibility
• increase in goal-directed activity or psychomotor agitation
• increase in risky behavior

2. Symptoms don't meet criteria for a Mixed Episode.

3. Level of severity sufficient to cause social or occupational impairment, hospitalization, or psychotic features.

4. Symptoms are not due to a substance or medical condition.

If the criteria above are met, then Miss B can be diagnosed for Bipolar-I, however to do so, additional information or family history may be required.

Diagnostic Criteria for a Manic Episode

1. Persistent elevated, expansive, or irritable mood for at least one week
(unless hospitalization is required).

At least three of the following symptoms are present during mood disturbance

(four if mood is irritable):

• inflated self-esteem or grandiosity
• decreased need for sleep
• increased talkativeness
• flight of ideas or racing thoughts
• distractibility
• increase in goal-directed activity or psychomotor agitation
• increase in risky behavior

2. Symptoms don't meet criteria for a Mixed Episode.

3. Level of severity sufficient to cause social or occupational impairment, hospitalization, or psychotic features.

4. Symptoms are not due to a substance or medical condition.

If the criteria above are met, then Miss B can be diagnosed for Bipolar-I, however to do so, additional information or family history may be required.

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