Essay on Maladaptive Behavior and Psychopathology
Case Vignette
Joanne is a 26-year-old single African American female of the Pentecostal faith, who recently moved to the Chicago Area to take a job in the publishing business. Joanne is requesting medication because she fills “unstable”. The history she describes seems to have begun about four years ago when she was in college, getting “A’s” in most of her classes, and having a wide circle of friends. During a particularly stressful period of final exams, she began to feel depressed, had difficulty sleeping and eating, and lost about fifteen pounds.
Although she completed her exams satisfactorily, her symptoms continued for about the next two months, and during that time she became more isolated socially. After she graduated, she felt much better, got a job, and felt increasingly energized. She began feeling so energized she didn’t seem to need much sleep and would wake up after 3 or 4 hours feeling wide awake and could put in 10 and 11 hour days of work.
She would feel her thoughts racing with new ideas and seemed to come up with creative ideas, although she often did not carry through on these, or other people didn’t seem to understand them. Although she denies the use of drugs or excessive use of alcohol, she does admit that she was partying and socializing a great deal. She said that at this time she found herself preoccupied with sexual thoughts and found sexual implications in whatever people said to her or what she saw on TV.
She was also very talkative and felt euphoric except at those times when she became extremely irritable and “cranky” towards people. She found herself striking up conversations with complete strangers. She began to feel like she could hear people that actually weren’t there talking to her, and she began to think that her apartment could be haunted. These voices would sometimes tell her to do things, like line objects up in a certain order, or take a different route home, or start saying certain words aloud. She also felt like she could read other people’s thoughts and was sure they could read hers and that they would answer her thoughts even when she didn’t say them out loud. “I’m sure I’ve always been psychic,” she said, “but it just really took off. I could sense all kinds of things.”
She said her friends became concerned and took her to an emergency room. She was hospitalized for several days and put on lithium. Most of her symptoms seemed to abate. Although she felt more fatigued and “slowed down,” her sleeping pattern improved, and her appetite increased. In the course of the move to the Chicago land Area, she had discontinued her use of the medication she’d been given—the prescription had run out, and she had lost contact with the prescribing psychiatrist. She has been noticing that she has been having difficulty sleeping, feels “jittery,” has been getting concerned about what other people are thinking, and is having difficulty focusing on work projects because her thoughts are racing.
Diagnostic
I would diagnose Joanne with major depressive disorder. To be diagnosed with major depression disorder Joanne must have five of the nine symptoms listed in the DSM-5 present during the same two week period. These systems can last for a week, a month, or several years. It started four years ago while Joanne was in college during a particularly stressful period of final exams. (1) Joanne reported having a major depressive episodes exceeding a two week period, in fact lasting two months, where she has felt depressed. (2) Joanne has reported having insomnia where she will sleep 3 to 4 hours a night and work 10 to 11 hours. (3)Joanne’s appetite changed causing a significant loss of weight, 15 pounds without dieting. (5) Joanne who has many friends but she has become socially isolated.
I suspect Joanne to have an Alcohol- Related Disorder. Although she denies the use of drugs or excessive use of alcohol, she does admit that she parties and socializes a great deal. Joanne’s thoughts raced with new and creative ideas, although she fails to carry through on these ideas. Joanne’s parting has created a physical hazard and interpersonal problems. Joanne finds herself preoccupied with sexual thoughts and sexual implications in whatever people say to her and with what she watches on TV. There are times when Joanne is very talkative and feels euphoric, and times when she is extremely irritable and “cranky” towards people. Because Joanne suffers from major depressive disorder and Alcohol-Related Disorder, She finds herself striking up conversations with complete strangers. The alcohol is allowing her to relax and let down her barriers. Joanne reported hearing people that actually weren’t there talking to her, and she began to think that her apartment could be haunted. The voices that Joanne is hearing are probably due to the severity of the depression.
Looking at the diagnostic criteria for Alcohol-Related Disorders, I’m going to have to change my mind about diagnosing Joanne with alcohol-related disorder, because I don’t see where she has used alcohol to the point where it has become a clinical significant impairment.
I still believe Joanne to have Major Depressive Disorder along with Bipolar I Disorder. In order to diagnose Joanne with bipolar I disorder criteria must be meet for current or past hypomanic episodes plus criteria must be met for major depressive episode. (1) Joanne has lived a normal life and has moved to Chicago to start a career. She is now displaying hypomania, which is consistent of a person with bipolar I disorder. (2) Joanne’s thoughts race with new and creative ideas, although she fails to carry through on these ideas, and other people don’t seem to understand them. Joanne flies from one idea to the next. (3) Joanne is displaying hyperactivity and a (4) decreased need for sleep. She began feeling so energized she didn’t seem to need much sleep and would wake up after 3 or 4 hours feeling wide awake and could put in 10 and 11 hour days of work.
Essay on Maladaptive Behavior and Psychopathology part 2
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