Diagnostic Case Study

DIAGNOSTIC CASE STUDY:

Diagnoses considered:

• ADHD вЂ" had been previously diagnosed

• Bipolar Disorder

• Bipolar II Disorder

• Intermittent Explosive Disorder

• Major Depressive Disorder

• Schizophrenia

• Schizoaffective disorder

Consideration of the above referenced diagnoses were based upon the following characteristics:

• Endearing behaviors at times.

• Exceptionally bright (per his teachers)

• Excessive length of outbursts- longer than 30 minutes

• Over activity and impulsivity

• Lack of attention for dangerous situations and actions.

• Perception that nothing can hurt him (grandiose perceptions)

• Classmates avoid him (find him overwhelming)

• Uncontrolled mood swings

• Previous diagnosis of ADHD (medicated)

• Behaviors/ moods worsening over past four months (more severe and prolonged)

• Doesn’t hear during his tantrums nor does he remember incidents following the tantrum.

• Violent, destructive, self injurious behaviors during tantrums

• Following the tantrum he is remorseful and seeks reassurance

• Moods are random and unpredictable

• Verbalizing suicidal thoughts during tantrum.

• Difficulty sleeping and doesn’t require much sleep

• Gross and gory nightmares

• Imaginary figures appearing to him multiple times daily instructing him to do “bad things”.

• Mother suffers from depression.

• Father’s aunt had bipolar disorder and committed suicide by 30

• Not welcome in the homes of neighborhood children.

• Claimed to have MANY friends, but mom stated he had none

• Ambivalent response to medication effectiveness by parents

Diagnosis selected:

• Bipolar II Disorder (Recurrent Major Depressive Episodes with Hypo manic Episodes)

• Retain diagnosis for ADHD

Axis I:

314.01 Attention Deficit Hyperactivity Disorder

296.89 Bipolar II Disorder

Code number Axis I Diagnosis Selected

Justification for the Diagnosis:

Daniel met the following criteria for Bipolar II Disorder:

• Presence of one or more major depressive episodes.

1. Depressed mood in children and adolescents can be irritable mood.

2. Insomnia or hyper insomnia nearly every day.

3. Psychomotor agitation.

4. Feelings of excessive or inappropriate guilt (following tantrum).

5. Diminished ability to think or concentrate.

• Presence of at least one Hypo manic Episode.

1. A distinct period of persistently elevated, expansive, or irritable mood lasting throughout at least four days (four months markedly worse).

2. During the period of mood disturbance the following symptoms