Diagnostic Case Study Essay

DIAGNOSTIC CASE STUDY:
Diagnoses considered:
• ADHD – 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 have persisted and been presence to a significant degree. o Inflated self esteem or grandiosity (thinks he has many friends and can not be hurt in dangerous situations). o Decreased need for sleep. o Flight of ideas. o Distractibility.
3. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
4. The disturbance in mood and the change in functioning are observable by others.
5. The episode is not severe enough to necessitate hospitalization.
6. The symptoms are not due to direct physiological effects of a substance or general medical condition.

• There has never been a Manic or Mixed Episode.
• The mood 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.
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The children avoid him. Differential Diagnosis reveals that although Daniel meets the criteria for Bi Polar II disorder he does not meet the criteria unequivocally. According to the DSM –IV-TR, Attention Deficit/ Hyperactivity Disorder is not diagnosed if the symptoms are better accounted for by another mental disorder (e.g., Mood Disorder [especially Bi Polar Disorder], or Anxiety Disorder). In all of these disorders the symptoms of inattention typically have an onset after age 7 years, and behavior or teacher complaints concerning inattentive, hyperactive, or impulsive behavior (p.91). When a Mood disorder co-occurs with Attention Deficit/ Hyperactivity Disorder, each should be diagnosed. Currently Daniel continues to meet the criteria for ADHD and meets the criteria for BiPolar Disorder II, he is therefore diagnosed with both disorders, co-morbidly on Axis I.

Axis II:
__ V71.09_________ _______NONE__________
Code number Axis II Diagnosis

Axis III:
• R/O Seizure Disorder

Axis IV:
• Educational Problems o Students in class with him avoid him because he overwhelms them.
• Problems related to social environment: o He is not allowed to stay at his grandparent’s house without a supervising parent. o He is not permitted at the homes of neighborhood children due to behavioral issues.