Case 14 Cheryl R

Attention: Instructions. Please read the case study ( Case 14
Cheryl R) and answer this question below

1-2 pages of overview of the case, target symptoms, and medication treatment plan.

Include minimum of 4 scholarly peer-reviewed references
All writing and references must follow current American Psychological Association (APA) standards. Support paper with no less than 4 professional peer-reviewed scholarly journal. References properly cited in APA format. All articles must be within a five-year timeframe. Attention: The references need to be scholarly articles from professional scholarly journals only. Well known journals, because the institution requires me to verify the journal in Ulrich Website to make sure it is scholarly.

Case 14
Cheryl R. is a twenty-eight-year-old married woman with two children
under three years of age. She has been referred by her family doctor, who has
been treating her depression for nine months with fluoxetine, 20 mg daily.
Her physician states that medication adjustment is not indicated and thinks
“talking therapy” will be beneficial. Her psychiatric history is negative for
hospitalizations, and she has never been in therapy. She describes a “lifetime of
sadness” with periodic episodes of suicidal ideation during late adolescence.
Cheryl reports moderate improvement in her depression since starting the
medication and wants to continue taking it. However, she says that some of
her initial symptoms of irritability, tearfulness, and tiredness have never really
improved. She reports continued initial insomnia and describes lying awake
worrying about things.
Her major concern is that she is not the “best mother” she can be. On
particularly “bad days,” she places the children in front of the television and
retreats to her room. She wishes she had more “good days,” which occur about
every three months and last about a week. During these periods she begins
sewing and craft projects for the house, socializes with neighbors, exercises, and
“feels on top of the world.”
She appears slightly nervous and describes her mood as “pretty bad.” She
describes her marriage as “average” and her children as the “center of her life.”
She is moderately impatient with the interview questions relative to history
taking, since she wants to “get on with things.”
You are encouraged by Cheryl’s motivation for treatment. However, you
internally question whether she may fit the profile for bipolar II. In the process of
the diagnostic interview, you elicit enough information indicative of hypomanic
periods that predated the initiation of fluoxetine to warrant further consultation
with her original prescriber or a psychiatrist.
Listed below are important diagnostic specifiers for bipolar I and bipolar II. The reader
should refer to DSM-5 for a full explanation of coding and recording procedures for
these specifiers.
Episode severity
Remission status
With anxious distress
With mixed features
With rapid cycling
With melancholic features
With atypical features
With mood-congruent psychotic features
With mood-incongruent psychotic features
With catatonia
With peripartum onset With seasonal pattern The mixed episode was recognized in DSM-IV-TR as a discrete clinical entity, requiring that full diagnostic criteria be met simultaneously for bipolar I and major depression. In DSM-5 a specifier has been added, termed mixed features, applicable to a current manic, hypomanic, or depressive episode in bipolar I or bipolar II disorder. Mixed features would apply to mania or hypomania with depressive features, and to depressive episodes with features of mania or hypomania. Recent attention has focused on developing more precise diagnostic indicators and treatment regimens for bipolar depression, mixed features, and rapid cycling. It is speculated that continued research may lead to the identification of separate and distinct bipolar I processes (Soares 2000; Goldberg 2000). For the treating therapist, it is important to point out that there is ongoing controversy regarding the role of antidepressants in bipolar depression. The potential for antidepressants to induce mania is well documented. Concerns about this effect have led, by extension, to the suggestion that antidepressant treatment may play a role in the development of rapid cycling. Correspondingly, the literature and expert guidelines are not in absolute concordance regarding the use of antidepressants in bipolar I depression, especially for sequential courses of therapy. There is general consensus that if an antidepressant is used in bipolar depression, it should be in combination with a mood stabilizer, and not as monotherapy. Likewise, there is disagreement regarding recommendations for the length of antidepressant treatment. Chapter 17 addresses medication treatment. The presence of rapid cycling features in bipolar I and II disorders warrants special attention, due to the diagnostic and treatment challenges it presents. Rapid cycling is defined as at least four episodes of mania, hypomania, or major depression in the previous twelve months. The characteristics of rapid cycling are these:

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology for therapists. ProQuest Ebook Central


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