An individual is referred to your office by his parole officer. This 19-year-old male, named Sam, was recently arrested for a “psychotic break” that caused him to throw a chair through the neighborhood drug store window. Sam’s parents arrive and Sam agrees to have his parents present during the interview.
His parents state Sam recently withdrew from college after experiencing a “resounding moment” in which he changed his major from engineering to philosophy and increasingly had reduced his sleep, spending long hours engaging individuals in the commons in conversations about the nature of reality and how he is gaining an appreciation “for all life”. He had been convinced about the importance of his ideas, stating frequently that he was more learned and advanced than all his professors. He told many that “I should be the one teaching these courses, after all, I understand it much better than my professors”. Sam has also increased the number of high-risk behaviors – drinking and engaging in sexual relations in a way that was unlike his previous history. He also has spent a considerable sum of money on “projects to help the world” – unfortunately, he has never completed a project.
Sam’s parents also state that Sam was diagnosed previously by his PCP with MDD and GAD. “These new behaviors are just that – new – since he went to college”.
Further discussions with Sam and his parents reveal that he has never experienced hallucinations and you believe that he currently is not experiencing any delusions. Sam states “I am what I am”.
- What diagnosis do you believe may apply to this individual?
- What classifications of medications can be used to treat this disorder? Which medication do you recommend and why?
Based on the information provided, it seems that Sam is experiencing a significant change in his behavior and functioning, which could be indicative of a mood disorder with features of mania. Specifically, Sam may be experiencing a manic episode. Here are some key points supporting this assessment:
- Elevated Mood: Sam has experienced a “resounding moment” and a sudden change in his major from engineering to philosophy. He has also expressed grandiosity, believing he is more knowledgeable than his professors and that he should be teaching courses. These are indicative of an elevated or irritable mood, which is a hallmark of a manic episode.
- Reduced Need for Sleep: Sam has reduced his sleep and spends long hours engaged in conversations. This is a common symptom of mania.
- Increased Risky Behaviors: Engaging in high-risk behaviors such as excessive drinking and sexual relations that are unlike his previous history is consistent with manic behavior.
- Excessive Spending: Sam is spending a considerable sum of money on projects but fails to complete them. This reckless spending is another symptom of mania.
- No Current Hallucinations or Delusions: Sam denies experiencing hallucinations or delusions, suggesting that he is not in a psychotic state.
Given the symptoms described, a possible diagnosis for Sam could be Bipolar I Disorder, Single Manic Episode. This diagnosis indicates that Sam is currently experiencing a single episode of mania without a history of depressive episodes.
The treatment of choice for acute mania in Bipolar I Disorder typically involves mood stabilizers or antipsychotic medications. Common medication options include:
- Lithium: Lithium is a mood stabilizer commonly used to treat mania in bipolar disorders. It can help stabilize mood, reduce manic symptoms, and prevent future manic episodes.
- Anticonvulsants: Medications such as valproic acid (Depakote) or lamotrigine (Lamictal) can also be used as mood stabilizers to manage manic symptoms.
- Atypical Antipsychotics: Medications like aripiprazole (Abilify), risperidone (Risperdal), or olanzapine (Zyprexa) are often prescribed to manage acute manic episodes.
The choice of medication depends on various factors, including the severity of symptoms, side effect profile, and individual patient response. Given that Sam does not seem to be experiencing psychotic symptoms or hallucinations, a mood stabilizer like lithium or an anticonvulsant may be considered as a first-line treatment.
However, it’s essential for Sam to undergo a comprehensive evaluation by a mental health professional to confirm the diagnosis and determine the most appropriate treatment plan. Additionally, psychotherapy and psychosocial interventions can play a crucial role in the long-term management of bipolar disorder.