Case 2 – Bipolar Disorder

Clinical Internship

Trainee’s Name:

Muhammad Usman Bin Tahir

Supervisor:

Ms. Maria Ahmed

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Psychological Advisory Panel

Rawalpindi

2022
 DECLARATION

I, Muhammad Usman Bin Tahir – Trainee (Intern) Clinical Psychologist at

Psychological Advisory Panel, duration 19 July 2022 – 28 August 2022 hereby declare that

the matter presented in this case report is original work under supervision of Ms. Maria

Ahmed – Clinical Psychologist, Psychological Advisory Panel.

Dated: Signature of Trainee

16-08-2022
 Table of content

Sr No Topics Page No

1 Demographics 04

2 Identifying Information 04

3 Source Presenting Complaints 04

4 Interviewed Information 05

5 Psychological Assessment 05

6 Tentative Diagnosis 06

7 Prognosis 06

8 Recommendations 07
Case 2 – Bipolar Disorder 4

CASE 2 – BIPOLAR DISORDER

Demographics

Name: ABC

Gender: Female

Age: 34 years

Date of administration: Unknown

Siblings Only Child

Occupation Call Center Manager

Identifying Information

Client was a call center manager who was 34 years old. She was raised as an only kid

and currently resides in her boyfriend's apartment. She frequently sees her mother because

they are close.

Source and Presenting Complaints

She and her boyfriend went to her general practitioner's appointment. She bemoaned

her weariness and lack of vigor for life. These grievances first surfaced a year ago but have

gotten worse over the last two months. She was frequently battling with the senior manager

and found it impossible to maintain her composure at work, so she was compelled to take

time off. Additionally, she had been irritated with her partner and was quickly offended when

he attempted to "motivate" her. Even though she was aware of his good intentions, she still
Case 2 – Bipolar Disorder 5

found it to be quite annoying and felt bad for responding to him in this manner. She lost all

desire for sex and socializing.

Interviewed Information

She had a lot of support from her partner, but she was always afraid he would leave

her. When she had been at home for the previous six weeks, she had spent the most of her

time in bed. She acknowledged with embarrassment that she occasionally neglected to wash

or even brush her teeth. She was unable to focus while she watched television inanely. She

frequently felt "empty," and it bothered her that she was unable to respond to her boyfriend's

efforts to connect with her. She struggled to fall asleep, so she watched TV until late. She

frequently stayed in bed till late in the morning because she felt fatigued.

Psychological Assessment

The psychological assessment can be done through informal and formal both.

Informal Assessment

The informal assessment was basically done from clinical interview and the MSE.

Clinical Interview

She is the only child in the family. She resides at her boyfriend's apartment with him.

She frequently sees her mother because they are close. After having a stroke last year, her

father passed away. She is in good health and is free of illness. She abstains from alcohol and

drug use. She recalls being very high' when she was 19 years old and being committed to a

mental hospital on a section. She has been off lithium for years, although she does recall

taking it for a period. The only other mental health incident she can recall was while she was

on vacation in Greece, when she felt highly euphoric and thought she was Venus, the goddess
Case 2 – Bipolar Disorder 6

of love. She went topless to the neighborhood market, was stopped, and was then sent to a

psychiatric hospital. She received inpatient care for two weeks before being released with

some medication. She can barely remember the incident, but she does recall not taking the

medication when she got back to the UK.

Mental State Examination

The Client appearance was normal when she entered the session room. She was sitting

in comfortable posture. Her speech was normal in rate and the voice tone was normal. She

maintained good eye contact and physical built was good. Her mood was not euthymic at all.

Her level of consciousness was not that alert. She was not that attentive and also lacked in

concentration. She had no impairment in memory and the general knowledge was normal.

She reported insight regarding her problem and wanted to get to normal life. She had

grandiose delusions and no obsessional thoughts.

Formal Assessment

 YMRS

 MAS

Tentative Diagnosis

Bipolar disorder with current depressive episode.

Prognosis

With a history of two bouts of mood illness, both of which appear to have been manic

episodes (characterized by grandiose delusions, ecstatic mood, and disinhibition necessitating

admission to an inpatient unit), this woman is currently experiencing a moderate to severe

Case 2 – Bipolar Disorder 7

depressive episode. Bipolar disorder with a present depressive episode is the most likely

diagnosis.

Recommendations

She should be referred to the mental health team for an urgent examination in order to

manage the current depressed component. Antidepressants should be avoided because they

(used alone) have the potential to trigger mania. This is especially true if the illness exhibits

rapid cycling (more than four mood episodes per year) or if a recent manic episode occurred.

Psychotherapies like interpersonal therapy (IPT) or cognitive behavior therapy (CBT) may be

beneficial. Evidence-based therapies for moderate to severe bipolar depression include

quetiapine alone or fluoxetine plus olanzapine. If the patient is currently taking lithium or

sodium valproate, adjusting the dose within the therapeutic range may be helpful. Olanzapine

or lamotrigine on their own are also helpful.