Assessing a Patient With Bipolar 1 Disorder

Danny's case, we do not have enough information thus far to make an accurate diagnosis. The information that he has provided is helpful as a starting point, but Danny has indicated that he is somewhat uncooperative at this point (he says he is not here for you to diagnose him with depression and that his arrival at your office is mandated by the school as part of his probation -- otherwise he would not be there).

So, in order to properly diagnose Danny, more time will be needed and more information. Nonetheless, there are signs, just from the little that we have to go on, that could point us in the right direction. The history provided by the parents and the comments made my by Danny himself do suggest that Danny may be showing symptoms of bi-polar disorder…but more work must be done before this diagnosis can be made.

In order to better assess the situation, we might ask Danny a host of other questions, such as: Have there ever been times when you feel like you are a kid on Christmas morning? Do these instances ever last for days on end? Do you experience times of high energy? Do you ever have racing thoughts or feel pressure to keep talking? Do you ever feel overwhelmed by your thoughts, confused by them, or do they generally lead to clarity and illumination? Do you start lots of projects and goal-directed activities? Do you ever feel more distracted than usual? If so, how long do those periods usually last? What's the longest they have lasted? (4-7 days hypo manic meaning Bipolar 2, 7 + days manic meaning bipolar).

When you become sad you have trouble enjoying yourself? Does your appetite change? Do you experience a prolonged loss of appetite? Do you feel like you are moving in slow motion? Are you fatigued or do you have a loss of energy? Do you have trouble concentrating or making decisions? Do you feel that there is a difference between being sad and being depressed? If so, could you explain this difference? When you tried to hurt yourself were you trying to die? Have you ever tried to kill yourself? Do you find yourself thinking about death or suicide when you are sad? Do you find that your social life, education, or occupation is ever affected by the feelings you experience? I do believe Danny when he says that he just wanted to take the car for a spin and not steal it, though his inability to equate taking it for a spin and theft could be something that may be beneficially addressed in cognitive behavior therapy.

If I had to speculate, I would diagnose Danny as having possible bi-polar disorder. There are some indications in the text that would lead me to speculate that this is the case.

For instance, when his mother states that "there was one incident in which Danny tried to harm himself" and that he is only getting a "couple hours of sleep per night" and when Danny himself states that "he believes everyone has weeks or months where they just feel sad" -- these could be symptoms of Bipolar 1 -- of Danny having a major depressive episode. There are other indications in the text that might indicate that Danny has had a manic episode.

For instance, he can be "the real life of the party" and many people find him to be "charismatic"…or that he has been "staying up late playing video games"…even stealing the car for a quick spin could be a symptom of a manic episode (he was feeling on top of the world, as he himself describes). As DSM-V (2013) states, the diagnostic criteria for Bipolar 1 Disorder are as stated, "For a diagnosis of bipolar 1 disorder, it is necessary to meet the following criteria for a manic episode.

The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes" (p. 123). This diagnosis may very well apply to Danny, who has showed hypomanic symptoms and has suggested that he may be experiencing major depressive episodes (feeling sad for weeks or months at a time). A possible psych testing (MMPI) could be given since he is withholding information and the University is looking for treatment recommendations. Also this could be a way of ruling out a.