Question

For each case history provide:

1. a diagnosis;
2. list the criteria required for the diagnosis; and
3. provide examples from the case history for each of the criteria listed.
   For example, if one of the criteria for a diagnosis is "delusions", then you should list "delusions, e.g., believes he is receiving special/hidden messages from television programs that he only understands".

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Elisabeth Jacks was 38 years old and ran a catering service with her second husband, Donald, who was the main informant.

Elisabeth already had two grown children, so Donald could understand why this pregnancy might have upset her. But she had seemed unnaturally sad. From about her fourth month of pregnancy, she spent much of each day tired. Her appetite, voracious during her first trimester, fell off, so that by the time of delivery she was several pounds lighter than usual for a full-term pregnancy. She had to give up keeping the household business accounts, because she couldn't focus her attention long enough to add a column of figures. Still, the only time Donald became really alarmed was one evening at the beginning of Elisabeth's ninth month, when she told him that she had been thinking for days that she wouldn't survive childbirth and he would have to rear the baby without her. "You'll both be better off without me, anyway," she had said.

After their son was born, Elisabeth's mood brightened almost at once. The crying spells and the hours of rumination disappeared; briefly, she seemed almost her normal self. Late one Friday night, however, when the baby was three weeks old, Donald returned from catering a banquet to find Elisabeth dressed in nothing but bra and panties, icing a cake. Two other just-iced cakes were lined up on the counter, and the kitchen was littered with dirty pots and pans. "She said she'd made one for each of us, and she wanted to party," Donald told the clinician. "I started to change the baby – he was howling in his basket – but she wanted to drag me off to the bedroom. She said 'Please, sweetie, it's been a long time.' I mean, even if I hadn't been dead tired, who could concentrate with the baby crying like that?"

On Saturday, Elisabeth was out all day with girlfriends, leaving Donald home with the baby. On Sunday she spent nearly $300 "for Christmas presents" at an April garage sale. She seemed to have boundless energy, sleeping only two or three hours a night before arising, rested and ready to go. On Monday she decided to open a bakery; by telephone, she tried to charge over $1,600 worth of kitchen supplies to their VISA card. She'd have done the same the next day, but she talked so fast that the person she called couldn't understand her. She hung up in frustration.

Elisabeth's behaviour became so erratic that for the next two evenings Donald stayed off work to care for the baby, but his presence only seemed to provoke her sexual demands. Then there was the marijuana. Before Elisabeth became pregnant, she would have an occasional toke (she called it her "herb"). During the past week, not all the smells in the house had been fresh-baked cake, so Donald thought she might be at it again.

Yesterday Elisabeth had shaken him awake at 5 A.M. and announced, "I am becoming God." That was when he had made the appointment to bring her for an evaluation.

Elisabeth herself could hardly sit still when she talked to the interviewer. In a burst of speed, she described her renewed energy and plans for the bakery. She volunteered that she had never felt better in her life. In rapid succession she then described how she was feeling (ecstatic), how it made her feel when she put on her best silk dress (sexy), where she had purchased the dress, how old she had been when she bought it, and to whom she was married at the time.

Answer 1

#. The diagnosis of the patient is Bipolar disorder due to pregnancy .

Criteria :-

MANIC EPISODE :

A. Distinct period of abnormally and persistently elevated expansive or irritable mood and increased goal-directed activity or energy, lasting 1 week and present most or the day, nearly every day.

B. During this period, 3 of the following symptoms (4 if mood is only irritable) are present:

1. Inflated self-esteem or grandiosity.

2. Decreased need for sleep.

3. More talkative than usual or pressure to keep talking.

4. Flight of ideas or racing thought.

5. Distractibility.

6. Increased goal directed activity or psychomotor agitation.

7. Excessive involvement in high risk activities.

C. Sufficiently severe to cause marked impairment in functioning.

D. Not attributable to physiological effects of substance or other medical condition.

MAJOR DEPRESSIVE EPISODE :

A. Five or more of the following symptoms have been present during the same 2-week period (most of the day, nearly every day) and represent a change from previous functioning; at least one of the symptoms is either (1) or (2).

1. Depressed mood.

2. Markedly diminished pleasure in most or all activities.

3. Significant weight loss or weight gain, or decrease or increase in appetite.

4. Insomnia or hypersomnia.

5. Psychomotor agitation or retardation

6. Fatigue or loss of energy.

7. Feelings of worthlessness or excessive or inappropriate guilt.

8. Diminished ability to think or concentrate or indecisiveness.

9. Recurrent thoughts of death, recurring suicidal ideation without a plan, or a suicide attempt or specific plan for committing suicide.

B. Sufficiently severe to cause marked impairment in functioning.

C. Not attributable to physiological effects of substance or other medical condition.