Case Study: Petunia Park
Case Study: Petunia Park
Subjective:
CC (chief complaint): Mental health assessment
HPI: Petunia Park, is a 25-year-old who presents to the clinic for mental health assessment. The patient reports having four psychiatric hospitalizations, with the most recent being in spring 2020. She reported having episodes of high energy and creativity lasting about a week, followed by depressive periods. She further reported experiencing hypersexual behavior during “high” periods. Other symptoms that the patient reported included low mood, lack of motivation, fatigue, and reduced interest. She reported to having a history of taking and stopping medications since they made her feel like they squashed her creativity.
Substance Current Use: She reported smoking nicotine; 1 pack per day, taking alcohol in later teens and used marijuana once, which made paranoid. She denied taking cocaine, stimulants, inhalants, sedatives, or other illicit drugs.
Medical History:
- Hypothyroidism
- Polycystic ovary syndrome
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- Current Medications: Thyroid medication and birth control pills for the PCOS.
- Allergies: No known allergies
- Case Study: Petunia Park
- Reproductive Hx: Experiences regular menses. Denies being pregnant. Acknowledged engaging in frequent sexual encounters with multiple partners.
ROS:
- GENERAL: Patient admitted to experiencing periods of low energy and being fatigued.
- HEENT: Denies headache, blurred vision, running noses, or sore throat.
- SKIN: Denie having any skins rashes.
- CARDIOVASCULAR: Denies having heart palpitations
- RESPIRATORY: Denies experiencing shortness of breath or coughing.
- GASTROINTESTINAL: Admitted that her appetite fluctuated with mood, having poor appetite during “creative” episodes and tendency to overeat during ‘crash” periods
- GENITOURINARY: Admitted having regular menses. Denied experiencing painful sensation or pain when urinating. Denies any significant changes in urination frequency.
- NEUROLOGICAL: Has a history of auditory hallucinations during sleep deprivation.
- MUSCULOSKELETAL: Denied experiencing muscle or joint pain.
- HEMATOLOGIC: Denied having uncontrolled bleeding
- LYMPHATICS: She denied having swollen lymph nodes
- ENDOCRINOLOGIC: reports having hypothyroidism
Objective:
Vitals
Temp 98.2 Pulse 90 Respiration 18 B/P 138/88
Physical Findings
Alert and oriented
Appeared disheveled
Mood labile, fluctuating between elevated and depressed
Speech pressured at times
Tangential thoughts
Diagnostic results:
Urine drug and alcohol screen negative.
CBC within normal ranges
CMP within normal ranges.
Lipid panel within normal ranges.
Prolactin Level 8; TSH 6.3 (H)
Assessment:
Mental Status Examination:
The patient is a 25-year-old female patient whose physical appearance fits her stated age. She appears neatly groomed and appropriately dressed. The patient is alert and well-oriented to time, place, and person. Her mood is labile and shifts between depressed and elevated. Her thought process indicates that she was having racing thoughts in her episodes of high energy and with pressured speech. She has no delusions or obsessions. She is noted to having a history of suicidal ideation but have not had it in the recent past. It can be noted that she has fair judgement and intact cognition.
Diagnostic Impression:
- Bipolar I Disorder, most recent episode manic; According to Mousavi et al. (2021) bipolar I disorder is “a chronic and recurrent psychiatric disorder in which a person has a manic episode for 1 week, which may present before or after hypomanic or major depressive episodes” (p.1). The patient presented with symptoms including manic and hypomanic episodes, chronic stress, and heightened risk of sudden mood swings.
- Major Depressive Disorder with psychotic features: This is a mental disorder where an individual has depression together with loss of touch of reality (psychosis) (Wang et al., 2021). The patient suffers from a both low mood and psychosis. In this case, the patient presented with hypomanic episodes evident, which is not a feature of MDD, and thus informed the decision to rule it out.
- Schizoaffective Disorder, bipolar type: Diagnosis of schizoaffective disorder, bipolar type, requires one to have a minimum of two of these symptoms in a month, and with one of the symptoms being from the first three, “delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms” (Paul et al., 2021). In this case, the patient did not satisfy these conditions and hence it was ruled out. Case Study: Petunia Park
Reflections:
The provided an opportunity of carrying out a comprehensive psychiatric evaluating involving gather detailed history of patient’s symptoms. Patient’s history of mood swings, periods of high energy and creativity, followed by depressive episodes, is consistent with Bipolar I Disorder. It is important to ensure provision of a comprehensive treatment that addresses the indicated symptoms
Case Formulation and Treatment Plan:
Non-pharmacotherapy
Cognitive behavioral therapy: CBT will be used to treat the negative thought pattern, enhance coping approaches, and promote adherence to the treatment plan.
Pharmacotherapy
Imitating mood stabilizers: Lithium; dose 300mg 1-2 times daily and antipsychotics: Aripiprazole: Dose 10 mg daily
Psychoeducation;
The patient will be educated on the importance of adhering to the medications provided as well as the impact of nicotine of mental health.
Health promotion activities;
The patient will be advised on the importance of proper nutrition, regular sleep pattern, and need of addressing stress triggers.
Follow-up and Monitoring
The patient was scheduled for a follow-up appointment after four weeks to monitor treatment response, possible side effects, and adherence to the regimens.
References
Mousavi, N., Norozpour, M., Taherifar, Z., Naserbakht, M., & Shabani, A. (2021). Bipolar I disorder: a qualitative study of the viewpoints of the family members of patients on the nature of the disorder and pharmacological treatment non-adherence. BMC psychiatry, 21, 1-11. https://doi.org/10.1186/s12888-020-03008-x
Paul, T., Javed, S., Karam, A., Loh, H., & Ferrer, G. F. (2021). A misdiagnosed case of schizoaffective disorder with bipolar manifestations. Cureus, 13(7). https://doi.org/10.7759/cureus.16686
Wang, M. Q., Wang, R. R., Hao, Y., Xiong, W. F., Han, L., Qiao, D. D., & He, J. (2021). Clinical characteristics and sociodemographic features of psychotic major depression. Annals of General Psychiatry, 20, 1-8. https://doi.org/10.1186/s12991-021-00341-7 Case Study: Petunia Park
