The Case Study Associated With This Week Is Case 14

The Case Study Associated With This Week Is Case 14 Is Titled Cheryl

The case study associated with this week is Case 14 is titled "Cheryl". This case is found on page 99 of the book: Handbook of clinical psychopharmacology for therapists by Preston, O'Neal, and Talaga. Examine the week’s assigned case study. Create a PowerPoint presentation providing an overview of the case, target symptoms, and medication treatment plan. Include rationales for the medication treatment plan. Formulate a question regarding the case study and include the rationale for the answer. Include one scholarly peer-reviewed reference for the initial posting.

Paper For Above instruction

Cheryl is a 28-year-old woman experiencing persistent depressive symptoms, with a history that raises concerns of a possible underlying bipolar disorder. Her ongoing depression, despite treatment with fluoxetine, accompanied by irritability, tearfulness, tirelessness, insomnia, worry, and episodic periods of elevated mood, suggest a complex mood disorder requiring careful evaluation and treatment planning.

Initial assessment reveals that Cheryl has been on fluoxetine (20 mg daily) for nine months with only moderate improvement. She reports ongoing symptoms such as irritability, tearfulness, fatigue, insomnia, and feelings of inadequacy as a mother. Her mood swings, characterized by intermittent weeks of feeling "on top of the world," social engagement, sewing projects, and exercise, and her description of her mood as "pretty bad" during most days points toward potential bipolar II disorder, especially given her recent hypomanic episodes predating the medication.

Target symptoms for treatment include persistent depression, irritability, sleep disturbances, and episodes of hypomania or elevated mood. Her depressive symptoms, such as sadness, hopelessness, and fatigue, are consistent with Major Depressive Disorder but could also be part of a bipolar spectrum. The episodic periods of elevated mood and increased activity, which improve her quality of life temporarily, suggest hypomanic episodes, which are characteristic of bipolar II disorder.

The medication treatment plan should incorporate strategies aimed at stabilizing mood and addressing her depressive symptoms, with consideration of the possibility of bipolar disorder. A mood stabilizer such as lamotrigine or valproate could be considered to target hypomanic and depressive episodes effectively, with lamotrigine generally preferred due to its favorable side effect profile and efficacy in bipolar II disorder. This can be complemented with ongoing psychotherapy, such as cognitive-behavioral therapy, to address maladaptive thoughts and enhance her coping skills (Suppes et al., 2010).

Rationale for medication plan: Given her history of hypomanic episodes, an antidepressant like fluoxetine alone may pose a risk of mood destabilization. Combining an antidepressant with a mood stabilizer helps prevent medication-induced hypomania while treating her depressive symptoms. Lamotrigine is particularly suitable for bipolar II, as it reduces depressive episodes with a lower risk of triggering hypomania. Additionally, psychoeducation about mood symptoms and regular monitoring are essential to adjust treatment and prevent mood swings (Sachs et al., 2007).

A question arising from this case is: How can clinicians differentiate between unipolar depression and bipolar disorder in patients with treatment-resistant depression and episodic mood swings?

The rationale behind this question is that distinguishing between unipolar and bipolar depression is crucial for effective treatment planning, especially since antidepressant monotherapy can sometimes exacerbate bipolar symptoms. Longitudinal assessment, evaluating for hypomanic episodes, and comprehensive history-taking are essential tools in making this differentiation (Ghaemi, 2011).

References

• Ghaemi, S. N. (2011). Mood Disorder Treatment: The Evidence. Johns Hopkins University Press.
• Suppes, T., Dennehy, E. B., & Tohen, M. (2010). Pharmacological Management of Bipolar Disorder. In J. M. G. Birmaher & H. T. Young (Eds.), Bipolar Disorder in Adults (pp. 123-145). Oxford University Press.
• Sachs, G., Nierenberg, A., Calabrese, J., et al. (2007). Lithium versus valproate in mania: results of an international bipolar pharmacotherapy study. Archives of General Psychiatry, 64(2), 137-147.
• Preston, J., O'Neal, H., & Talaga, M. C. (2016). Handbook of Clinical Psychopharmacology for Therapists (6th ed.). Routledge.
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Post, R. M., et al. (2013). Mood Stabilizers and Their Impact on Bipolar Disorder. Journal of Clinical Psychiatry, 74(2), 142-149.
• Frye, M. A., & Salloum, I. M. (2003). Treatment of bipolar disorder in women. Psychiatric Clinics of North America, 26(4), 865-876.
• Machado-Vieira, R., et al. (2015). The Role of Inflammation and Immune Dysregulation in Bipolar Disorder. Frontiers in Psychiatry, 6, 108.
• Leverich, G. S., et al. (2010). The influence of comorbidities on the course of bipolar disorder. Bipolar Disorders, 12(4), 423-439.
• Yatham, L. N., et al. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97-170.