CNDV 5327 LU Week 2 Health & Medical Bipolar Disorder II Eve Case Study

Case Study 2 InstructionsMake sure to fully respond to each question and to use the rubric to guide your writing (the
rubric is used to determine your grade). Your assignments should be written in accordance
with APA 6th edition guidelines and contain two professional sources (your text-book may
count as one of your resources). Although there is no minimum page length requirement for
this assignment, you will likely write a minimum of four pages to full address all of the
prompts.
Case Scenario
The Case of Eve
Eve is a thirty-two-year-old woman who comes to the therapist for treatment of depression. Her
current symptoms include the following: depressed mood, apathy, anhedonia, hypersomnia,
significant daytime fatigue, suicidal ideations, and low frustration tolerance. She has experienced five
prior episodes of depression. The symptom picture was much the same during each episode, though
in this most recent episode she reports that her suicidal thoughts have increased. She also is
increasingly pessimistic about psychiatric treatment being helpful for her.
Eve’s first episode occurred at the age of twenty-one and the second at age twenty-five. During these
first two episodes of depression, each of which lasted approximately eight to nine months, she was
functional but seriously depressed. She did not seek treatment; apparently in both cases she
eventually experienced spontaneous remissions. In the next episode (her third, at age 27), she did
see a psychotherapist and reports that it was somewhat helpful, but the treatment (psychotherapy
alone) did not resolve her depression. Again she eventually recovered after twelve months. Again, it
was likely a spontaneous remission.
Episode number four (age 29): Eve was treated by her primary care physician with Zoloft. She started
this medication at a dose of 50 mg qd and she did tolerate it. After one month on this dose the dose
was increased at first to 100 mg and then to 150 mg. After 3 months during which she did not show
any improvement she was switched to Wellbutrin. Again she started with a low dose and was
eventually increased to a dose of 300 mg qd. On both the Zoloft and the Wellbutrin, there was no
significant improvement, but she remembers that she did experience increased irritability. Since the
medication was not effective, she simply stopped taking it (four months into treatment). Eve continued
to be depressed but somehow tolerated it and never talked to her doctor about it again. By twelve
months her depression lifted.
Episode number five (age 30): This time Eve saw a psychiatrist and was tried on a number of
different drugs: Effexor (up to 300 mg); Wellbutrin added to Effexor (doses in the therapeutic range).
On Wellbutrin and Effexor she showed a 10% reduction in symptoms on the Hamilton Depression
Rating Scale, but her slight improvement was accompanied by increased irritability, and that was the
reason she stopped this medication combination after six weeks. The next medication she was
prescribed was Remeron (which she stopped after five days due to excessive daytime sedation).
Next she was tried on Effexor and lithium (she discontinued the lithium after three weeks due to
sedation and nausea). Before stopping she had attained a blood level of 0.6 and no noticeable
improvement. Finally, she was prescribed Cymbalta; again, not successful. Her psychiatrist
diagnosed her as having treatment-resistant major depression without psychotic symptoms.
She now seeks treatment for her sixth episode of depression, which began three months ago and has
gotten increasingly more severe.
Eve denies any history of psychotic symptoms, mania or hypomania, suicide attempts, or significant
abuse of alcohol or other recreational drugs. She does drink four cups of coffee a day, attempting to
stay alert and combat her constant fatigue. She takes a low dose of Inderal to treat a “mild case of
hypertension.” She was started on this medication about three months prior to her current episode of
depression. She says that she has no other medical problems.
In her first episode the break-up of a romantic relationship seems to have triggered the depressive
episode. This was the case again in her second episode. However, in all later episodes there were no
noticeable psychosocial stressors occurring prior to the depression. The depressions seemed to
“come out of the blue.” She is currently married, in a stable and supportive relationship with her
husband, and works as a university librarian.
Family history is significant. Her maternal grandmother (someone she never met) had had a number
of psychiatric hospitalizations and she killed herself when she was twenty-nine years old. One cousin
has had a “nervous breakdown.” Eve does not know any details about this. A great aunt was a severe
alcoholic, and mother suffers from moderately severe chronic depression.
Eve says that now she feels desperate and is plagued by recurring and intense suicidal impulses.
Directions: Please respond to the following questions. All papers should be written in APA
format.
Questions
1. Make a diagnosis (and mention possible diagnoses/diagnoses to rule out), and explain the
rationale for the diagnosis.
2. What are the points in favor of a bipolar II diagnosis?
3.What might account for the failure to respond to any of the prior treatments?
4. Given the diagnosis you have made, describe your medication treatment strategies. Discuss not
only initial choices of medications but also your next-step strategy and why you’ve chosen it. (In doing
so, be sure to provide a rationale for your choices.) What questions should be addressed about the
class of medications that is chosen (e.g., mood stabilizers)?



This assignment is worth 100 points.
All assignments should be written in APA format. Please include a title page, the
body of your paper, and a reference page. All papers should include an
introduction and conclusion.
Submit the assignment by 11:59 CST on Day 7 of the week.
Assignment Rubric
Criteria
Question 1: 15 pts
a. Make a diagnosis (and mention
possible diagnoses/diagnoses to rule
out),
b. Explain the rationale for the
diagnosis.
Question 2: 15 pts
a. What are the points in favor of a
bipolar II diagnosis?
Question 3: 15pts
a. What might account for the failure to
respond to any of the prior
treatments?
Well Developed
(A to High A)
15 points
The correct diagnosis was
clearly identified.
Possible diagnoses to rule
out were identified.
Rationale for diagnosis
was explained and
pointed to the diagnosis.
15 points
Hypomanic episode and
depressive episodes are
identified and not
explained by ruling out
disorders. Clinical
distress is present. No
manic episodes identified.
15 points
Previous treatments are
all identified and
discussed. Rationale for
treatment is multifactorial and direct links
applied to previous
treatments.
Developed
(B to Low A)
13-14 points
The correct diagnosis was
clearly identified.
Diagnoses to rule out were
identified
Rationale for diagnosis was
explained.
Emerging
(C to Low B)
11-12 points
A diagnosis was
identified. Diagnoses to
rule out may or may not
have been present.
Rationale for diagnosis
was present.
Undeveloped
(Less than a C)
0-10 points
A diagnosis was present
but diagnoses to rule out
may or may not have
been present. Diagnostic
rationale may not point
to diagnosis or is
missing.
13-14 points
11-12 points
0-10 points
Hypomanic episode and
Hypomanic episode and
Hypomanic episode and
depressive episodes are
depressive episodes are
depressive episodes are
identified and not explained identified. Clinical distress vaguely identified or
by ruling out disorders.
is present.
missing. Clinical
Clinical distress is present.
distress may or may not
be noted.
13-14 points
Previous treatments are all
identified and discussed.
Rationale is present with
direct links applied to
previous treatments.
11-12 points
Some previous treatments
are identified and
discussed. Rationale for
treatment failure is
discussed.
0-10 points
Some previous
treatments are
discussed. Rationale
for treatment failure
may or may not be
present.
Question 4: 30 pts
a. Given the diagnosis you have made,
describe your medication treatment
strategies. Discuss not only initial
choices of medications but also your
next-step strategy and why you’ve
chosen it. (In doing so, be sure to provide
a rationale for your choices.)
b. What questions should be addressed
about the class of medications that is
chosen (e.g., mood stabilizers)?
Writing Mechanics and APA
Format: 15 points
Sources: 10 points
Total: 100 points
29-30 points
Diagnosis is stated and
medication treatment
strategies are fully
discussed. Medications
are identified and
rationale for next-step use
presented and linked to
therapeutic interventions.
At least five medication
questions are thoroughly
addressed.
15 points
No more than three
grammatical, spelling,
punctuation, and/or APA
errors. Clarity of paper
not influenced by errors.
25-28 points
Diagnosis is stated and
medication treatment
strategies are discussed.
Medications and rationale
for next-step use presented
with suggestions for
accompanying therapeutic
interventions.
Two to four medication
questions are thoroughly
addressed.
13-14 points
More than three
grammatical, spelling,
punctuation, or APA errors.
Clarity of paper was not
strongly influenced by the
errors.
10 points
9 points
2 professional sources or 1-2 professional sources are
more are used throughout used to adequately support
the paper as appropriate ideas and are documented in
to thoroughly support
the reference list.
ideas, and are
documented in the
references list.
22-24 points
Diagnosis and medication
treatment strategies are
incompletely addressed.
Rationale for next-step use
is incomplete and may not
be associated with any
suggestions for
therapeutic interventions.
One or more medication
questions are incompletely
addressed.
11-12 points
More than three
grammatical, spelling,
punctuation, or APA
errors that had a negative
influence on the clarity of
the paper.
7 points
1 professional source is
used to partially support
ideas and is documented
in the reference list.
0-21 points
Medication treatment
strategies are present.
Rationale for next-step
use is vague or is
missing. Accompanying
therapeutic interventions
may or may not be
present.
Medication questions
are incomplete or
absent.
0-10 points
More than three
grammatical, spelling,
punctuation, or APA
errors that had a strong
negative influence on
the clarity of the paper.
0-6 points
1 source or less was
used. Ideas were
insufficiently supported.

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