She has also recently experienced a "depressive episode characterized by the presence, while depressed, of two (or more) of the following:" poor appetite, insomnia and hypersomnia, low energy and fatigue, low self-esteem, poor concentration, difficulty making decisions, feelings of hopelessness, and a lack of energy that stood in notable contrast to her agitated, incessant movement and energy during her manic phase.
During her manic phase, Katherine showed clear signs of inflated self-esteem or grandiosity, a decreased need for sleep, was more talkative than usual, had a lack of need for sleep, was agitated in a manner observable to others, had racing thoughts and a flight of ideas accompanied with goal-directed social and academic activity, and also showed features of involvement in pleasurable activities such as binge drinking, shopping, sexual activities, and other types of "excessive involvement in pleasurable activities that have a high potential for painful consequences" as per the DMV-IV.
Review of issues in care and expert opinions
The willingness of Katherine's family to be involved speaks well of the potential of her case to have a good outcome. To confirm the diagnosis, her parents were asked to complete a Mood Disorder Questionnaire (MDQ), through which they confirmed Katherine's rapidly shifting moods throughout her adolescence. Katherine would often be best friends with girls, and then have a falling-out with them. Her school record, though strong, was often characterized by bursts of activity, followed by long periods of 'mental health days.'
Katherine was prescribed a mood stabilizer, to immediately address her condition and to make her a more active part of her treatment. Her parents were referred to therapists in the area that dealt specifically with managing college students and mental disorders. In treating a bipolar adolescent, it is essential that everyone around that individual get 'on board' with their treatment. One of the problems is that mania can feel positive. When confronted with her diagnosis, Katherine said that she enjoyed the increased creativity and goal-directed behavior regarding her school assignments. It was difficult to show the patient that this increased activity was fleeting. "Adherence appears to vary with the age of the patient and duration of illness…Clinical experience suggests that a younger patient in a first episode simply wants to get on with life and has particular difficulty accepting the chronicity of the illness" (Sherman 2007, p.3). Additionally, "patient beliefs about the illness...
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