Clinical Scenarios/Case Study #3
History
A 34-year-old call-center manager PCP with her boyfriend. She complains of tiredness and a lack of enthusiasm for life. These complaints started a year ago but have worsened over the past 2 months. She has been forced to take time off work as she was constantly arguing with the senior manager and found it difficult to remain calm and composed at work. She has also been irritable with her boyfriend and gets upset easily if he tries to motivate her. She knows that he means well, but she still finds it very irritating and yet feels guilty for responding to him in this way. She has lost all interest in sex or going out to social events. Despite being offered a great deal of support by her boyfriend, she constantly worries that he will leave her. Over the past 6 weeks when she has been at home, she has spent most of her time in bed. She admits guiltily that there are days when she does not shower or even brush her teeth. She watches the television but is not able to take in anything. She feels empty most of the time and finds it upsetting that she cannot even react to her boyfriends efforts at reaching out to her. She watches TV until late, finding it difficult to sleep. In the morning, she feels exhausted and tends to lie in bed until midafternoon. She has had thoughts of dying, but resists acting on these as she does not want to punish her boyfriend or her mother, who she lives with as well.
Mental State Examination
She is an only child. She lives with her boyfriend and her mother in her mothers home.
She is close to her mother and does not go shopping with her as previously did. Her father died
following a stroke last year. She is healthy and has no medical problems. She does not drink or
use drugs. She remembers being admitted to a psychiatric hospital at age 19 years old, because
she became very high. She remembers taking lithium for a while, but now has been off it for
years. The only other psychiatric episode she can recall was on a vacation to Greece when she
became quite elated and was convinced that she was Venus, the goddess of love. She went to the
local market, topless, was arrested and admitted to a local psychiatric hospital in Greece. She
was treated as an inpatient for 2 weeks and was discharged with some medication. She has
only hazy memories of the episode but remembers not taking the medication on her return back
to Miami.
Care plan about bipolar patient
