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Bipolar Case Study
Meet the Patient
Olivia is a 15-year-old girl. Her mother brings her to the clinic due to worsening behavior, drastic mood swings, and recent incidents of drug use. She reports Olivia is increasingly difficult to manage at home and is struggling academically.
Olivia first saw a psychiatrist at age 7. She was evaluated for attention-deficit/hyperactivity disorder (ADHD) because of long-standing restlessness, impulsivity, and distractibility. After ineffective behavioral interventions, she began treatment with a methylphenidate-based medication at age 8. Improvement was seen at school, in her social life, and at home. However, she complained about side effects, including loss of appetite and feeling emotionally flat. This led to inconsistent adherence to the medication regimen.
More About the Patient
In meetings with Olivia and her mother, both report that Olivia’s grades dropped from As and Bs to Cs and Ds. She has lost many of her long-standing friends, and conflicts at home have escalated to the point that her mother describes her as “nasty and mean”.
In the past three months, Olivia’s behavior has become “moody”. She spends days by herself and hardly speaks to anyone. At other times, she is a “holy terror” at home frequently yelling at her sister and parents to the point that everyone is “walking on eggshells”.
Her grades have plummeted; she skips school and has frequent conflicts with teachers and peers. Recently, her mother found marijuana in her room.
Patient History
Olivia’s family history is pertinent for a father who “had real problems”. Although her mother doesn’t know his diagnosis, he had been on lithium. The father left the family before Olivia was born, and the two never met.
Olivia has no general medical problems. She denies the use of alcohol, illicit substances, and medications other than the prescribed ADHD medication.
Olivia appears wary and sad. She reports not liking how she feels, saying she’s felt depressed for a week, then okay, then “hilarious” for a few days, and then “murderous”, like someone is “churning up my insides”. She doesn’t know why she feels like that. She hates not knowing how she will feel day after day. She denies any psychotic symptoms or suicidal or homicidal thoughts.