Bipolar Disorder Essay, Research Paper
Case Study I: Kelly
Kelly has met criteria for Major Depressive Disorder (MDD), Recurrent. She has no history of any personality disorders or of any medical conditions. Parents have frequent talks about divorce and there is decrease in her school grades. She has suffered from depressed mood being irritable and unstable, loss of energy, anhedonia, diminished ability to concentrate leading to the decline in her school grades, decrease in the her appetite, and suicidal ideation and plan for committing suicide. She has had 2 separate Major Depressive Episodes within a two-month interval at early age of onset of 14 years. 40-70% of children with MDD have another disorder as well. If MDD is present at a young age in children, there is an increased risk of other comorbid disorders as they get older. The earlier the onset and as the number of depressive episodes increase the worst the prognosis is. The most serious consequence of MDD is the high risk of suicide attempts or completed suicide. Up to 70% of depressed kids report suicidal ideation and 25% of clinically referred kids attempted suicide. Attempt peak at age 13-14 years. and declines after age 17-18 years. Girls show more ideation and will attempt more, whereas boys will complete suicide by using violent measures.
Depression has been found to be highly genetic. Depressed children have been found to come from families with stressful situation. The talk of divorce between Mr. and Mrs. X could have played a role in their daughter s depression. Neurological factors have also seem to play a part in the cause of depression. Early intervention has been known to lower the risk of another episode in children with early onset. Medicine and Cognitive Behavioral Treatment (CBT) have been found to be very effective in children and adolescents. The focus is to make child or adolescent aware of thinking problems, negative thoughts and beliefs that leads to self-criticism and self-blame by teaching coping and social skills. Prozac and Zoloft have often been prescribed to depressed patients.
Case Study II: Max
Max meets the criteria for Bipolar Disorder II (BP) with comorbid Attention Deficit/Hyperactivity Disorder (ADHD). He has no history of any personality disorders or of any medical conditions. There has been no change in the home environment; mother attributes feelings of depression to son s condition. He has shown symptoms of a hypomanic episode including a constant elevated mood for the past week, inflated self-esteem and grandiosity, decrease need for sleep, has been more talkative than usual. He also meets criteria for ADHD with symptoms occurring before the onset age of 7 years. Symptoms of inattention included not listening when spoken to directly, often did not follow through with instructions and failed to finish school assignments, had difficulty organizing tasks, forgetful, and loss of school supplies and assignments. Symptoms of hyperactivity included fidgeting and leaving seat in class, often ran about and climbed excessively in inappropriate situations, and talked excessively and was often on the run.
For children first seen for symptoms of BP, 90% of prepubertal children and 30% of all patients with BP also have ADHD. About 20% of all patients have their first episode during adolescence with peak age of onset between 15-19 years of age. Individuals with prepubertal of onset of BP have family members have been diagnosed with the disorder at an early onset. An early onset and course of BP in adolescents is chronic and resistant to treatment, with poor prognosis. BP affects males and females equally. Findings from familial and gene studies with adults indicate that BP is the result of a genetic vulnerability in combination with environmental factors. BP generally requires a multimodal treatment plan with education of the patient and the family about the illness, medications such as lithium, and psychotherapeutic interventions to address the youngster s symptoms and related psychosocial impairments. The goal of treatment is to decrease BP symptoms and prevent relapse while reducing long-term illness and enhancing the youngster s normal health and development.