Review the case study, then use the attached Case Study Template to complete the case and thoroughly answer the assigned questions at the end.

Vitals: Pain 8 BP 160/80 Pulse 76 Respirations 18 Height 5’10” Weight 190lbs

Patient Intake and History: 

  • The patient is a 26-year-old college graduate who is currently euthymic but who has a history of major depressive episodes.
  • He has experienced major depressive episodes, mostly untreated, of varying lengths and severities since he was a teenager.
  • His symptoms have included insomnia, despondent thoughts, depressed mood, low interest in activities, poor energy, and impaired cognition.
  • He says his self-esteem drops and he feels rejection-sensitive and guilt-ridden for no apparent reason.
  • He has never had suicidal thoughts.
  • Some of the depressive episodes have been incapacitating and have interfered with school and work.
  • He appears to have good interepisode recovery and is able to return to class and work.
  • The patient also has symptoms of social anxiety.
  • He is often nervous around new people and acquaintances.
  • He experiences anticipatory anxiety and will avoid certain social events.
  • These symptoms are present regardless of his affective state.
  • He has asked for a consultation because he has legal issues regarding drinking and driving that he thinks were likely fueled by his psychiatric symptoms.
  • At the time of the infraction (several months ago, just before graduating college), he had been started on a selective serotonin reuptake inhibitor (SSRI) for the depression and generalized anxiety disorder (GAD) symptoms.
  • Within days of starting, he experienced elevated mood in a sustained fashion over several days.
  • He lost all anxiety, fear, and avoidance.
  • He was unusually talkative; had racing thoughts; was distractible, hyperactive, and impulsive; and had decreased need for sleep.
  • He exhibited grandiosity, in which he felt invincible and that the law did not apply to him; this led him to purposefully antagonize a man in a bar, drive while drinking, and challenge authority when police were called.
  • The mood elevation is complicated by the fact that the patient admits to heavy alcohol use on weekends throughout college.
  • The mood elevation abated with cessation of the SSRI treatment.
  • He has now completed college; he has few friends in the immediate area, but his family is very supportive.
  • He wants to be a news reporter and is planning on applying to graduate school.
  • The patient has no family history of bipolar disorder; his mother has GAD.
  • He is not currently taking any medications.

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