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Case #1 (Last Names A-F) Case Study Writing Assignment PSYC 170 (Abnormal Psychology) Note: The following instructions are taken verbatim from the syllabus. The case description and questions to be answered follow, on page 2. The rubric that will be used to grade these is posted on Blackboard—Please review it. Assignment Instructions: The case study writing assignment is worth 20% of your final grade. The purpose of the assignment is for students to apply what they learn in the course to a clinical case. The assignment will involve: reading a description of a hypothetical clinical case that involves the types of problems covered in this course and answering several critical thinking questions about the specific case. Cases will be posted on Blackboard, along with the rubric that will be used to grade them. The entire assignment should consist of no more than 4-5 double-spaced, typed pages using 12-point font with 1-inch margins all around. Put your name and student ID number at the top of the assignment and number your responses to the questions posed. The case study writing assignment must be submitted via Blackboard (no emails accepted) and is due according to the staggered schedule based on the first letter of your last name, below. Make sure to select the specific case that is assigned to you. Last name A-F: Case #1, Due Mon., Oct. 24 by 11:59 pm via Blackboard Last name G-N: Case #2, Due Mon., Oct. 31 by 11:59 pm via Blackboard Last name O-Z: Case #3, Due Mon., Nov. 7 by 11:59 pm via Blackboard Students may always elect to submit the assignment early. If the assignment is received late, 10% of the total possible points on this assignment will be subtracted for each day late. Extensions on this assignment will be permitted only in the case of a documented medical or family emergency with supporting documentation from the Dean’s Office, with the period of extension determined on a case-by-case basis. Graded case study assignments, including feedback per the rubric, will be posted on Blackboard as soon as available. Please keep in mind that it will take time to grade them, and grades may not be posted until a few weeks after the date you submitted it.

It was 2:00 a.m., the third night that Tonya, a 20-year-old college student, had gone without sleep, but she felt that she was bursting with energy. She sat alone by a statue in the middle of the campus, writing furiously in her notebook. The words poured out of her, but her thoughts raced so fast that her pen could hardly keep up. As her hand began to cramp, Tonya cursed her body. “How am I ever going to finish my book,” she thought, “if my damn hand gets tired out?” Suddenly, Tonya had a flash of insight. Her mother was a secretary for a large medical corporation, Tonya could dictate her novel, and her mother could type it. Brilliant! Off she scrambled to a pay phone to tell her mother about her idea. When her mother picked up the phone, Tonya began talking quickly and unintelligibly, rambling on and on about a book, what happened in sociology class, reasons why so many kids do drugs; how her parents never appreciated her talents or supported her, and how eating lettuce made her brain work better. When her mother suggested that Tonya get some sleep, Tonya slammed down the phone and stormed across campus, screaming out about her mother’s insensitivity and how much more intelligent dolphins are than humans. As Tonya wandered across campus, her thoughts continued to race. Suddenly, she remembered Brian, who was still sleeping in her dorm room. Tonya met Brian for the first time earlier in the evening and decided to invite him back to her room; after snorting a few lines of his cocaine, Tonya and Brian had sex. As Tonya’s thoughts continued to wander, she began to worry that she would not be able to finish her book and reached a state of near panic when she collapsed to the ground and began crying uncontrollably. This was the state in which the campus security guards found her. Although Tonya was initially brought to the University hospital, she was soon transferred to an inpatient psychiatric unit. While in the hospital, Tonya refused to take any medications. The day before she was to leave the hospital to go home, she became severely agitated and irritable. She accused her parents and doctors of trying to ruin her life, was verbally abusive to other staff and patients, and finally had to be sedated once again, delaying her release. When Tonya came out of sedation, she became the life of the unit. She seemed to have boundless energy and organized card games and contests. While she seemed somewhat like her old self, her mother noticed that she was more confident than usual. Tonya discussed her plans: how she was going to graduate in three years, live in France, and become a famous writer. Next, Tonya was seen in an outpatient therapy center following her discharge from a weeklong stay at the inpatient psychiatric unit. During her initial meeting with the psychologist, Tonya was speaking rapidly and with great determination no matter the topic, frequently and abruptly changing from one subject to another. Highly distractible, Tonya got up to look out the window whenever a car with a loud engine drove by. She seemed unusually cheerful and optimistic for a bright young woman who had just been forced to leave college. When asked, Tonya admitted that she sometimes went on shopping sprees that she really couldn’t afford. She also confessed to driving recklessly, blaming “all the other stupid drivers” who “forced” her to speed excessively. Finally, she admitted that there had been three other occasions in which she had engaged in sexual behavior with someone she did not know very well. While she admitted that this was unusual for her, she minimized its significance because “nothing bad had ever happened.” Always busy and on the go, Tonya stated that she rarely felt “low.” She knew some friends that did, but during the rare times that she had felt “low,” she had dealt with it by forcing herself to get even busier. The low periods would eventually pass, usually without incident. However, Tonya recalled one time that had been different. She recalled that following an argument with her father, she began crying uncontrollably, feeling ashamed and angered. This

incident led to several days of sadness and sulking on her part. Until her mother was able to coax her back to life, Tonya recalled lying lifelessly in her room, feeling unmotivated to go to class, socialize with her friends, or even get out of bed to take a shower. In terms of developmental and family history, Tonya grew up in a small southern town. Her family had moved to Atlanta when she was in junior high school. Tonya described her father as a moody man who drank heavily and never seemed to be around. Her mother, with whom Tonya was extremely close, raised Tonya and her younger brother. Tonya reported that there was a history of alcoholism and depression on her father’s side of the family and that a great-uncle had spent much of his life in a state hospital for “moodiness.” As a child, Tonya had always excelled in school. She had taken honors courses in high school and went to college on a full scholarship. Tonya admitted that she had “gotten drunk a few times in high school,” but said that she no longer drank because she did not like how alcohol made her feel. Reluctantly, she confessed that she did use “speed” and other “uppers” to help her study at night. She denied that these were a problem because they helped her be “more productive.” Critical Thinking Questions (Please answer all three questions and number your responses): 1. What is the most appropriate DSM-5 diagnosis and why? Do not just list DSM-5 diagnostic criteria for your choice. Instead, explain why this individual’s symptoms best fit your chosen diagnosis. Bipolar I is the most appropriate diagnosis for the following reasons: -Met criteria for manic episodes A. Elevated, irritable mood, increased energy and goal-directed activity, was hospitalized --- 3rd night w/o sleep but felt that she was bursting with energy; slammed the phone, stormed across campus, screaming b/c her mother refused to help her; trying to write a book; mother noticed she was more confident than usual; was brought to hospital/psychiatric unit B. 1) Decreased need for sleep: went 3 nights without sleep 2) More talkative: talking quickly, rambling when on the phone with mom 3) Flight of ideas/racing thoughts: “her thoughts raced so fast that her pen could hardly keep up” 4) Distractibility: highly distractible — got up to look out window when car drive by 5) Increased in goal-directed activity: was trying to write a book 6) Excessive involvement in activity with negative consequences: unaffordable shopping spree, illegal drugs, sex with strangers she just met C. Was hospitalized D. “Speed” and other “uppers”??? The most appropriate DSM-5 diagnosis for Tonya would be bipolar I because by looking at the description, she meets the criteria for a manic episode. In order to be diagnosed with bipolar I, the patient needs to meet criteria for a manic episode. First of all, according to DSM-5, the patient needs to have abnormally elevated, expansive, or irritable mood, increased goaldirected activity or energy for at least one week or if hospitalization is necessary. For Tonya, she

fulfill this requirement because she slammed the phone and screamed while storming across campus when her mother suggested that she should get some sleep, her mother also noticed that she was more confident than usual, these show her elevated and irritable mood. Increased goaldirected activity is present in Tonya’s case for the reason that she tried to write and finish a book all in one night. Moreover, she has gone three nights without sleep but she felt that she was bursting with energy this clearly demonstrate that she has increased energy. Finally, she was brought to the hospital by a security guard when she was found crying uncontrollably on the ground. Secondly, the patient needs to meet three or more additional symptoms to a significant degree and represent a noticeable change from usual behavior. Here are all the symptoms that were present in Tonya’s case: decreased need for sleep, more talkative than usual, flight of ideas or subjective experience that thoughts are racing, distractibility, increased in goal-directed activity, and excess involvement in activities that have a high potential for painful consequences. Tonya has gone at least three days without sleep; she was talking quickly, unintelligibly, and rambling when she called her mom; she stated that “her thoughts raced so fast that her pen could hardly keep up”; while she was meeting with the psychologist, she got up to look out the window whenever a car with a loud engine drove by; she tried to finish a book in one night, and was saying how she was going to graduate in three years, live in France, and become a famous writer; Tonya admitted that she sometimes went on a shopping spree that she couldn’t afford, driving recklessly, and engaged in sexual behaviors with people she didn’t know well, as well as using cocaine. Thirdly, the mood disturbance needs to be sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization or the presence of psychotic features. Tonya has been forced to leave college when she was hospitalized which gets in the way of her education and social life. Lastly, the episode is not attributable to the physiological effect of a substance or to another medical condition. At the end, Tonya confessed that she used “speed” and other “uppers” to help her study at night in high school, however, besides that, the only time she has used drugs was cocaine while she was manic. Due to the fact that she used cocaine during her manic episode and not before, it does not disqualify her diagnosis of bipolar I. The reason that I diagnose Tonya with bipolar I instead of bipolar II is that the things/actions she takes are more than observable changes. Her symptoms are also severe enough that she was hospitalized.

2. Based on your diagnosis, what treatment would you recommend for this case? Please justify your selection of treatment modality. What theory of etiology is your treatment recommendation based on? Etiology: biological perspective; diathesis-stress model Treatment: combination of psychotherapy and medications =Psychotherapy (family therapy b/c her relationship with her dad isn’t so good and can also teach mom ways to cope with Tonya, not CBT because it’s more effective when treating depressive symptoms and Tonya doesn’t really have that): improves daily function, develop behavioral strategies to help cope with symptoms and stabilize mood =Medication: lithium

Based on Tonya’s diagnosis, I would recommend her a combination of medication and psychotherapy, more specifically, lithium and family therapy. I selected both medication and psychotherapy for Tonya because lithium or therapy alone is not enough and also not as effective. For psychotherapy, I felt that family therapy would be appropriate for Tonya since she mentioned that she got into an argument with her father before and felt “low” after, she also described her father as a moody man who drank heavily and never seemed to be around. From what Tonya said, it seems like her relationship with her father is not very good and could possibly cause her distress. In addition, with family therapy, the therapist can also educate her mother ways of responding and coping with her daughter when she’s going through a manic episode. Therefore, family therapy would be beneficial for both Tonya and her parents. As for lithium, it has been used to treat bipolar for a long time and has been effective at moderating mood swings and glutamate levels in the brain. The treatment I selected for Tonya is based on the biological perspective. The biological perspective is appropriate in Tonya’s case because her condition could be because of her genetics. She described her father as a “moody man” and there’s also a history of alcoholism and depression on her father’s side of the family, also one of her great-uncle had spent much of his life in a state hospital for “moodiness.” The environment also plays an important role in the etiology of Tonya’s disorder, for example, her father never seemed to be around and that he drinks heavily. 3. High levels of energy, euphoria, and productivity can be experienced as positive. At what point do these things become maladaptive? =When interferes with day to day life/ daily functions =Distress/impairment =Statistically significant/infrequent When high levels of energy, euphoria, and productivity are causing distress and/or impairment, interfering with daily functions, are occurring at a statistically infrequent rate, or violating norms, they become maladaptive and abnormal. In Tonya’s case, her manic episode caused her to go without sleep for three days, which is not what the majority of people would do, in other words, is statically infrequent. She also got so irritated at her mother that she was storming across campus and screaming, this would be considered “weird”, and therefore, violates the norm. At one point during Tonya’s manic episode, she was so worried that she wouldn’t be able to finish her book that she reached a state of near panic, this shows that her episode causes her distress and reached the point of maladaptive.

1. The most appropriate DSM-5 diagnosis for Tonya would be bipolar I because by looking at the description, she meets the criteria for a manic episode. In order to be diagnosed with bipolar I, the patient needs to meet criteria for a manic episode. First of all, according to DSM-5, the patient needs to have abnormally elevated, expansive, or irritable mood, increased goal-directed activity or energy for at least one week or if hospitalization is necessary. For Tonya, she fulfill this requirement because she slammed the phone and screamed while storming across campus when her mother suggested that she should get some sleep, her mother also noticed that she was more confident than usual, these show her elevated and irritable mood. Increased goal-directed activity is present in Tonya’s case for the reason that she tried to write and finish a book all in one night. Moreover, she has gone three nights without sleep but she felt that she was bursting with energy this clearly demonstrate that she has increased energy. Finally, she was brought to the hospital by a security guard when she was found crying uncontrollably on the ground. Secondly, the patient needs to meet three or more additional symptoms to a significant degree and represent a noticeable change from usual behavior. Here are all the symptoms that were present in Tonya’s case: decreased need for sleep, more talkative than usual, flight of ideas or subjective experience that thoughts are racing, distractibility, increased in goal-directed activity, and excess involvement in activities that have a high potential for painful consequences. Tonya has gone at least three days without sleep; she was talking quickly, unintelligibly, and rambling when she called her mom; she stated that “her thoughts raced so fast that her pen could hardly keep up”; while she was meeting with the psychologist, she got up to look out the window whenever a car with a loud engine drove by; she tried to finish a book in one night, and was saying how she was going to graduate in three years, live in France, and become a famous writer; Tonya admitted that she sometimes went on a shopping spree that she couldn’t afford, driving

recklessly, and engaged in sexual behaviors with people she didn’t know well, as well as using cocaine. Thirdly, the mood disturbance needs to be sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization or the presence of psychotic features. Tonya has been forced to leave college when she was hospitalized which gets in the way of her education and social life. Lastly, the episode is not attributable to the physiological effect of a substance or to another medical condition. At the end, Tonya confessed that she used “speed” and other “uppers” to help her study at night in high school, however, besides that, the only time she has used drugs was cocaine while she was manic. Due to the fact that she used cocaine during her manic episode, not before, it does not disqualify her diagnosis of bipolar I. The reason that I diagnose Tonya with bipolar I instead of bipolar II is that the things/actions she takes are more than observable changes. Her symptoms are also severe enough that she was hospitalized. 2. Based on Tonya’s diagnosis, I would recommend her a combination of medication and psychotherapy, more specifically, lithium and family therapy. I selected both medication and psychotherapy for Tonya because lithium or therapy alone is not enough and also not as effective. For psychotherapy, I felt that family therapy would be appropriate for Tonya since she mentioned that she got into an argument with her father before and felt “low” after, she also described her father as a moody man who drank heavily and never seemed to be around. From what Tonya said, it seems like her relationship with her father is not very good and could possibly cause her distress. In addition, with family therapy, the therapist can also educate her mother ways of responding and coping with her daughter when she’s going through a manic episode. Therefore, family therapy would be beneficial for both Tonya and her parents. As for lithium, it has been used to treat bipolar for a long time and has been effective at moderating

mood swings and glutamate levels in the brain. The treatment I selected for Tonya is based on the biological perspective. The biological perspective is appropriate in Tonya’s case because her condition could be because of her genetics. She described her father as a “moody man” and there’s also a history of alcoholism and depression on her father’s side of the family, also one of her great-uncle had spent much of his life in a state hospital for “moodiness.” The environment also plays an important role in the etiology of Tonya’s disorder, for example, her father ...