Board Question

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I found this on another forum, did not get the official answer what do you think?

A resident is asked to evaluate a 15 y/o girl who came to the office accompanied by her older sister who is concerned of her shifting moods. The sister explains that her younger sibling has been in an overly good euphoric mood for the past 13 months. She requires less sleep, and has been very productive. However, she and the rest of the family are concerned about her restlessness and irritability. They also complain that she likes to shift topics a lot during her conversations. Upon futher questioning, you also discover that during this time, the pt. has often sat quietly in her room for up to four days at a time without saying much at all. She did come down for dinner when asked, however she seemed low at these times. She is an otherwise good kid with good grades who does not have a boyfriend. Her PE is normal, and she is responsive to you and makes good eye contact. You notice that she is well kept, and she thinks that nothing is wrong and that she is fine. What is your diagnosis?

A)Cyclothymia
B)Dysthymia
C)Bipolar I
D)Bipolar II
E)Normal behavior for ager
F)Early Schizophrenia
G)Possible Drug abuse-do drug test 1st

EDIT: My first thought was that the answer was D. But I do not know if she ever did have a depressive episode or a manic episode.

And what are major differences between cyclothymia and bipolar II? They seem to have similar symptoms is it the time/duration issue?

 

[Anasazi23]

I found this on another forum, did not get the official answer what do you think?

A resident is asked to evaluate a 15 y/o girl who came to the office accompanied by her older sister who is concerned of her shifting moods. The sister explains that her younger sibling has been in an overly good euphoric mood for the past 13 months. She requires less sleep, and has been very productive. However, she and the rest of the family are concerned about her restlessness and irritability. They also complain that she likes to shift topics a lot during her conversations. Upon futher questioning, you also discover that during this time, the pt. has often sat quietly in her room for up to four days at a time without saying much at all. She did come down for dinner when asked, however she seemed low at these times. She is an otherwise good kid with good grades who does not have a boyfriend. Her PE is normal, and she is responsive to you and makes good eye contact. You notice that she is well kept, and she thinks that nothing is wrong and that she is fine. What is your diagnosis?

A)Cyclothymia

Likely the diagnosis. She meets the time duration criteria for adolescents (1 year), has pathology consistent with Hypomanic episode:
--expansive, irritable mood lasting at least four days
--decreased need for sleep
--increase in goal-directed behavior
--symptoms uncharacteristic for the person
--disturbance observable by others
--no drug abuse as far as we know.
She also has mild depressive symptoms not consistent with a major depressive episode. Though we are lacking information in this area.
No reported major depressive episode or manic episode.
No evidence of schizoaffective or superimposed schizophreniform, delusional disorder, or other type of psychosis.

B)Dysthymia

This doesn't make sense.

C)Bipolar I

No full-blown manic episode

D)Bipolar II

No evidence of major depressive episodes. However, she does meet criteria for a hypomanic episode. So I can see how you thought this was a possibility. Unfortunately, the only info we have about possible depressive episodes is the isolation in her room. That could be a lot of things, including early psychosis.

E)Normal behavior for age

Also a possibility. For the purposes of the test question, unlikely to write-off a family member's concern as normal.

F)Early Schizophrenia

No real evidence for this. No description of thought disorder, speech disturbance, A/V hallucination, delusions, etc.

G)Possible Drug abuse-do drug test 1st

This is always part of the differential. From a practical standpoint, it's easy to do a drug screen, and would save a lot of work if, for example, she tested positive for cocaine. In that case, the diagnosis would be substance induced mood disorder.

This is why I hate test questions. They expect you to make diagnoses without the most relevant information. As stupid as it sounds, they're trying to steer you away from drug abuse by saying that she doesn't have a boyfriend, is well kempt, and has good grades. Decline in the functions (or aquisition of a boyfriend) point to drug abuse in testing land.

I'd go with A.

 

[mdblue]

I found this on another forum, did not get the official answer what do you think?

A resident is asked to evaluate a 15 y/o girl who came to the office accompanied by her older sister who is concerned of her shifting moods. The sister explains that her younger sibling has been in an overly good euphoric mood for the past 13 months. She requires less sleep, and has been very productive. However, she and the rest of the family are concerned about her restlessness and irritability. They also complain that she likes to shift topics a lot during her conversations. Upon futher questioning, you also discover that during this time, the pt. has often sat quietly in her room for up to four days at a time without saying much at all. She did come down for dinner when asked, however she seemed low at these times. She is an otherwise good kid with good grades who does not have a boyfriend. Her PE is normal, and she is responsive to you and makes good eye contact. You notice that she is well kept, and she thinks that nothing is wrong and that she is fine. What is your diagnosis?

A)Cyclothymia
B)Dysthymia
C)Bipolar I
D)Bipolar II
E)Normal behavior for ager
F)Early Schizophrenia
G)Possible Drug abuse-do drug test 1st

EDIT: My first thought was that the answer was D. But I do not know if she ever did have a depressive episode or a manic episode.

And what are major differences between cyclothymia and bipolar II? They seem to have similar symptoms is it the time/duration issue?

I'll go w/ G- UDS to R/O drug abuse-and cannabis may be a possibility.

 

[psych2b]

I second the motion for (g) - possible amphetamine abuse?