Assignment task:
The patient is a 41-year-old self-employed gentle- man, presenting with eight year history of depression and mood instability, and one year history of migraines and seizures. The depression was exacerbated two years ago, after having been made redundant and had his house repossessed. Symptoms described included persistent low mood, and feeling like he wants to "curl up and die". He had lost motivation in completing his college course, and partaking in other activities of interest. He was also noticed to become increasingly socially withdrawn.
Somatic symptoms include sleep-onset insomnia; nocturnal awakenings, loss of appetite and weight. Further consultations over the course of one year elicited periods of elevated mood. These included overspending money; inappropriate social behaviours, such as phoning friends at early hours of the morning and getting himself into embarrassing situations. This included dancing around in public. He also described staying awake for up to 72 hours due to constant thoughts running through his mind, and works very effectively on his website during this time. These elevated moods can last up to 10 days in duration. In between the high and low moods, he describes feelings of intense anger, when he can attempt to be physically violent towards his mother.
1. What are the salient features?
2. What are your differential diagnoses (bipolar I, bipolar II, etc)?
3. What is your diagnosis?
4. What is your management?