Running head: CASE 19 1

Case 19/Outline

Arlethia Almond

Keiser University

Dr. Michelle Green

July 24, 2021

About Case 19

 The paper will cover Case 19 from the Brown & Barlow (2017) Casebook.

 It is about Eric who suffers from a psychological problem that makes to worried and

develop anxiety.

 He seeks perfection in everything he does and failure to achieve his dreams makes him

depressed.

 A feeling of inadequacy and failure has also engulfed his thoughts for a long time and

that drives into more problems.

 His close family members have not been diagnosed with mental problems.

 The medical history indicates that Eric has suffered depression many times that has

escalated the symptoms leading to severe complications.

 He attempted suicide multiple times and this has generated serious conflicts between him

and his parents (Brown & Barlow, 2016).

Introduction

It is evident from the case study that Eric has mental disorders which has slowly

developed over the years. Change of moods, loss of desire to engage in pleasurable things,

concentrating too much on problems and feeling of worthlessness are some of symptoms of

Eric’s condition. The symptoms also developed into suicidal thoughts; an advanced symptom of

depression. The primary causes of Eric’s depression are that he perceives himself as a failure and

inability to maintain his career. Since Eric has multiple mental disorders based on the symptoms

of his condition, the paper will discuss depressive disorders as well as Bipolar and related

disorders, their causes, signs and symptoms, diagnosis and possible treatment.
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Clinical History

Eric was brought up in a closely knitted religious family with no history of mental problems.

Eric brother and two sisters had a normal growth and pursued their studies well and currently

engage in fruitful careers. Eric began to portraying different signs of emotional difficulties while

he was in high school that made him struggle in some class activities. Eric struggled with class

readings and examinations that resulted in the fluctuation of his academic grades and hence

increasing his worry about qualifying to join a good college. Eric’s depressive moods were

accelerated by his parents and teachers comparing him with his older brother, hence worsening

his perception being a failure. Eric has been hospitalized on a number of occasions although his

parents blocked further hospitalization due to exhaustion of insurance money and also because

hospitalization tends to escalate his depressive moods. Furthermore, Eric’s parents engage

preventive measures in an effort to prevent severe complications and to reduce his engagement in

aggressive behaviors. However, this efforts has resulted developing a perception of being

regarded as a child although aged 30s. The prevention of Eric’s hospitalization especially by his

father has resulted has resulted in inconsistency of treatment hence escalating his depressive

symptoms. The medicine prescribed at the course of Eric’s hospitalization significantly reduced

his aggressive behaviors but remained inefficient in reducing his depressive episodes. Eric

thought the side effects of his drugs were as problematic as his mental challenges.

Presenting Problem/Symptoms

Eric’s main problem is that he wants everything he does to be perfect and failure to achieve

perfection makes him to develop aggressive behaviors; which are symptoms of intense stress and

depression. Eric stated experiencing continuous signs of concentration challenges, too much

worries and anxiety in his first visit to the hospital. Eric is highly is highly worried about failure
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to accomplish his objectives including the inability to maintain a job, failure to build healthy

relationships and feeling of being worthless and burden to his family. Eric stated his

overconcentration on his problems and worries which has reduced his focus on other important

things. Additionally, Eric’s overconcentration on his problems has resulted in the loss of interest

in more pleasurable and important things. Lack of concentration has made Eric to continuously

repeat planned ideas in his memory to avoid forgetting important things. Worries about his self-

perception and poor career development sometimes made Eric to encounter difficulty in

disposing off newspapers, preparing to much for job interviews with frequent revision and

rewriting of his professional resume. Eric usually develop mood swings that makes to engage in

aggressive behaviors such as fistfights and reckless driving in highly agitated depressive

episodes. Eric’s resignation from his stockbroker job led to serious depressive episodes

developed from self-perception of being worthless which also made him to believe associate his

failure with CIA monitoring and control. The negative perceptions about CIA being involved in

his downfall made Eric to develop imaginations about hearing voices of CIA advising him to

continue with his medications as a means of controlling him.

Differential Diagnosis

The DSM-5 criteria required in Eric’s case are

Depressive disorders

Under the DSM-5 criteria, Eric’s depressive disorder can be attributed to more than five

depression symptoms that are evident during the 2-week period and portray a significant

transformation from his preceding behaviors and mental functioning. Eric’s symptoms

matches the two basic symptoms required by the DSM-5 criteria, that is; Lack of desire in

pleasurable tasks and depressed moods.

Depressive symptoms in Eric’s case include:

1. Lack of interests in pleasurable tasks as Eric feel pain even when performing tasks that he

should enjoy.

2. Depressed moods that drives into more problems such as reckless driving and

overspending his family’s finances.

3. Distractibility which makes Eric’s ability to concentrate one activity. For example he

ignites the family car’s engine and left it running for hours leading to destruction of the

engine.

4. Feelings of being a worthless individual due to his inability to develop healthy

relationships and build a good career, unlike his siblings. Eric’s thinks he is burden to his

parents as he cannot achieve stability for self-autonomy.

5. Consistent suicidal thoughts that due to feelings of being useless and the thought that CIA

is monitoring and controlling him, hence blocking his success. Eric attempted suicide on

four different occasions.

6. Eric experienced excessive agitation that makes him drive at dangerous speeds and

wrecking the family car.

Bipolar and related disorders

Individuals are diagnosed with bipolar and related disorders when they undergo moments of high

excitement, delusions, hyperactivity and mania as well as other moments of sad feelings and

hopelessness. The use bipolar word implies fluctuations between low and high moments. In

some instances, a bipolar disorder might be accompanies by depression and mania symptoms

that result in mixed episodes due to the mixture of depressive and manic features. Individuals

with mixed episodes usually have a sense of guilt, sadness and uselessness coupled with racing
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thoughts, high energy, over-activity and talkativeness. It is common for individuals with mixed

episodes to shift from being extremely happy to experiencing suicidal thoughts and the shift

happens within minutes. Under the DSM-5 criteria, a person is diagnosed with bipolar disorder

if they express at least one hypomanic of manic episode. An individual is considered manic, an

individual must show expansive, elevated or irritable mood and must take place for at least seven

days and should happen almost every day. On the other hand, an individual is considered

hypomanic when the mood can take place for not less than 4 days and the symptoms are

experienced within all these days. During the manic and hypomanic episodes, at least three of the

symptoms below should be observed and should reflect a substantial change from the normal

behavior.

1. Reduced desire for sleep

2. Overrated self-esteem

3. Racing thoughts

4. Increased talkativeness

5. Easily distracted

6. Increased participation in goal-directed tasks

7. Participating in tasks with possible negative consequences such as uncontrolled buying

sprees.

DSM-5 criteria for Anxiety disorders

When evaluating an individual for anxiety disorder under the DSM-5 criteria, psychological

experts consider the presence of the following factors:

1. The expression of excess worry and anxiety concerning different events, tasks and topic.

Worry takes place for not less than six months and is evidently excessive.
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2. Individual’s worries are difficult to control. Both adults and children with excessive

worry can easily change from one topic to the other.

3. Worry and anxiety are tied to not less than 3 of the cognitive or physical symptoms listed

below:

 Feelings of restlessness

 High level of fatigue

 Reduced concentration or a feeling of empty mindedness

 Being easily irritated

 High level of muscle pain or soreness

 Lack of sleep

The differential diagnosis which may be considered for bipolar disorder entails different

conditions with symptoms that resembles mania. It also include organic mood disorders like

metabolic and endocrine diseases, tumors and substance abuse. Mania taking place in the

domain of drug abuse is termed as secondary mania (Spoorthy, Chakrabarti & Grover, 2019).

Additionally, schizoaffective disease is diagnosed in the presence of a manic disorder

superimposed in presence of schizophrenia.

The client in case study-19bmeets the criteria because he has exhibited symptoms of both

depressive and bipolar disorders. However, the client does not meet the criteria for anxiety

disorder because they are not related in terms of signs and symptoms

Diagnosis

a. Epidemiology

There is a growing number of anxiety disorders and is regarded as the most common type of

psychiatric disorder. Different epidemiological research indicates that a third of the demography
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suffer from an anxiety syndrome within their lifespan. The research also indicate that anxiety

disorder is more prevalent among the female gender and the prevalence is at climax during the

individual’s midlife. Anxiety disorders are closely connected with a significant level of

impairment, high degree of health-care usage and consequently huge economic impact on the

society. Even though efficient pharmacological and psychological treatments are available for

treating anxiety syndromes, a considerable number lacks the right diagnosis or do not get quality

treatment. No reliable evidence to indicate if the prevalence levels have changed in the previous

years. Variations in prevalence levels as portrayed in various countries and regions may be

resulting from variations in methodology instead of culture-based elements. Increased

comorbidity is evident among individuals anxiety disorders as well as between those with

anxiety syndromes and other psychological syndromes respectively. Epidemiological researches

may assist in preparing the relevant treatment and prevention initiatives as well as assisting in

better understanding the etiological diagnosis of anxiety and related disorders.

 Over 40 million people who are above 18 years are affected by anxiety in the US

(McIntyre & Calabrese, 2019)

 Only 36.9% of patients obtain treatment (Nuñez et al.,2018)

 17.3 million American adults affected by depressive disorders in the US

 More women than men affected by depressive disorders

 2.8 % of adults diagnosed with bipolar related disorders in the previous year (McIntyre &

Calabrese, 2019)

b. Etiology of the Diagnosis

 Changed brain structure, chemistry and environment genetics cause bipolar and related

disorders
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 Distress as a result of biological, psychological or social factors lead to depressive

disorders

 Medical conditions and brain chemistry may cause anxiety disorders (Saeed,

Cunningham & Bloch, 2019)

Conclusion

In conclusion, mental health is a growing concern. Recent statistics indicate that there is an

increasing number of individuals being diagnosed with depressive, bipolar and anxiety disorders.

The case of Eric is a clear example of how brain chemistry coupled with environmental

conditions may aggravate the medical conditions of the affected persons.

References

Brown,T.A. & Barlow, D.H. (2016). Casebook in Abnormal Psychology 5th Edition.

Cengage Learning.

McIntyre, R. S., & Calabrese, J. R. (2019). Bipolar depression: the clinical characteristics and

unmet needs of a complex disorder. Current medical research and opinion, 35(11), 1993-

2005.

Nuñez, N. A., Comai, S., Dumitrescu, E., Ghabrash, M. F., Tabaka, J., Saint-Laurent, M., ... &

Gobbi, G. (2018). Psychopathological and sociodemographic features in treatment-

resistant unipolar depression versus bipolar depression: a comparative study. BMC

psychiatry, 18(1), 1-11.

Saeed, S. A., Cunningham, K., & Bloch, R. M. (2019). Depression and anxiety disorders:

benefits of exercise, yoga, and meditation. American family physician, 99(10), 620-627.
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Spoorthy, M. S., Chakrabarti, S., & Grover, S. (2019). Comorbidity of bipolar and anxiety

disorders: An overview of trends in research. World journal of psychiatry, 9(1), 7.