Matthew is a 9-year-old boy who lives with his father and sister. He has been exhibiting behavioral and emotional problems that impair his social, home, and school life. Matthew's mood fluctuates throughout the day, starting distracted and irritable in the morning and becoming more agitated, talkative, and energetic in the afternoon and evening. Due to these ultradian mood cycles, Matthew is diagnosed with Other Specified Bipolar Disorder with manic episodes, mild, with mixed features. It is recommended that Matthew continue taking Risperdal and engage in a multimodal treatment plan with his father.

1. Lisa Rogers
Matthew Morgan is a 9-year-old Caucasian male who lives with his single father, Tom, and his 14-year
old sister Emily who was referred to the clinic to get an assessment of his emotional status. Matthew has
been exhibiting behavioral and emotional problems, which have caused impairment socially, at home, and
at school. Matthew has few friends due to his tendency to “overact” to things. Matthew’s home life is also
disrupted due to his behaviors; Tom reports that Matthew’s needs have made it difficult for him to have a
social life. Matthew’s mother left when Matthew was a baby and contact has been cut off. Matthew’s
mother reportedly was diagnosed with Bipolar Disorder. Matthew was prescribed Ritalin by his
physician, but after being placed on Ritalin, Matthew ran out of school and was returned kicking and
screaming. He was then placed in an alternative setting, during which time the Ritalin was discontinued
due to the concern that the Ritalin was escalating Matthew’s behaviors. When Matthew’s behaviors were
charted at school and home, it was clear that there was a pattern to his fluctuating moods. Matthew begins
the day distractible, fatigued and in an irritable mood, which is replaced by increased physical movement,
agitation, and excessive talking in the afternoon. His behaviors continue to escalate in the evening and
Matthew experiences elevated mood, increased energy and a decreased need for sleep. Matthew also
shows increased goal directed activity; Matthew appears to be obsessed with finding his mother and with
working on his go-cart. Matthew also exhibits feelings of worthlessness, as evidenced by Matthew’s self-
deprecating comments, and recurrent thoughts of death; Matthew has expressed that he wishes he were
dead. Due to Matthew’s ultradian cycling, Matthew’s symptoms are consistent with a diagnosis of Other
Specified Bipolar Disorder with manic episodes, mild, with mixed features. Matthew’s symptoms are
consistent with a manic episode due to Matthew’s functional impairment. A diagnosis of ADHD is not
appropriate in this case because of the episodic nature of Matthew’s symptoms. Matthew has inherited a
predisposition to the disorder from his mother, as evidenced by her history of the diagnosis. It is
recommended that Matthew continue to take Risperdal, since this seems to be effective in treating his
symptoms. It is also recommended that Matthew and his father engage in a multimodal treatment plan to
prevent relapse, manage problems within the family, and to increase medication compliance.