1 bipolar disorder 8 Captain of the Ship: Bipolar Disorder The following case study details the treatment approach for a 35-year-old Caucasian male who presented to the clinic for help with his mood disorder. The assessment and intake supported the diagnosis of bipolar disorder, subtype II. The following analysis presents the details related to both pharmacology and psychotherapy, as well as information related to medical management, community support resources, and appropriate follow-up. Chief Complaint The client came to the clinic reporting that he “could no longer deal with his up-and-down mood swings and that he was at the end of his rope.” History of Presenting Problem This client stated that he has had mood swings for as long as he could remember, and that right now he was in the “up” phase of this alternating mood pendulum. From an inspection of the genogram that the client provided, there was a noticeable inheritance pattern of the bipolar. Notably, this client had evidence of bipolar on both maternal and paternal sides of his genogram. Research has shown that bipolar has a high heritability rate. Kern (2014) reported on the concordance rates of twins with bipolar, stating the rate was from 60-80%. In other studies, the heritability of bipolar is demonstrated albeit at lower rates (Maier et al. (2005). The DSM-V characterizes bipolar II disorder as one in which individuals experience a period of at least 4 days of hypomanic symptoms; once this criterion is met, the person fits the diagnosis of bipolar II regardless of the duration of future hypomanic episodes (APA, 2013). Additional symptoms to support this diagnosis were the client’s admission that he was taking on several projects and tasks at work simultaneously; sleeping little; experiencing racing thoughts; and feeling invincible. The intake showed the client’s extremely fast talking, switching subjects haphazardly, and admission of both depressive and hypomanic episodes, all of which point to a diagnosis of bipolar II (296.89 F31.81) (APA, 2013). Current Medications This client denied taking any medications, either over the counter or from a doctor. Although he claimed he was in good health, he did report that he frequently got headaches but not of migraine proportions. He described them as more of an annoyance than a health problem. He gained relief from either Motrin or Tylenol during these headache episodes. He denied taking any vitamins or herbs or any other OTC substances. Relevant History The client reported that his mood swings began when he was in his early 20s. As he witnessed other family members suffering from these mood swings, he came to believe they were normal. The client appeared to be in good health, was not overweight, and appeared to take good care of himself. He was dressed well and was oriented x4. He stated that he earned a good living working as a financial consultant, enjoyed his work, but could not deal with the revolving mood swings anymore. His p ...