JM is a 67-year-old Hispanic woman who has been diagnosed with Bipolar Disorder II based on her history of hypomanic and depressive episodes over the past 5 years. She currently experiences elevated and irritable moods daily as well as symptoms of depression like diminished interest in activities and feelings of worthlessness. Her family history indicates genetic risk factors for mood disorders. Treatment involves mood stabilizing medication and psychotherapy to help her manage her condition.

1. Bipolar Disorder II
Yanetsi Alayon
Junior M. Peralta
St. Thomas University
NUR 530 Psychopathology
Dr. Seraphin
September 22nd, 2022
Fictitious Patient Case Study
JM is a Hispanic Mexican woman aged 67 years. She has a long
history of hypomanic episodes and depression.
For the past 5 years, JM has had variable diagnoses of
borderline personality, and major depression.
Most recently she was diagnosed with Bipolar Disorder II.
For the past week, the patient has been experiencing expansive,
elevated, and irritable mood that has been present mostly during
the day, more severe in the morning, and occurs almost every
day.

2. Although bipolar disorder affects people from different races
equally, there is a high incidence of the condition among the
Hispanic and Latino population.
2
A review of his symptoms points out that she indeed has had
numerous episodes of depression which began about 5 years
ago, but more clear hypomanic episodes emerged about a
month ago.
Her preeminent personal conflict, and hyper-sexuality during
hypomanic episodes resulted in the provisional diagnosis of
borderline personality.
Based on the full history of the patient, it is suspected that the
patient is having bipolar disorder type 2.
“Since my husband’s death, 5 years ago, I have felt very
alienated and lonely,” patient stated.
For the past year, JM has been taking mood stabilizers but
continues having lower-level symptoms of depression. Mood
stabilizers taken: valproic acid 250 milligrams (mg) 2 times a
day.
The condition is normally characterized with depression. The
depressive episodes last for about a week. Therefore, symptoms
of bipolar disorder are closely related with those of depression.
The symptoms often last for days, weeks, months or years.
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Allergies
Having a history of asthma, the patient is allergic to pollen and

3. cold
Aspirin
Non-steroidal anti-inflammatory drugs, such as ibuprofen, and
naproxen.
The patient is also allergic to a class of medication known as
beta blockers.
There is a close association between allergies and mental
illness. For instance, Asthma increases the risk of bipolar
disorder, depression and anxiety.
4
Physical findings and Psychiatric findings
The patient admits feeling depressed and having a diminished
interest in almost all activities.
The patient denies an increase in appetite though there is not
weight gain.
Excessive guilt
Psychomotor agitation
JM admits feeling a diminished need for sleep
There is clear evidence of distractibility
The patient admits to having suicidal thoughts.
Hypomania is characterized by irritable mood
Vital Signs
BP: 127/82 mmHg.- the condition is associated with a higher

4. risk of cardiovascular death and high blood pressure.
Heart rate (pulse): 88 bpm.
Respiratory rate: 26 breaths per minute.
Temperature: 37 °C
Weight: 92 Kg
Height: 6 feet
BMI: 25
Mild headache.
No labs/diagnostic tests were reviewed.
Bipolar patients are at a greater risk of hypertension and other
cardiometabolic ailments and a higher pulse rate.
6
Family history
Bipolar disorder has a genetic component, the disorder often
runs in families.
Genetic disorders (Asthma, Diabetes Mellitus) Mother and sister
Mood disorder – (Major Depressive Disorder) Grandfather
Bipolar Disorder II – Sister and his father
Suicidal attempts – Brother
General patient information
No history of tobacco use
Drug use: mood stabilizers
History of alcohol use
Current Employed as Receptionist
Previously employed as Cashier
Heterosexual, sexually active, uses
condoms, and rents an apartment
shared with a colleague.

5. Bipolar disorder is largely inheritable. A family history of
the condition increases the risk. For instance, if one of the
parent had the condition, there is a greater likelihood of one
getting the condition. The effect of the father is greater.
Equally, a history of drug abuse increase the risk by 48%
(Miklowitz et al., 2021).
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Mental Status Check
Appearance: pale
Attitude/Behavior: restless
Mood: high and low moods
Affect: a feeling of hopelessness
Speech: disordered speech
Thought process: racing thoughts
Thought content/ perception: very forgetful
Cognition: psychomotor retardation
Insight: less extreme
Judgment: poor judgment
Principal diagnosis based on DSM5
Based on the DSM5, Bipolar Disorder is a condition that is
characterized by mood fluctuations in an individual mood,

6. energy, and ability to function.
Bipolar Disorder II comprises hypomanic and depressive
episodes which alternate and are usually less stark and do not
prevent function.
JM has the condition because he experiences alternate periods
of high and low moods, delusions, over activity, euphoria, and
sometimes a feeling of hopelessness(Carvalho et al., 2020).
A feeling of irritable, elevated, and expansive, mood change
lasted for more than a week.
The patient has lost interest in most of the daily activities and
feels a sense of worthlessness and fatigue in performing the
day-to-day activities.
Other diagnoses addressed during the visit include borderline
personality and major depression.
Major depression is a major symptom of bipolar disorder.
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Differential Diagnoses
Major depressive disorder- is a mental illness that is
characterized by a person having a pervasive low mood for
about two weeks, low self-esteem, and
loss of interest in normally enjoyable activities. The condition
affects how a person thinks feels and performs daily tasks. it
can also affect a person’s appetite, sleeping habits, and appetite.
Bipolar I Disorder- refers to manic episodes that occur for
about 7 days.
The manic episodes are so severe making a person requires
immediate medical care.
The common symptoms of this condition include interest loss, a
feeling of worthlessness, guilt, self-doubt, and lacking energy.

7. No diagnostic testing or screening tool clinically required at
this time.
Pharmacologic and Non-Pharmacological Treatment
Cognitive-behavioral therapy provides the healthiest and most
efficient alternative based on relapse prevention.
It helps in improving the depression symptoms, the mania
severity, and psychosocial functioning.
Mood stabilizers are typically needed for stabilizing the mood-
stabilizing medication to control hypomanic episodes(Miller et
al., 2020). In this case, JM takes valproic acid 250 milligrams
(mg) 2 times a day.
Patients can effectively manage the condition by sticking to a
consistent routine and taking the medication as prescribed.
The patient needs to monitor her mood. Keep track of the mood
daily, counting factors such as medication, sleep, and events
that affect mood.
Developing a schedule is essential for stabilizing the mood.
Organizing and sticking to a schedule help to
attain a form of maintaining stability.
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Definition of the disease or disorder
Bipolar Disorder II is a mental illness characterized by
hypomanic and depressive episodes.

8. The condition causes thrilling mood swings including high and
low emotions.
An individual with Bipolar Disorder II often feels depressed,
hopeless, sad, and loses interest in everyday activities. These
mood swings usually affect a person's
sleep, judgment, energy, behavior, activity, and the cognition.
Though the condition is lifelong, it can be managed by
controlling a person's mood swings and symptoms through a
treatment plan.
Epidemiology, incidence, and prevalence of the disease or
disorder
It is estimated that approximately 7 million people globally
have Bipolar Disorder (BD) II. The United States has the
highest rate of nearly 4.4%, and the lowest rate in India at
0.1%. The condition is more frequent among women living
alone and individuals from low socioeconomic levels
(Miklowitz et al., 2021).
Incidence of BD II is also influenced by gender and ethnicity.
The earliest signs of a person with this condition manifest in the
early twenties. There is evidence of higher rates of the
condition among low-income families, and unmarried and
unemployed groups, though the social disturbance that occurs
due to stark mental illness cannot be ruled out (Miklowitz et al.,
2021).
Pathogenesis
Bipolar Disorder II is genetic and normally occurs

9. due to the shared susceptibility genes. The condition is
considered by dysregulation in the serotonin and dopamine
systems.
BD 2 disorder is related to preeminent activity in the amygdala,
an important brain structure involved in recognizing the
implication of emotionally pertinent stimuli of both positive and
negative valence(Millgram et al., 2021).
Equally, bipolar disorder occurs due to chemical imbalances in
the brain.
The chemicals are involved in controlling the brain's functions.
Some of these chemicals are neurotransmitters. Organic lesions
related to manic syndromes include some brain areas that
moderate neurovegetative activities such as emotion, sleep,
appetite, and energy.
Further limiting stress whenever possible also helps; this means
not taking too many commitments at the same time. Spirituality
help one to deal with stress by providing one with a sense of
purpose, peace, and forgiveness.
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Recommendations
Psychotherapy is the most effective treatment for Bipolar
Disorder II. Some of the medications are mood-stabilizing and
antidepressant.
Medications are focused on preventing relapse.
Individuals suffering from manic episodes are frequently
directed to continue to take mood stabilizers to control bipolar
disorder (Gordovez & McMahon, 2020).
This typically comprises a single mood stabilizing
medication such as valproate and lithium.

10. Psychotherapy comprises individual counseling, self-
management practices education, and family therapy.
Referrals
Mental health counselor or Psychiatrist.
Therapy is intended to help the patient stick with y the
medicine, which can reduce the risk of reversion and the
necessity for hospitalization.
Self-management is aimed at encouraging the patient to build
better relationships with others.
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References
Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder.
New England Journal of Medicine, 383(1), 58-66.
https://doi.org/10.1056/NEJMra1906193
Gordovez, F. J. A., & McMahon, F. J. (2020). The genetics of
bipolar disorder. Molecular Psychiatry, 25(3), 544-559.
https://doi.org/10.1038/s41380-019-0634-7
Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J.,
McLaren, R., Geddes, J. R., & Cipriani, A. (2021). Adjunctive
psychotherapy for bipolar disorder: A systematic review and
component network meta-analysis. JAMA Psychiatry, 78(2),
141-150.
https://doi.org/10.1001/jamapsychiatry.2020.2993
Miller, J. N., & Black, D. W. (2020). Bipolar disorder and
suicide: A review. Current Psychiatry Reports, 22(2), 1-10.
https://doi.org/10.1007/s11920-020-1130-0
Millgram, Y., Gruber, J., Villanueva, C. M., Rapoport, A., &
Tamir, M. (2021). Motivations for emotions in bipolar

11. disorder. Clinical Psychological Science, 9(4), 666-685.
https://doi.org/10.1177/2167702620979583
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