Jenn is a 32-year-old Caucasian female who has experienced long periods of depression over the last 10 years, including two suicide attempts. During depressive episodes, she loses weight and experiences sleep problems. Recently, she has had 4-day periods of little sleep where she feels energetic and productive, though also irritable. During these times, she engages in spending sprees. Based on her symptoms, Jenn is diagnosed with Bipolar II Disorder, which involves one or more episodes of hypomania and major depressive episodes. Changes in multiple levels of the central nervous system are evident in bipolar disorder, including excessive neuron transmission. Both genetic and environmental factors are involved in the disorder.

1. DSM-IV-TR PresentationBy Fredi Beckett

2. Case StudyJenn is a 32 y/o Caucasian female who describes long periods of depression for the last 10 yrs. She has multiple episodes of feeling depressed, with 2 suicide attempts of overdosing on meds. During those times, she lost between 10-15 lbs. over a 3 mo periods and had significant sleep problems, especially falling sleep and waking early. She also describes a few periods in the last 2 years when she could go about 4 days with little sleep and feel “really good about myself”. “These times never lasted long enough”. During this time, she would get a lot done at the house and her mind was “racing” faster than she could talk. During these 4-day periods she was quite irritable with others but did not feel depressed. She also describes going on “spending sprees” of about 300-400 dollars during these times. She wishes she had more of these times as she felt like she could get “stuff done”.

3. Diagnosis & CriteriaBipolar II Disorder – MRE unspecified296.89 1 or more episode of hypomania

4. 1 or more Major Depressive episodes

5. Not better accounted for by effects of a medication, substance use, Mood Disorder, Schizoaffective Disorder, Schizophrenia, Delusional Disorder, or Psychotic Disorder NOSRecording ProceduresDiagnostic code is 296.89None of the specifiers are codableFourth digit 0 if only one hypomanic episode. For recurrent, indicates nature 1 = mild, 2 = moderate, 3 = severe. If currently in partial or full remission, indicates nature of most recent episode, hypomanic = 4, Major Depressive = 5, Mixed = 6, Unspecified = 7.

6. Neurobiology Changes evident at all levels of CNS in BPDKey finding is excessive neuron transmissionMultiple genes are involvedEnvironmental stressors – not causal, but contribute to level of disease