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Mad love


Diagnosis​

The diagnosis for Casey is Bipolar II Disorder (296.89). To reach that diagnosis the following must be true:

  1. Presence (or history) of one or more Major Depressive Episodes.
    • Within the movie there is a Major Depressive Episode. Her parents also referred back to the fact that Casey had experienced episodes before as well.
  2. Presence (or history) of at least one Hypomanic Episode.
    • A Hypomanic Episode was also included in the movie. Evidence on whether or not she had been through more than one episode of this before was not provided.
  3. There has never been a Manic Episode or a Mixed Episode.
    • Casey’s symptoms were not severe enough to classify as a Manic or Mixed Episode.
  4. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
    • Although Casey had some odd behaviors that seemed almost similar to ones that would be presented in Schizophrenia or a very similar disorder, they would not be classified as actual delusions. The inconsistencies in her behaviors seem to classify more into Bipolar Disorder.
  5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • Casey’s ability to form relationships was greatly affected by her symptoms. Also, distress was definitely seen within social situations. Casey was found in a bathroom with her dress off and hitting the walls and crying.
A diagnosis of a Major Depressive Episode was found by the following:

  1. Must include five or more of the following over a 2-week period:
    1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). NOTE: In children and adolescents, can be irritable mood.
    2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
    3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. NOTE: In children, consider failure to make expected weight gains.
    4. Insomnia or hypersomnia nearly every day
    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
    6. Fatigue or loss of energy nearly every day
    7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
    8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
    9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
      • Casey presented symptoms a, d, g, and i.
  2. The symptoms do not meet criteria for a Mixed Episode.
    • Her symptoms were not presented as both Manic and Depressive on a nearly daily basis.
  3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • Distress and impairment were definitely apparent in social situations. The example of the bathroom scene previously mentioned demonstrated this.
  4. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
    • No drugs were being used besides nicotine and no other stated medical condition was present.
  5. The symptoms are not better accounted for by Bereavement, i.d., after the loss of a loved one; the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness suicidal ideation, psychotic symptoms, or psychomotor retardation.
    • No loved ones were lost; the symptoms had been reported for over 2 months and she had attempted suicide numerous times.
Additional discussion found on the linked page.
 

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