For several years, Giancarlo has experienced periodic mood swings and seemingly abrupt changes in behavior. He reports that he will generally feel "down in the dumps" for a few months and then suddenly find himself with an overabundance of energy. He describes this by using a gambling metaphor: "It's like I'm just losing hand after hand, can't catch a break, and everything's just going to crap. Then, out of nowhere, I'm on a winning streak. I literally cannot lose. I can do whatever I want, bet as much as I want, and it's no problem. It's like a wild phase I go through now and then. Then, it just peters out, and I'm stuck with my losing hands again." When pressed for details about what happens during these "wild phases," Giancarlo becomes withdrawn and expresses a great deal of guilt and shame over his behavior. The specific nature of each wild phase varies considerably. In general, Giancarlo reports feeling highly positive about himself, as evidenced by his "can't lose" attitude. While at work, he is incredibly productive and uses this time as an opportunity to catch up with his workload. He states, however, that he has so many good ideas in his head that he'll start working on one and then quickly shift his attention to something else. This has led to several half-finished projects, so although he is more focused, his effort is not always used wisely. Socially, he tends to be very outgoing and friendly. Often, his wild phases include spending great sums of money. Sometimes, they involve rampant sexual activity. Of his most recent episode, Giancarlo says, "I was having sex with anything that moved. It was just nonstop, no talking, no protection, and I didn't even know their names half the time." When questioned further about this particular topic, Giancarlo began crying and had great difficulty discussing it. When Giancarlo is not experiencing a wild phase, he generally feels quite negative. He has difficulty falling asleep every night and suffers from a marked lack of energy. Most of the time he feels lethargic but forces himself to get out of bed and go to work. The lack of sleep makes it difficult for Giancarlo to concentrate, and he often falls behind at work. He also withdraws socially. He sees his girlfriend regularly but rarely feels up to going out with friends. When his mood gets particularly bad, he'll do his best to avoid everything. He stops watching sports, reading books, listening to music, and playing games. In his words, "I'll just lie in bed and feel sorry for myself and then beat myself up for feeling this way." Giancarlo shows no evidence of substance abuse and is not currently on medication. Question: 1- How does Giancarlo's negative mood state disrupt his physical functioning? A) He is drinking heavily to cope with his negative feelings. B) He has difficulty sleeping and constantly feels exhausted. C) He rarely feels like eating and has lost a dangerous amount of weight.
For several years, Giancarlo has experienced periodic mood swings and seemingly abrupt changes in behavior. He reports that he will generally feel "down in the dumps" for a few months and then suddenly find himself with an overabundance of energy. He describes this by using a gambling metaphor: "It's like I'm just losing hand after hand, can't catch a break, and everything's just going to crap. Then, out of nowhere, I'm on a winning streak. I literally cannot lose. I can do whatever I want, bet as much as I want, and it's no problem. It's like a wild phase I go through now and then. Then, it just peters out, and I'm stuck with my losing hands again." When pressed for details about what happens during these "wild phases," Giancarlo becomes withdrawn and expresses a great deal of guilt and shame over his behavior.
The specific nature of each wild phase varies considerably. In general, Giancarlo reports feeling highly positive about himself, as evidenced by his "can't lose" attitude. While at work, he is incredibly productive and uses this time as an opportunity to catch up with his workload. He states, however, that he has so many good ideas in his head that he'll start working on one and then quickly shift his attention to something else. This has led to several half-finished projects, so although he is more focused, his effort is not always used wisely. Socially, he tends to be very outgoing and friendly. Often, his wild phases include spending great sums of money. Sometimes, they involve rampant sexual activity. Of his most recent episode, Giancarlo says, "I was having sex with anything that moved. It was just nonstop, no talking, no protection, and I didn't even know their names half the time." When questioned further about this particular topic, Giancarlo began crying and had great difficulty discussing it.
When Giancarlo is not experiencing a wild phase, he generally feels quite negative. He has difficulty falling asleep every night and suffers from a marked lack of energy. Most of the time he feels lethargic but forces himself to get out of bed and go to work. The lack of sleep makes it difficult for Giancarlo to concentrate, and he often falls behind at work. He also withdraws socially. He sees his girlfriend regularly but rarely feels up to going out with friends. When his mood gets particularly bad, he'll do his best to avoid everything. He stops watching sports, reading books, listening to music, and playing games. In his words, "I'll just lie in bed and feel sorry for myself and then beat myself up for feeling this way." Giancarlo shows no evidence of substance abuse and is not currently on medication.
Question: 1- How does Giancarlo's negative mood state disrupt his physical functioning?
A) He is drinking heavily to cope with his negative feelings.
B) He has difficulty sleeping and constantly feels exhausted.
C) He rarely feels like eating and has lost a dangerous amount of weight.
Question:2 - In case where patients experience drastic shifts in mood, the positive episodes can be as dangerous if not more so, than the negative ones. How does this apply in Giancarlo's case?
A) He is more confrontationel and combative with others when he feels positive.
B) He engages in reckless behavior that can have serious negative consequences.
C) He is at increased risk of commiting suicide so that he doesn't return to his negative mood state.
Diagnostic Criteria Checklist - Some of the symptoms associated with various bipolar and related disorders are summarized in the following table. Indicate which symptoms are clearly present in Giancarlo's case. Check all that apply.
A) Dimished ability to think or concentrate during negative mood swings.
B) Recurrent thoughts of death or suicide ideation during negative episodes.
c) Insomnia nearly every day during negative episodes.
D) More talkative than usual during elevated mood swings.
E) Positive mood states that occur as the result of drugs or medications.
Quetion 4- Based on the full diagnostic criteria listed by the DSM-5 for bipolar and related disorders (not just the symptoms highlighted in the previous question), Giancarlo appears to meet the criteria for a diagnosis of
A) Bipolar I disordee
B) Bipolar II disorder
C) Cyclothymic disorder
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