What disorder/s does she have? A Clou02021%20(1).pdf100%Rachel, a 15-year-old girl, was re-ferred for a psychiatric evaluation be-cause of worsening difficulties at homeand at school over the prior year. Themother said her chief concern was that"Rachel's meds aren't working." Rachelsaid she had no particular complaints.In meetings with the patient and hermother, both together and separately,both reported that Rachel's grades haddropped from As and Bs to Cs and Ds,that she had lost many of her long-standing friends, and that conflicts athome had escalated to the point that hermother characterized her as "nasty andone. During these periods of persistertsadness, she would sleep more thanusual, complain that her friends didn'tlike her anymore, and not seem inter-ested in anything. At other times, shewould be a "holy terror" at home, fre-quently yelling at her sister and parentsto the point that everyone was "walkingon eggshells." At about that time, Ra-chel's grades plummeted, and her pedi-atrician increased the dosage of herADHD medication.Rachel's family history was pertinentfor a father who "had real problems."Although her mother did not know hisdiagnosis, he had been treated with lith-ium. The father had left the family be-fore Rachel was born, and the two hadmean."Rachel first saw a psychiatrist at age 7when she was evaluated for attention-deficit/hyperactivity disorder (ADHD)because of restlessness, impulsivity, anddistractibility. After behavioral interven-tions were ineffective, the patient begantreatment with a methylphenidate-based medication at age 8. Improvementwas seen at schoo!, in her social life, andat home. For the ensuing 6 years, Rachelhad done well and was "pretty muchlike other kids as long as she took hermedicine."Al around age 14, however, Rachelbecame "moody." Instead of being a"bubbly teenager," she would spenddays by herselt and hardly speak to any-never met.In exploring the periods of irritability,dysphoria, and social isolation, the clini-cian asked whether there had been timesin which Rachel was in an especiallygood mood. The mother recalled multi-ple periods in which her daughter wouldbe "giddy" for a week or two. She wouldlaugh at "anything" and would enthusi-astically help out with and even initiatehousehold chores. Because these were the"good phases," the mother did not thinkthese episodes were noteworthy.Rachel had no medical problems. Shedenied use o! alcohol, illicit substances,2770 F Clear nsưing 6 years, Racheld was "pretty muchlong as she took her14, however, RachelInstead of being a" she would spendhardly speak to any-be "giddy" for a week of two She wouldlaugh at "anything" and would enthusiastically help out with and even initiatehousehold chores. Because these were the"good phases," the mother did not thinthese episodes were noteworthyRachel had no medical problems. SHdenied use of alcohol, illicit substanceand medications other than the pre-scribed ADHD medication.On examination while alone, Rachelwas a casually groomed teenager whowas coherent and goal directed. She ap-peared wary and sad, with some affec-tive constriction. She did not like howshe had been feeling, saying she felt de-pressed for a week, then okay, then "hi-larious" for a few days, then "murderous," like someone was "churning upmy insides." She did not know why shefelt like that, and she hated not knowinghow she would be feeling the next day.She denied psychotic symptoms, confu-sion, and suicidal and homicidal thoughts.She was cognitively intact.

The Diagnostic and Statistical Manual of Mental Illnesses (DSM) classifies mental disorders that…

Rachel, a 15-year-old girl, was re- ferred for a psychiatric evaluation be- cause of worsening difficulties at home and at school over the prior year. one. During these periods of persistert sadness, she would sleep more than usual, complain that her friends didn't like her anymore, and not seem inter- ested in anything. At other times, she would be a "holy terror" at home, fre- The mother said her chief concern was that "Rachel's meds aren't working." Rachel said she had no particular complaints. In meetings with the patient and her mother, both together and separately, both reported that Rachel's grades had dropped from As and Bs to Cs and Ds, that she had lost many of her long- quently yelling at her sister and parents to the point that everyone was "walking on eggshells." At about that time, Ra- chel's grades plummeted, and her pedi- atrician increased the dosage of her ADHD medication. standing friends, and that conflicts at home had escalated to the point that her mother characterized her as "nasty and Rachel's family history was pertinent for a father who "had real problems." Although her mother did not know his diagnosis, he had been treated with lith- ium. The father had left the family be- fore Rachel was born, and the two had mean." Rachel first saw a psychiatrist at age 7 when she was evaluated for attention- deficit/hyperactivity disorder (ADHD) because of restlessness, impulsivity, and distractibility. After behavioral interven- tions were ineffective, the patient began treatment with a methylphenidate- based medication at age 8. Improvement was seen at schoo!, in her social life, and at home. For the ensuing 6 years, Rachel had done wel! and was "pretty much like other kids as long as she took her medicine." never met. In exploring the periods of irritability, dysphoria, and social isolation, the clini- cian asked whether there had been times in which Rachel was in an especially good mood. The mother recalled multi- ple periods in which her daughter would be "giddy" for a week or two. She would laugh at "anything" and would enthusi- astically help out with and even initiate- household chores, Because these were the "good phases." the mother did not think these episodes were noteworthy. Rachel had no medical problems. She den ed use of alcohol, illicit substances At around age 14, however, Rachel became "moody." Instead of being a "bubbly teenager." she would spend days by herself and hardly speak to any-