Evaluating Mood and Behavioral Symptoms in a Young Artist: A Case Study

QUESTION

Mylie is a 27 y/o, single, female who presents with a history of depression since her sophomore year in high school. She was initially treated with fluoxetine as a teen, which she felt helped at first but then stopped working. A switch to sertraline similarly helped for a period of time and then no longer seemed effective. She has been taking escitalopram 20mg daily for the past month. On interview, she shares that she is an artist and plans to become famous. She sometimes stays up all night to complete projects and denies feeling tired. She shares that she sometimes has ‘so many good ideas at once’ that it is hard to ‘catch them all’. Her mother accompanies her in the waiting area. Kayla says that her mother has been ‘trying to control her’ lately and has been complaining that Kayla ‘goes out a lot’ and ‘comes home at all hours of the night’.

ANSWER

Evaluating Mood and Behavioral Symptoms in a Young Artist: A Case Study

Introduction

This case study delves into the presentation of Mylie, a 27-year-old single female, who seeks medical evaluation for her history of depression, treatment with various antidepressants, and recent concerns about her mood and behavior. Mylie’s unique circumstances, including her artistic pursuits, sleep patterns, and family dynamics, provide a complex clinical scenario that requires a comprehensive assessment and intervention plan.

Mood and Treatment History

Mylie’s history of depression dating back to her high school years reveals a chronic and recurrent course of the condition. She has previously been treated with fluoxetine and sertraline, both of which initially provided relief but later lost effectiveness. Currently, she is taking escitalopram 20mg daily. This history highlights the challenges of managing depressive symptoms and the need for reassessment and potential adjustments in her treatment plan.

Manic Symptoms and Behavioral Changes

Mylie’s interview reveals significant manic symptoms, including increased energy, decreased need for sleep, racing thoughts, and an elevated sense of self-esteem. She mentions having “so many good ideas at once,” which is characteristic of the manic phase of bipolar disorder. Furthermore, her artistic creativity and ambitions, combined with staying up all night to complete projects, suggest the possibility of a hypomanic or manic episode.

Family Involvement

Mylie’s mother’s presence and concerns are noteworthy. Her complaints about Mylie “going out a lot” and “coming home at all hours of the night” suggest potential conflicts and changes in Mylie’s behavior that could be attributed to her manic symptoms. Family involvement is essential for obtaining a complete clinical picture and providing support and insight into the patient’s condition.

Assessment and Diagnosis

Mylie’s presentation raises questions about the possibility of a bipolar disorder diagnosis. A comprehensive assessment, including a thorough psychiatric evaluation, mood disorder screening, and family history, is crucial for a precise diagnosis. Additionally, considering her history of depression and inadequate response to multiple antidepressants, bipolar disorder should be a focal point in the differential diagnosis.

Conclusion

Mylie’s case underscores the importance of a holistic approach to mental health evaluation and treatment. Her history of depression, mood instability, and family dynamics suggest a complex clinical scenario. A comprehensive assessment, precise diagnosis, and tailored intervention plan are vital to address her current symptoms and provide long-term mental health support. Furthermore, considering her artistic pursuits and creativity, a collaborative approach involving psychiatric care and therapy that embraces her talents and aspirations can help her achieve emotional well-being and artistic success.