It’s Tuesday…late on Tuesday, but still Tuesday, so it’s Hot Topic time! Now that we’re into the diagnostic categories, it’s important to start looking at questions and thinking about differential diagnoses – what information do you need for an initial diagnostic impression? What are the features that distinguish similar disorders from one another? This week, we’re looking at Mood Disorders:
A social worker in private practice receives a referral for a 32 year old woman who reports ongoing difficulties with social and romantic relationships. During the initial appointment, the woman expresses frustration about a recent breakup and states that her ex-boyfriend “got tired of the highs and lows.” When the social worker asks her to clarify, the woman reports going through frequent periods of feeling depressed as well as periods in which she feels “super happy, super productive, just super!” She says "I've always been this way, I don’t know why I can’t find someone who can deal with it." What is the most likely diagnosis for the client in this case?
A. Bipolar II
B. Cyclothymic Disorder
C. Mood Disorder NOS
D. Adjustment Disorder
So let's talk briefly about differentiating between Bipolar II and Cyclothymic Disorder. Bipolar II is characterized by the presence or history of a full-fledged Major Depressive Episode and the presence or history of a Hypomanic Episode. If a person has ever had a Manic episode or a Mixed episode, they do not have Bipolar II! Cyclothymic Disorder might be viewed as a watered-down version of Bipolar II -- the person has, for at least 2 years, experienced numerous periods of hypomanic symptoms and periods of depressive symptoms that do not meet the criteria for a Major Depressive episode; it's important to note that during this 2 year period, the person has not been without the symptoms for more than 2 months. There are situations in which a person could have Cyclothymic Disorder and Bipolor I or Bipolar II, but for the purposes of the test, you will be thinking about differential diagnoses (as opposed to co-occurring disorders). So, if the question describes a Major Depressive Episode and symptoms of hypomania, think Bipolar II; and if the question describes a person who has long-term symptoms of depression and hypomania, think Cyclothymic Disorder. When you’re studying, try this: read a question and without looking at the answers (cover them up, if need be) write down, or say out loud, what your top diagnostic choice would be, and if that isn’t available, your second choice. Now look at the answers – is your top choice there? How about your second choice? This should help get you in the habit of using information from the stem to develop a diagnostic impression.
The correct answer is B. The stem tells you that the woman experiences frequent periods of what sound like depressive and hypomanic symptoms, and that these symptoms have been ongoing and are causing impairment in her social life. A is not correct because we do not have the Major Depressive Episode or Hypomanic Episode needed for Bipolar II. C is not the best answer because we have enough information for Cyclothymic Disorder and D is not correct because the symptoms described do not fit Adjustment Disorder.
Coming up next week: Anxiety Disorders
Think our straightforward, sensible approach could help you PASS your social work or MFT exam? If you're preparing for a social work exam, check out our Social Work Study Materials. If you're preparing for an MFT exam, check out our MFT Study Materials. Learn more about our offerings at The Therapist Development Center.
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