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Eve’s Case Study

Eve’s background

The critique will deliver a theoretical diagnosis and examination of therapeutic founded on a patient analysis of Eve. The vignette expresses the patient as a 32-year-old female pursuing therapy for a routine of 6 depressive spells that first began about 11 years back at year 21 following the ending of a romantic affinity. Her depressive outbreaks seem to embody signs of a depressed attitude, disinterestedness, reduced capacity to discern enjoyment, extreme daytime drowsiness and exhaustion, suicidal thoughts, and increased irritability. After several attempts to resolve the episodes with psychotherapy and trials with various antidepressants and mood stabilizing medications, her attacks continue to cause considerable grief and impair her quality of life.

First diagnostic evaluation

Eve is most probably experiencing bipolar II syndrome based on her clinical presentation, family history of mental health, and record of several unsuccessful therapies. Major depressive disorder (MDD) and bipolar II share several clinical guidelines, making it difficult for a specialist to distinguish them (Preston, 2021). Their chances are that clients may not always be mindful of their increased and dysfunctional emotionality and might not be particularly open and honest with this personal data. Eve’s non Openness is because hypomania is a state where users may feel particularly viable or productive and not display it as a prospective symptom. Nonetheless, hypomanic episodes can be more brutal to identify in clients (Singh & Rajput, 2006). Differential examinations to evaluate MDD include attention deficit disorders, schizophrenia spectrum ailments, panic or anxiety conditions, cyclothymic diseases, substance use conditions, personality disorders, and bipolar conditions (American Psychiatric Association, 2013).

Founded on Eve’s symptom exhibition, the most crucial differential diagnoses to eradicate are probable MDD, cyclothymic disorder, and substance usage disorder (APA, 2013). The cyclothymic condition can be eliminated instantly, as demonstrated by the existence of a bonafide significant depressive spell. Drug abuse infection is not feasible based on facts obtainable exceeding rejection of alcohol or drug misuse and an outlying genetic link to a grand aunt. She had an intense alcohol problem (APA, 2013). MDD can be better differentiated from bipolar II disorder by administering a screening or assessment tool, like the Mood Disorder Questionnaire, which can help clinicians identify or eliminate bipolar disorder as a possible diagnosis (Singh & Rajput, 2006). The following signs, nevertheless, suggest that MDD can be ruled out for the following purposes:

  1. Antidepressant medications failed to alleviate Eve’s illness, which is strongly associated with a sign of bipolar disorder.
  2. Extreme tiredness and sleeplessness are both signs of bipolar illness.
  3. There is a high likelihood that bipolar illness has a parental hereditary component (Preston, 2021).

Supporting indication

According to an assessment of her behaviors to those listed in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013), Eve probably satisfies the following bipolar II condition diagnostic criteria,

  1. Unstable episodes.
  2. A stretch of at least four days during which there is an extraordinary rise in energy and a change in mood.
  3. Higher self-esteem, a lower need for relaxation, being more extroverted, and a rise in goal-directed activities are four notable mood characteristics (caused by the unpleasant mood state).
  4. A change in operating between incidents is discernible.
  5. Changes in mood and performance that other people can detect.
  6. Not enough extreme symptoms to require hospitalization or to seriously hinder doing daily duties.
  7. Drugs did not bring on the incident.

Incident of severe depression:

  1. A persistently gloomy mood decreased interest in or enjoyment of activities, excessive sleepiness, exhaustion, and repeated suicidal tendencies are five or more symptoms that endure for two weeks or more.
  2. Substantial deterioration of social functioning and operationally.
  3. Drugs did not bring on the incident.

Bipolar II Disorder:

  1. Partially one irrationality state and one severe depressive phase have occurred.
  2. There is no proof or history of mania.
  3. There is no more straightforward explanation for episodes than schizophrenia-associated illnesses.
  4. Depression signs transition between hallucinosis and therapeutically, and severe functional disorders are brought on by depression.

Additional supporting factors

Eve’s condition has characteristics that are consistent with bipolar II illness, including the following:

  1. Age (21 years old) when symptoms first appeared.
  2. Uncertain mood swings that frequently occur in a sequence.
  3. Hypomanic indicators are of no significance as they are less likely to be detected as impairing the person themself. Depressive moods dominate the symptomatology and are substantially more widespread and incapacitating.
  4. Bipolar II disease has a significant indication of occurring due to genetic preconceptions and the father’s side history of depression (Singh & Rajput, 2006).

Treatment history analysis

Eve’s prior diagnoses of MDD and therapy-resistive MDD are likely related to variables that may have led to her lack of responsiveness to pharmacotherapeutic treatments. In the past, she has primarily received antidepressant prescriptions (such as Cymbalta, Effexor, Zoloft, Remeron, and Wellbutrin), which are known to be unhelpful for patients with bipolar illness (Preston, 2021). Lithium, a short mood stabilizer, was withdrawn after three days due to inefficiency and terrible detrimental reactions. The strategy created to manage MDD rather than bipolar II disease may have made counseling methods ineffectual. Eve’s poor response to therapy is caused by the interaction of all of these elements.

Recommendations for treatment

Through this specific diagnosis, the therapeutic approach has to be revised. The best way to treat bipolar illnesses is with drugs because data demonstrates that they are primarily biological (Singh & Rajput, 2006). Bipolar II disorder can benefit from psychotherapy combined with pharmacological treatments (Preston, 2021). It has been shown that cognitive behavioral therapy, group counseling, psychotherapy, and family counseling benefit these people. However, prescriptions remain the standard treatment for bipolar anxiety and depression (Preston, 2021).

As it will be down to the treating doctor to determine the dose after taking Eve’s existing medicines, age, weight, height, and any medical conditions must be considered. An antipsychotic medication called aripiprazole acts to stabilize neurotransmission.

Often, lithium is the first-line option for mood stabilizers. Still, given Eve’s past experiences with its inefficiency and unpleasant adverse effects, the best course of action is to put her back to the doctor so that she may be reviewed for Divalproex, a regularly recommended drug. Divalproex is an antipsychotic medication with anticonvulsant effects comparable to lithium. Still, lesser side effects, no danger of overdose, and a more comprehensive therapeutic range make it a potentially excellent fit for Eve’s requirements (Preston, 2021).

If Eve does not perform this alternate anticonvulsant, quetiapine is another medication recommended for use when patients have more extreme bipolar II condition psychological distress (Preston, 2021). The Food and Drug Administration (FDA) has authorized quetiapine, a compensatory schizophrenia medication, to address bipolar depression because it has a lower proportion of the extrapyramidal detrimental reactions frequently seen with antipsychotic medicines (McDonald & Cook, 2021).

The psychoeducation component of Eve’s therapy program is crucial. Counselors can spend additional interaction with patients and impart knowledge that can promote compliance with treatment schedules and guarantee safe usage. It might be indispensable to advise a customer about the pharmacokinetic and pharmacodynamic characteristics of the prescriptions they are using when transferring them to a new medication. Including the following points in these discussions can help patients benefit the most from their therapy:

  1. A classification of the medicine and a statement of the condition is used for treatment.
  2. Body’s reactions and how it benefits the client.
  3. Dosage details include the dose, usage, when, how it should be administered, storage instructions, and how the medicine looks.
  4. Common adverse effects, contraindications, and what to do if they occur.
  5. Possible relations with other drugs or meals.
  6. The duration to experience the outcomes of the prescription.

Ethical and legal considerations

A therapist must stay up to date on pertinent legislation and moral standards regarding medical and counseling at the national, state, and operational levels since they influence human health and the welfare of society. Following the American Counseling Association’s Code of Ethics (Francis, 2020), it is standard protocol for practitioners to safeguard the health of the communities by maintaining that counselors provide accurate assessments, create treatment options in consultation with healthcare experts, and make referrals to healthcare practitioners when necessary. Working as a registered, licensed therapist within the bounds of professional competence and sending patients to qualified prescribers rather than issuing prescriptions.

The Drug Enforcement Agency (DEA) is in charge of regulating the proper use of prescription medications and guarding against the risk that might result from abusing them or using illegal narcotics. As a consultant in the medical community, offering precise and reliable evaluations and recommendations for drug assessment. However, help the DEA and the community’s general health by preventing the prescription of harmful pharmaceuticals to people. It will also be the psychiatrist’s responsibility to inform the appropriate people of any knowledge of another doctor or prescription who may not be following their standards of conduct and engaging in unlawful conduct to prevent future harm to their clients and neighborhoods (McDonald & Cook, 2021). Substance abuse and misuse are significant problems that constantly impact America in avoidable ways.


Eve’s case raises concurrency issues. The diagnosis of the patient requires prudence on the part of the counselor. One of the primary goals of Eve’s appointments is to teach her the signs of hypomania so she can start noting and reporting occurrences of the condition. Other areas of concentration include teaching clients about bipolar II disease and Eve’s new counseling approach, ECT, and CBT.


American Psychiatric Association Division of Research. (2013). Highlights of changes from DSM-iv to DSM-5: Somatic symptoms and related disorders. Focus, 11(4), 525-527.

Francis, P. C. (2020). Legal and ethical issues in college counseling.

McDonald, K. E., & Cook, A. (2021). APA Style: A Foundation for Advocacy in Counseling. The Journal of Counselor Preparation and Supervision, 14(1), 8.

Preston, J. D., O’Neal, J. H., Talaga, M. C., & Moore, B. A. (2021). Handbook of clinical psychopharmacology for therapists. New Harbinger Publications.

Singh, T., & Rajput, M. (2006). Misdiagnosis of bipolar disorder. Psychiatry (Edgmont), 3(10), 57.


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