1. Clinical Impression

3. Bipolar I Disorder Also known as Bipolar Affective Disorder A psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania or hypomania Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and abnormally depressed states for a period of time in a way that interferes with functioning. http://en.wikipedia.org/wiki/Bipolar_disorder

4. Bipolar I Disorder DSM IV-TR Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Manic A. Currently or mostly in a manic episode. B. There has previously been at least one major depressive episode, manic episode, or mixed episode. C. The mood episodes in Criteria A and are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. Page 546

5. DSM IV-TR Criteria for Manic Episode A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). B. During the period of mood disturbance, three or more of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: 1. inflated self-esteem or grandiosity 2. decreased need for sleep (feels rested after only 3 hours of sleep) 3. more talkative than usual or pressure to keep talking 4. flight of ideas or subjective experience that thoughts are racing 5. distractibility (attention too easily drawn to unimportant or irrelevant external stimuli, impulsive) 6. increase in goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. excessive involvement in pleasurable activities that have a high potential for painful consequences (unrestrained buying sprees, sexual indescretions, etc) C. The symptoms do not meet criteria for a mixed episode. D. The mood disturbance is sufficiently severe to cause marked impairment… E. The symptoms are not due to direct physiological effects of a substance…

6. Previous Manic Episode 1993 Impulsive: grabbed the car’s steering wheel while mother was driving. April 2002 Very talkative in class because or numerous running ideas in her mind Spend recklessly, buying a lot of things from the mall maxing out her 2 credit cards 2008 October: Observed to be very talkative while on the way to the cemetery, spent 14,000 for shopping December: episodes of hyperactivity, spent most of the time at the gym to lose weight

7. Bipolar I Disorder DSM IV-TR Diagnostic Criteria for Secerity/ Psychotic/ Remission Specifiers for Current or Most Recent Manic Episode Severe With Psychotic FeaturesPresence of Delusions or Hallucinations Specify: Mood Congruent Psychotic FeaturesMood-Incongruent Psychotic Features Delusions or hallucinations whose content is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. Delusions or hallucinations whose content does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. Included are such symptoms as persecutory delusions (not directly related to depressive themes), thought insertion, thought broadcasting, and delusions of control. Page 544

8. Psychotic Features Thought that her co- workers at the library were talking about her of the thesis that she was doing. April 2002 Got out and ran away from the car because she thought there was a coup d’etat going on. October 31, 2008 PERSECUTORY DELUSIONS  MOOD - INCONGRUENT PSYCHOSIS

9. Clinical Impression: DSM IV Axis III No Physical Disorders No Medical Conditions Axis II No Personality Traits/ Disorders No Mental Retardation Axis I Bipolar I Disorder with Recent Manic Episode and Mood Incongruent Psychotic Symptoms

10. Clinical Impression: DSM IV Axis IV Pyschosocial and Environmental Factors contributing to her disorder Previous history of ADHD Pressures from growing up years to excel academically Moving to the Philippines

11. 91-100 Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms. 81-90 Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns. 71-80 If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning. 61-70 Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships. 51-60 Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning. 41-50 Serious symptoms OR any serious impairment in social, occupational, or school functioning. 31-40 Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood. 21-30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas. 11-20 Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication. 1-10 Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death. 0 Not enough information available to provide GAF.

12. Clinical Impression: DSM IV Axis V Global Assessment of Functioning Score of 31-40 Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.

13. Review DSM IV DSM IV Diagnosis of EB Axis IBipolar I Disorder with Recent Manic Episode and Mood Incongruent Psychotic Symptoms Axis II No Personality Traits/ Disorders No Mental Retardation Axis III No Physical Disorders No Medical Conditions Axis IV Pyschosocial and Environmental Factors contributing to her disorder Previous history of ADHD Pressures from growing up years to excel academically Moving to the Philippines Axis V Global Assessment of Functioning Score of 31-40 Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.

14. Clinical Impression: ICD 10 F30-39 Mood (Affective) Disorder F31.2 Bipolar Affective Disorder, Current Episode Manic with Psychotic Symptoms.21 With mood incongruent psychotic symptoms http://priory.com/psych/ICD.htm F31.2.21 Bipolar Affective Disorder, Current Episode Manic with Mood Incongruent Psychotic Symptoms