Test your diagnostic skills with this fictional case. We’ll review the details of the case of Robbie before you determine what you think the diagnosis will be. At the end, we’ll review the correct diagnosis.
Today we’re reviewing the fictional case of Robbie Lewis. He is a 42-year-old male who was recently brought to the hospital by his wife. She states that he has a history of major depressive episodes. At the worst, his wife says that the episodes have lasted several months. She says that for years, Robbie has consistently taken a mood stabilizer and that this has helped with his depressive symptoms. However, she says that he had recently stopped taking his medication as he had felt that his mood had been stable for so long that he maybe wasn’t needing the medication anymore.
She brought Robbie in today because he has been basically up for 72 hours, only sleeping for an hour or two here or there. She says that he has been acting erratically, and that he has been saying “bizarre” things and that she isn’t sure what he means. She notes that she is concerned about his and his safety.
In meeting with them, his wife has been providing the background information. As for Robbie, he is clearly agitated. When you try to ask him about what’s been happening lately, he says that he wants to leave the hospital because he has been “receiving energy directly from the sun” and that he can’t do that in the exam room without any windows.
His wife interrupts and says that he is making statements like this that are very out of character for him. She adds that he recently spent nearly ten thousand dollars on cryptocurrency and that this is odd as he hasn’t expressed any significant interest in this before. Robbie then starts talking about how it doesn’t matter that he hasn’t been interested before. You note how he is talking quickly as he continues to explain that he knew to buy this cryptocurrency because the person on the television was giving him messages. He adds that his wife doesn’t understand because she can’t see the secret messages that the person on the TV is giving.
Robbie continues that he wants to finish up the appointment quickly. He says that he is needing to get home to check his cryptocurrency and that he has something he wants to share but it’s important that nobody else knows. Robbie explains that he’s a prophet but that if people know this, they may try to stop his work. He states that his investment will help him unlock wealth the world has never seen and that he will be able to stop all the bad things from happening with this money. He does not clarify what the bad things he’s referring to are.
Before you can start to speak, Robbie continues to a new topic, beginning to speak about how he is actually from the Roman Emperor and that he was reincarnated.
At this point, his wife interrupts. She says that she gets exhausted listening to him, but that he seems to have endless energy. When you ask more questions about his symptoms, you learn that the worst has been for the last seven or eight day, but that when she thinks back, she noticed his mood begin to increase before this. She adds that his sex drive seemed to increase around the same time. He has also gotten two speeding tickets in the last two weeks, which is unusual for him.
Although his wife interrupted, Robbie did not seem to notice. He quickly became distracted by his phone and continued to be typing rapidly while you and his wife discussed the symptoms he has been displaying recently.
Robbie’s appearance is disheveled. He is restless. His speech is rapid. His thought process is disorganized and he appears to be experiencing flight of ideas and racing thoughts. Based on what he shares, he appears to be experiencing delusions. His mood, according to his wife, has been euphoric and irritable, and his affect while meeting with you is consistent with this. He does not seem to have any insight into his current symptoms, and his judgement appears to be severely impaired.
As a quick overview, Robbie was brought into the hospital by his wife. He has had a history of Major Depressive Disorder. She reports that he recently quit taking his mood stabilizer as his mood has been well-managed for many years. Currently, he has had an elevated mood for over a week. While you’re meeting with them, Robbie makes statements about needing to get energy from the sun, receiving secret messages from people on TV, and that he is a prophet. Since his mood has increased, he has been speeding more, putting large amounts of money into cryptocurrency investments, and had an increased sex drive.
His mood has been euphoric, but he has also been irritable. Robbie has slept for very little time in the last three days. It has been difficult to follow him at times as he is talking so quickly and because he can quickly change topics.
Based on what we can gather here, Robbie meets criteria for Bipolar 1 Disorder and it would be appropriate to add a specifier of with mood-congruent psychotic features.
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