Select an appropriate screening tool for Kristin and provide a score for the tool.
The Mood Disorder Questionnaire (MDQ) is the appropriate tool for Kristin, as it captures both depressive and hypomanic symptoms. Given her sadness, insomnia, irritability, and extended periods of high energy focused on crafting, Kristin would likely screen positive, indicating the need for further evaluation. The MDQ is ideal for detecting bipolar spectrum disorders, making it suitable given Kristin’s mood instability, which suggests bipolar II disorder rather than unipolar depression. Boland & Verduin (2022) emphasize the importance of comprehensive screening tools like the Mood Disorder Questionnaire (MDQ) for accurately identifying bipolar spectrum disorders.
Provide a rationale for the screening tool you selected
There were clear hints of hypomanic episodes, such as her crafting marathons without sleep and impulsive online shopping. The Mood Disorder Questionnaire (MDQ) helps capture both ends of mood instability, making it a better fit than a tool that only screens for depression.
Determine the most likely diagnosis for Kristin based on the available information
Based on the available information, the most likely diagnosis is Bipolar II Disorder, current episode depressed (ICD-10-CM: F31.81). Kristin’s combination of depressive symptoms (like weight loss, insomnia, and sadness) and distinct hypomanic phases (marked by bursts of creative energy lasting several days) matches this diagnosis. Importantly, her symptoms are not severe enough to qualify as full mania, which rules out bipolar I.
Provide the ICD-10-CM code for the selected diagnosis
The most appropriate diagnosis for Kristin is Bipolar II Disorder, with the corresponding ICD-10-CM code: F31.81.
Provide a treatment plan with rationale for each plan step
Start Lamotrigine (Lamictal) 25 mg daily, titrated to 200 mg as tolerated.
Lamotrigine is effective for managing depressive episodes in bipolar II disorder without triggering mania. Besag et al. (2021) conducted a systematic review of the efficacy and safety of lamotrigine for treating bipolar disorder across different age groups. The study found lamotrigine effective in managing depressive episodes and maintaining mood stability, with a favorable safety profile, particularly for bipolar II disorder.
Psychotherapy: Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT)
CBT helps with emotion regulation and impulse control, while MBCT can improve sleep and reduce rumination.
Lifestyle Modifications: Establish consistent sleep routines and limit screen time.
Enhances sleep quality and mood stability.
Offer nicotine cessation support to reduce mood dysregulation.
Psychoeducation: Educate Kristin on bipolar disorder and recognize early mood shifts. Rationale: Empowers Kristin with self-management strategies.
References
Besag, F. M. C., Vasey, M. J., Sharma, A. N., & Lam, I. C. H. (2021). Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review. Therapeutic advances in psychopharmacology, 11, 20451253211045870. https://doi.org/10.1177/20451253211045870Links to an external site.
Boland, R., & Verduin, M.L. (2022) Kaplan and Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
