SOWK 7371 – Case Study
Cynthia
Cynthia is a 29-year-old financial planner who is ma
ied and the mother of three children. Her husband
ought her to the emergency room after having spent the past 12 days in “another cycle of
depression,” marked by a quick temper, almost no sleep and tearfulness. He noted that these “dark
periods” have gone on as long as he has known her but that she had experienced at least a half dozen of
these episodes in the prior year. Cynthia’s husband reported that her mood typically stabilizes within a
few weeks of restarting her fluoxetine. He added that he wondered whether alcohol and clonazepam
worsened her symptoms, because she routinely ramped up their use when the dark periods begin.
Cynthia’s husband stated that he decided to
ing her to the ER because he discovered a blog she just
created that presented unethical financial planning advice to her clients. He noted she had been working
on this blog around the clock. She has also avoided eating and her responsibilities regarding the
children. When he confronted her, she claimed she was fine and was going to “make them as rich as the
Queen of England.”
Cynthia was first diagnosed with depression in college, after the death of her father. He had been a
wildly e
atic, alcohol-abusing businessman who Cynthia loved very much. Her paternal grandmother
had several “nervous
eakdowns,” but her diagnosis and treatment history were unknown. Since
college, her mood was generally “sad”. Interspersed with recu
ent bouts of enhanced dysphoria,
insomnia, and uncharacteristically rapid speech and hyper alertness. She had tried psychotherapy
sporadically and taken a series of antidepressant medications, but her husband noted that the baseline
depression persisted and that the “dark periods” were increasing in frequency.
Her outpatient psychiatrist reported that Cynthia appeared to have dysthymia and a recu
ent major
depression. He also said that he had never seen her during periods of edginess and insomnia-she always
efused to seem him until the “really down” periods improved. She also refused him access to her
husband or any other sources of collateral information.
Upon entering the evaluation room, Cynthia was angrily pacing. The LCSW noted she was dressed in a
jeans and shirt that was carelessly unbuttoned. Her eyes appeared glazed and unfocused. She
esponded to the LCSW’s entrance by sitting down and explaining that this was all a miscommunication,
and she was fine and needed to get home immediately to tend to her business. Her speech was rapid,
pressured, and very difficult to inte
upt. She admitted to not sleeping but denied that it was a problem.
She denied hallucinations but admitted, with a smile, to a unique ability to predict the stock market. She
efused cognitive testing, saying she would decline the opportunity to be a “trained seal, a guinea pig,
Mr. Ed, and a barking dog, thank you very much, and may I leave now?” Her insight into her situation
appeared poor, and her judgment was deemed to be impaired.
The Diagnosis is:
Bipolar disorder, Manic episode, moderate, with mixed features.
Write a one-page paper on the following;
What are the social impacts of the assigned diagnosis?
Along with the social impacts, consider the unique cultural impacts of this diagnosis within Hispanic groups.