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Mood swings, purchasing excessively when upset, impaired judgement. What would be an appropriate psychotropic agent?

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Practicing since : 1998
Answered : 415 Questions
Here is a hypothetical case.....
XXXXXXX is a 28-year-old male who comes for a psychological evaluation at the insistence of his spouse and parents. XXXXXXX reports he has been working on his PhD for the past three years. His wife of four years is also working on her PhD. He states that he knows his behavior is erratic at times, but attributes it to the intensity of working on his PhD. He says he feels like no one understands him and the tension he experiences. He states that he is either one extreme or the other.

When he gets upset, he often goes online and makes purchases of items he does not really need. He often spends thousands of dollars and uses his parents' credit card, which he has for emergencies. He reports that he is aware he is doing this, but cannot seem to stop himself. These purchases make him feel better. Later, when he realizes what he has done, he becomes really depressed and feels worthless. He attributes these feelings to his wife and parents harassing him about the expenditures. XXXXXXX also reports that, while he is in purchasing mode, he may stay awake for several days at a time. He feels really good during this time and rarely eats.

He states that he has always had ups and downs in his mood, but has been able to control it in the past. However, these episodes are happening much more frequently-sometimes every few weeks. He says that his family is more upset about his behavior than he is. He wishes they would just leave him alone.

Mental Status
XXXXXXX arrives on time for his visit, is dressed appropriately, and is oriented to time, place, and circumstance. He does not appear to have any hallucinations and is not out of touch with reality. He appears angry during the session and almost always shouts when discussing his wife's and parents' confrontations. He seems to have impaired judgment.

•Axis I: Bipolar disorder II.
•Axis II: No diagnosis.
•Axis III: No diagnosis.
•Axis IV: No diagnosis.
•Axis V: GAF: 65.

What would an the appropriate psychotropic agent (or agents) for the case?
Would would be the agents' potential effectiveness?
Posted Thu, 13 Sep 2012 in Mental Health
Answered by Dr. Susanta Padhy 35 minutes later
Thanks for the hypothetical thought provoking clinical situation

Possibilities from the case description may be as you have mentioned could be:

a) Bipolar II , where episodes of hypomania and depression occur

b) Cyclothymia, where rapid mood fluctuations of opposite polarity lasting for few hours to less than 2-4 days (for hypomanic like symptoms), 1 week to 2 weeks for depressive symptoms.

Either scenario (a) or (b) are likely to be aggravated in stressful situations

If diagnosis is correct, mood stabilizers like sodium valproate should be reasonably effective, with or without antidepressants / antipsychotics.

Hope, this gives some light to your hypothetical question
Let me know if you have any more questions
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