Assignment Task: What diagnosis would you give this case study? And why? Would it be Bipolar I or II?
Carl Foster is a 28-year-old male, local architect, and the father of two children (Peppa and Tony). He lives in a country house on the edge of town with plenty of room for the family and pets and his partner Jane.
Carl presented to the psychology clinic on Monday with Jane after being unable to get to sleep every night for the last 2 weeks. During the consultation Carl disclosed that even though he had not had much sleep and he was quite restless most nights he didn't mind because he was so energetic that he finished a lot of work and delivered on some overdue projects as well. He said he was quite happy and excited about having also been able to start on some amazing new office space designs he had been thinking about during the day too. He was very confident and probably certain, that these designs would be purchased by Google for their new headquarters and that he would be famous for designing them. Carl remarked that sleep was overrated and that even though he didn't sleep for long, it was enough.
Carl described his family situation as stable, but he had noticed that he had become quite irritable with Peppa and Tony when they were running around the house making noise and leaving their LEGO on the floor. On two occasions he had yelled out after treading on them. He said he lashed out at Tony very harshly a few times this week, which he regretted.
Carl appeared to speak quickly throughout the appointment, as if he had too much to say in the time allocated to the session. Jane said this was very uncharacteristic for Carl. She was also concerned that Peppa and Tony had noticed a change in their father's behaviour since they had asked "why did Daddy have a temper tantrum and why did he talk all the time now"? She also mentioned that he had purchased some very expensive home office furniture in anticipation of personal visits by the Google CEO that she was sure they couldn't possibly afford right now, especially since he had shifted the family investments into some extremely risky alternative cryptocurrencies. Carl said he had made a range of cryptocurrency investments recently and he thought they were all likely to make massive returns. Some had lost money recently, but he knew he could get even by chasing down some new meme coins. He was sure he was going to make huge returns because he was engrossed in the activity and using the nights to study the markets. He didn't think Jane needed to know the extent of the investments because he was really enjoying it and it would turn out brilliantly.
Jane said that even though Carl wasn't sleeping much he was still attending work functions, client meetings, and had also given a speech at his mother's birthday on the weekend. They were looking forward to a family vacation the next week with their friends.
A medical history of Carl was taken.
Carl was not taking any medications, was fit with a BMI in the healthy range. He had no current suicidal ideation or psychotic or dissociative experiences. He had no history of any drug or alcohol abuse and in fact had given up drinking alcohol 5 years ago, after his best friend lost their life drunk at the wheel of a car.
Carl reported that he had had some periods of very low moods previously, but he did not seek medical treatment for them. They had occurred for short periods of a month or two in school and university also and were quite debilitating. Last year he had another episode where he felt quite hopeless and helpless most days. This time the low moods lasted about 2 months. When he felt like this, he slept for more than 12 hours a day and had difficulty getting out of bed. Some days he didn't even bother because he was so tired and fatigued. On those days he said he felt like a "something had sucked out all the pleasure in life so I just didn't have any interest in anything". Jane remarked that this was a difficult time for the family because Carl was sad most of the time and felt like a failure for letting down the family. She was very concerned then that Carl just couldn't focus or concentrate and was worried about his ability to look after Peppa and Tony. During this time, Carl lost weight after having little appetite, lost his job and the family had missed important wedding and birthday celebrations. It had been a while since he felt that low.
Carl and Jane made a follow up appointment to discuss treatment options on Thursday. They were also instructed to monitor Carl for any worsening of his symptoms or any significant impairment in work or family functioning.