For several years, Giancarlo has experienced periodic mood swings and seemingly abrupt changes in behavior. He reports that he will generally feel "down in the dumps" for a few months and then suddenly find himself with an overabundance of energy. He describes this by using a gambling metaphor: "It's like I'm just losing hand after hand, can't catch a break, and everything's just going to crap. Then, out of nowhere, I'm on a winning streak. I literally cannot lose. I can do whatever I want, bet as much as I want, and it's no problem. It's like a wild phase I go through now and then. Then, it just peters out, and I'm stuck with my losing hands again." When pressed for details about what happens during these "wild phases," Giancarlo becomes withdrawn and expresses a great deal of guilt and shame over his behavior. The specific nature of each wild phase varies considerably. In general, Giancarlo reports feeling highly positive about himself, as evidenced by his "can't lose" attitude. While at work, he is incredibly productive and uses this time as an opportunity to catch up with his workload. He states, however, that he has so many good ideas in his head that he'll start working on one and then quickly shift his attention to something else. This has led to several half-finished projects, so although he is more focused, his effort is not always used wisely. Socially, he tends to be very outgoing and friendly. Often, his wild phases include spending great sums of money. Sometimes, they involve rampant sexual activity. Of his most recent episode, Giancarlo says, "I was having sex with anything that moved. It was just nonstop, no talking, no protection, and I didn't even know their names half the time." When questioned further about this particular topic, Giancarlo began crying and had great difficulty discussing it. When Giancarlo is not experiencing a wild phase, he generally feels quite negative. He has difficulty falling asleep every night and suffers from a marked lack of energy. Most of the time he feels lethargic but forces himself to get out of bed and go to work. The lack of sleep makes it difficult for Giancarlo to concentrate, and he often falls behind at work. He also withdraws socially. He sees his girlfriend regularly but rarely feels up to going out with friends. When his mood gets particularly bad, he'll do his best to avoid everything. He stops watching sports, reading books, listening to music, and playing games. In his words, "I'll just lie in bed and feel sorry for myself and then beat myself up for feeling this way." Giancarlo shows no evidence of substance abuse and is not currently on medication. Diagnostic Criteria Checklist - Some of the symptoms associated with various bipolar and related disorders are summarized in the following table. Indicate which symptoms are clearly present in Giancarlo's case. Check all that apply. A) Dimished ability to think or concentrate during negative mood swings. B) Recurrent thoughts of death or suicide ideation during negative episodes. c) Insomnia nearly every day during negative episodes. D) More talkative than usual during elevated mood swings. E) Positive mood states that occur as the result of drugs or medications.
For several years, Giancarlo has experienced periodic mood swings and seemingly abrupt changes in behavior. He reports that he will generally feel "down in the dumps" for a few months and then suddenly find himself with an overabundance of energy. He describes this by using a gambling metaphor: "It's like I'm just losing hand after hand, can't catch a break, and everything's just going to crap. Then, out of nowhere, I'm on a winning streak. I literally cannot lose. I can do whatever I want, bet as much as I want, and it's no problem. It's like a wild phase I go through now and then. Then, it just peters out, and I'm stuck with my losing hands again." When pressed for details about what happens during these "wild phases," Giancarlo becomes withdrawn and expresses a great deal of guilt and shame over his behavior.
The specific nature of each wild phase varies considerably. In general, Giancarlo reports feeling highly positive about himself, as evidenced by his "can't lose" attitude. While at work, he is incredibly productive and uses this time as an opportunity to catch up with his workload. He states, however, that he has so many good ideas in his head that he'll start working on one and then quickly shift his attention to something else. This has led to several half-finished projects, so although he is more focused, his effort is not always used wisely. Socially, he tends to be very outgoing and friendly. Often, his wild phases include spending great sums of money. Sometimes, they involve rampant sexual activity. Of his most recent episode, Giancarlo says, "I was having sex with anything that moved. It was just nonstop, no talking, no protection, and I didn't even know their names half the time." When questioned further about this particular topic, Giancarlo began crying and had great difficulty discussing it.
When Giancarlo is not experiencing a wild phase, he generally feels quite negative. He has difficulty falling asleep every night and suffers from a marked lack of energy. Most of the time he feels lethargic but forces himself to get out of bed and go to work. The lack of sleep makes it difficult for Giancarlo to concentrate, and he often falls behind at work. He also withdraws socially. He sees his girlfriend regularly but rarely feels up to going out with friends. When his mood gets particularly bad, he'll do his best to avoid everything. He stops watching sports, reading books, listening to music, and playing games. In his words, "I'll just lie in bed and feel sorry for myself and then beat myself up for feeling this way." Giancarlo shows no evidence of substance abuse and is not currently on medication.
Diagnostic Criteria Checklist - Some of the symptoms associated with various bipolar and related disorders are summarized in the following table. Indicate which symptoms are clearly present in Giancarlo's case. Check all that apply.
A) Dimished ability to think or concentrate during negative mood swings.
B) Recurrent thoughts of death or suicide ideation during negative episodes.
c) Insomnia nearly every day during negative episodes.
D) More talkative than usual during elevated mood swings.
E) Positive mood states that occur as the result of drugs or medications.
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