Mania (Bipolar Disorder) | Mental State Examination (MSE) | OSCE Guide | SCA Case | UKMLA | CPSA

Summary

Yvonne, a 54-year-old woman, is admitted to a psychiatric ward with signs of manic behavior and grandiose delusions. She believes she has been chosen by the royal family to invent solutions, including a cure for cancer. Exhibiting high energy, racing thoughts, and a lack of sleep, Yvonne denies any mental health issues and insists on her invincibility and exceptional intelligence. Despite being oriented to time and place, she lacks insight into her condition, which suggests a potential manic episode with delusions. The assessment reveals risks related to her delusions and possible impulsive behavior.

Takeaways

• 😀 Yvonne presents with an elevated mood, describing herself as feeling 'absolutely fantastic' and the best she's ever felt in her life.
• 😀 Her speech is rapid, pressured, and loud, showing signs of manic behavior.
• 😀 Yvonne denies the need for sleep, claiming she has excess energy due to numerous ideas and inventions she’s working on.
• 😀 She has no appetite, claiming she's too busy with her inventions to eat, reflecting symptoms of reduced appetite commonly seen in mania.
• 😀 Yvonne believes she has been chosen by the Royal Family to invent things, including a cure for cancer, demonstrating grandiose delusions.
• 😀 Despite her elevated mood and grandiose beliefs, Yvonne denies any thoughts of harming herself or others.
• 😀 She expresses frustration over a missing suitcase containing her inventions, which she believes could be stolen, showing paranoia and a focus on her delusions.
• 😀 Yvonne describes excessive self-confidence, believing she has special powers and is invincible.
• 😀 Her thoughts are racing, and she demonstrates flight of ideas, jumping between topics quickly (e.g., cancer cure, inventing faster travel, etc.).
• 😀 She has no insight into her condition, insisting that her symptoms are due to special powers granted by the Royal Family, not a mental health issue.
• 😀 Yvonne denies any use of alcohol or recreational drugs, but her behavior suggests possible psychiatric concerns like bipolar disorder with manic features.

Q & A

What symptoms did Yvonne present during her psychiatric assessment?

Yvonne displayed several symptoms indicative of a manic episode, including an elevated mood, rapid speech, increased energy, racing thoughts, grandiose delusions (such as believing she had been chosen by the royal family to invent a cure for cancer), and a lack of sleep and appetite. She also demonstrated impaired judgment, including risky behavior such as speeding to reach the patent office.

What was Yvonne’s primary belief regarding her recent inventions?

Yvonne believed that she had discovered a cure for cancer and that the royal family had chosen her to invent and share groundbreaking ideas. She felt that her inventions were so important that they would bring her fame and recognition, including interviews and autographs.

Did Yvonne exhibit any insight into her symptoms or the possibility that she was unwell?

No, Yvonne lacked insight into her symptoms. She firmly believed that her elevated mood, racing thoughts, and grandiose ideas were signs of her exceptional intelligence and special powers, rather than symptoms of a psychiatric disorder.

What were some of Yvonne’s thoughts about her husband and why she thought she was in the hospital?

Yvonne believed that her husband was jealous of her inventions and the attention she was receiving from the royal family. She speculated that he was responsible for her being admitted to the hospital, possibly out of spite, to prevent her from sharing her inventions.

How did Yvonne describe her sleep and eating habits?

Yvonne reported that she did not need sleep, as she was too energized and preoccupied with her ideas. She also had no desire to eat, as she was too focused on her work and had no time for meals.

What kind of behavior did Yvonne engage in that might indicate impaired judgment?

Yvonne exhibited risky behavior by speeding to reach the patent office, driven by her urgency to share her inventions. She also mentioned that her husband took away her car keys to prevent her from driving, which she interpreted as an obstacle to her progress.

Did Yvonne experience any auditory or visual hallucinations?

Yvonne denied experiencing auditory hallucinations (hearing voices) but mentioned being able to communicate with the royal family, which she believed was a special power. She also felt that some people had taken her suitcase containing her inventions, which contributed to her distress.

What was Yvonne’s emotional state during the interview?

Yvonne described her emotional state as 'absolutely fantastic' and exhibited an elevated mood throughout the interview. Her speech was rapid and animated, reflecting her heightened energy levels and excitement about her inventions and ideas.

How did Yvonne respond to the idea that her symptoms might be related to a mental health issue?

Yvonne strongly rejected the notion that her symptoms were related to mental illness. She maintained that she was the 'chosen one' and that her experiences were part of her special purpose, which made her resistant to any suggestion that she might be unwell.

What did Yvonne express about her future and how others might view her?

Yvonne expressed confidence that once people saw her inventions and understood her contributions, she would become famous and admired. She believed that the royal family would be proud of her work, and she anticipated receiving public recognition, including interviews and autograph requests.