Training Title 38
Name: Mr. Elijah Loman
Gender: male
Age:18 years old
T- 98.3 P- 93 R 22 118/68 Ht 5’7 Wt 149lbs
Background: Currently lives with his sister and two parents in Durham, NC. Not currently
employed. Completed high school, not currently in school. Hx of treatment for mood disorder
began age 15, previous trials of risperidone, quetiapine off and on, side effects of wt. gain. Has
hx of a six-day hospitalization one year ago after found wandering at night in the mall parking
lot without clothes. He refused medication due to previous experiences. Not currently partnered.
He has been sexually inappropriate with comments to female neighbors; pulled his pants down in
the mall. Denies any recent alcohol or substance use. Father has history of bipolar disorder. No
history of self-harm behaviors, no family suicides. Mother reports he has slept 4-5 hours in past
week, up spending money buying and playing new video games and says he is writing a book on
how others can be a video game master. Appetite is decreased. No medical hx; Hx of vandalism
as a juvenile. Has pending court date for indecent exposure. Allergies: latex
Symptom Media. (Producer). (2016). Training title 38 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-38

1. Introduction
Patient: Mr. Elijah Loman, 18‑year‑old male.

Context: Case study from Symptom Media video (2016).

Clinical Focus: Mood disorders in adolescents/young adults, diagnostic reasoning, treatment planning.

Importance: Adolescents with family history of bipolar disorder and behavioral disturbances require careful evaluation for mood disorders, psychosis, and risk behaviors.

2. Demographics and Background
Age: 18 years old.

Gender: Male.

Vitals: T 98.3, P 93, R 22, BP 118/68 (normal).

Height/Weight: 5’7”, 149 lbs (BMI ~23.3 → normal).

Family: Lives with sister and two parents in Durham, NC.

Education/Employment: Completed high school, not currently in school or employed.

Psychiatric History:

Treatment for mood disorder since age 15.

Previous trials of risperidone and quetiapine, discontinued due to weight gain.

Six‑day hospitalization one year ago after wandering unclothed in mall parking lot.

Behavioral History:

Juvenile vandalism.

Pending court date for indecent exposure.

Sexually inappropriate comments to neighbors.

Family Psychiatric History: Father with bipolar disorder.

Medical History: None reported.

Substance Use: Denies recent alcohol or drug use.

Allergies: Latex.

3. Psychosocial Stressors
Family Dynamics: Living with parents and sister, possible stress related to supervision.

Occupational/Educational Stress: Not in school or employed, lack of structure.

Legal Issues: Pending court case for indecent exposure.

Social Isolation: Not partnered, inappropriate sexual behaviors leading to social consequences.

Family Psychiatric History: Bipolar disorder in father increases genetic risk.

4. Clinical Presentation (Mood Disorder Features)
Reported Symptoms:

Decreased sleep (4–5 hours over past week).

Increased activity (video games, writing book).

Spending sprees (buying new games).

Decreased appetite.

Inappropriate sexual behavior.

Behavioral Indicators:

Hypersexuality, impulsivity.

Wandering unclothed (past hospitalization).

Grandiosity (writing book on being a “video game master”).

Risk Factors:

Family history of bipolar disorder.

Early onset of mood disorder.

Poor medication adherence.

Legal consequences of behavior.

5. Mental Status Examination (MSE)
Appearance: Normal grooming, appropriate weight.

Behavior: Hyperactive, impulsive, inappropriate.

Speech: Pressured, tangential.

Mood: Elevated, irritable.

Affect: Expansive, labile.

Thought Process: Flight of ideas, grandiosity.

Thought Content: No psychosis reported, but delusional‑like grandiosity.

Cognition: Alert, oriented ×3, poor judgment.

Insight/Judgment: Limited, refuses medication, poor awareness of consequences.

6. Differential Diagnosis
Bipolar I Disorder: Manic episode with decreased sleep, impulsivity, grandiosity, inappropriate behavior.

Bipolar II Disorder: Hypomanic episodes with depressive episodes (must assess history).

Schizoaffective Disorder: Rule out psychotic features independent of mood episodes.

Substance‑Induced Mood Disorder: Denied substance use, but must confirm.

Conduct Disorder/Antisocial Traits: History of vandalism, indecent exposure.

ADHD: Impulsivity and distractibility, but mood symptoms more prominent.

7. Diagnostic Considerations (DSM‑5)
Bipolar I Disorder: At least one manic episode lasting ≥1 week, with impaired functioning.

Mania Symptoms: Decreased need for sleep, grandiosity, increased activity, risky behaviors, distractibility.

Elijah’s Case:

Meets criteria for manic episode.

Family history supports bipolar diagnosis.

Legal and behavioral consequences indicate impaired functioning.

8. Assessment Tools
Mood Disorder Questionnaire (MDQ): Screens for bipolar disorder.

Young Mania Rating Scale (YMRS): Assesses severity of manic symptoms.

PHQ‑9: Screens for depressive symptoms.

C‑SSRS: Suicide risk assessment (though no self‑harm reported).

Collateral Information: Family reports critical for adolescent cases.

9. Treatment Plan
Pharmacological:

Mood stabilizers: Lithium, valproate, carbamazepine.

Atypical antipsychotics: Risperidone, quetiapine, olanzapine, aripiprazole.

Address weight gain concerns with alternative agents (e.g., aripiprazole, lurasidone).

Psychoeducation on adherence and side effects.

Psychotherapy:

Cognitive Behavioral Therapy (CBT).

Family therapy to involve parents and sister.

Psychoeducation on bipolar disorder.

Lifestyle Interventions:

Structured daily routine.

Sleep hygiene.

Avoidance of stimulants/substances.

Supportive Measures:

Legal advocacy and coordination with court system.

School or vocational counseling.

Crisis planning for impulsive behaviors.

10. Monitoring and Follow‑Up
Frequent psychiatric visits during acute mania.

Medication monitoring (serum lithium levels, liver function for valproate).

Family involvement in monitoring adherence.

Suicide risk reassessment.

Coordination with legal system and community resources.

11. Challenges
Medication Adherence: Refusal due to side effects.

Legal Issues: Pending court case for indecent exposure.

Family History: Genetic predisposition to bipolar disorder.

Behavioral Risks: Hypersexuality, impulsivity, spending sprees.

Stigma: Mental health stigma in young adults.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy, involve family appropriately.

Consent: At 18, Elijah is legally an adult, but family input remains important.

Safety: Risk management for impulsive behaviors.

Cultural Sensitivity: Address stigma and family dynamics.

13. Case Summary
Mr. Elijah Loman: 18‑year‑old male with manic symptoms, family history of bipolar disorder, and behavioral/legal consequences.

Likely Diagnosis: Bipolar I Disorder, current manic episode.

Treatment: Mood stabilizers, atypical antipsychotics, psychotherapy, family involvement, lifestyle interventions.

Outcome Goal: Stabilization of mood, improved functioning, adherence to treatment, prevention of relapse, reduction of risky behaviors.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Elijah’s age? a) 16 b) 18 c) 20 d) 22

Which family history is relevant? a) Father with bipolar disorder b) Mother with diabetes c) Sister with anxiety d) Uncle with hypertension

Which prior medications caused weight gain? a) Risperidone and quetiapine b) Lithium and valproate c) Fluoxetine and sertraline d) Aripiprazole and lurasidone

Which event led to hospitalization? a) Vandalism b) Wandering unclothed in mall parking lot c) Substance use d) Suicide attempt

Which symptom indicates mania? a) Decreased sleep b) Fatigue c) Constipation d) Weight gain

Which diagnosis requires at least one manic episode? a) Bipolar I Disorder b) Bipolar II Disorder c) Persistent Depressive Disorder d) GAD

Which tool assesses severity of manic symptoms? a) YMRS b) PHQ‑9 c) GAD‑7 d) MDQ

Which behavior reflects impulsivity? a) Spending sprees on video games b) Regular exercise c) Healthy eating d) Sleep hygiene

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