Step 2

Psychiatry 9

A 26-year-old woman presents to the emergency department with her boyfriend because she has not been sleeping well for the past 2 weeks. The patient reports sleeping about 2 hours per night, but she feels like she has plenty of energy. Her boyfriend reports that the patient is not at her baseline and has been exhibiting “unusual behaviors” that are causing him concern. Of note she has made over 500 posts to her Instagram page in the last 5 days. The patient reports that she did not want to come to the emergency department but that she came to appease her boyfriend. During the interview, the patient’s speech is rapid and uninterruptable but fluent. The patient’s affect is expansive, and she gets up several times to pace the room during the interview. She reports that she has begun a new business venture allowing her to quit her previous marketing job. Her boyfriend confirms that she has founded a new business, but he has always known her to love her marketing job. When asked about her past psychiatric history she reports a history of a major depressive episode during college which resulted in her failing a semester. She currently denies suicidal and homicidal ideations. Physical examination is unremarkable. Complete metabolic panel and urine toxicology screen are unremarkable.

Which of the following is the most likely diagnosis?

  • A) Bipolar 1 disorder
  • B) Bipolar 2 disorder
  • C) Borderline personality disorder
  • D) Disinhibited social engagement disorder
  • E) Insomnia disorder

Authors

Miles McIntosh

Editor

Dr. Ted O'Connell

Last updated

Feb 20, 2023

Source

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