Study Notes Case Study: Petunia Park
1. Introduction
Petunia Park is a 25‑year‑old female presenting for a mental health assessment.
She has a history of four psychiatric hospitalizations, most recently in spring 2020.
Reports episodes of high energy, creativity, and hypersexual behavior lasting about a week, followed by depressive periods with low mood, fatigue, and lack of motivation.
History of medication non‑adherence due to concerns that medications “squash creativity.”
Substance use: nicotine (1 pack/day), alcohol in late teens, marijuana once (caused paranoia).
2. Subjective Data
Chief Complaint (CC): “I need a mental health assessment.”
History of Present Illness (HPI):
Cyclical mood episodes: elevated mood with creativity and hypersexuality, alternating with depressive episodes.
Duration: high periods ~1 week; depressive episodes longer.
Past Psychiatric History:
Four hospitalizations.
Prior medication trials discontinued due to side effects.
Social History:
Lives independently.
Substance use: nicotine, alcohol, marijuana (single use).
Family History: Not clearly documented but relevant for mood disorders.
Review of Systems (ROS):
Psychiatric: mood swings, decreased motivation, fatigue, anhedonia.
No current psychotic symptoms reported.
3. Objective Data
Mental Status Examination (MSE):
Appearance: appropriate grooming.
Orientation: intact (knows date, place, time, person).
Speech: coherent, normal rate.
Mood: fluctuating between elevated and depressed.
Affect: congruent with mood.
Thought Process: logical, but history of racing thoughts during “high” periods.
Thought Content: denies current hallucinations or delusions.
Cognition: intact memory and attention.
Insight/Judgment: limited—stops medications due to perceived creativity suppression.
Physical Exam: Not remarkable.
Diagnostic Tools: PHQ‑9, Mood Disorder Questionnaire (MDQ) recommended.
4. Assessment
Primary Diagnosis: Bipolar Disorder (likely Bipolar I due to manic episodes with hospitalization).
Differential Diagnoses:
Cyclothymic Disorder (less severe, but Petunia’s hospitalizations suggest Bipolar I).
Major Depressive Disorder (does not explain manic episodes).
Substance‑induced mood disorder (unlikely given limited substance use).
Risk Assessment:
Suicide risk during depressive episodes.
Risky behaviors during manic episodes (hypersexuality, impulsivity).
5. Plan
Pharmacological Interventions:
Mood stabilizers: Lithium, valproate, lamotrigine.
Atypical antipsychotics: quetiapine, olanzapine, lurasidone.
Avoid antidepressant monotherapy (risk of mania induction).
Psychotherapy:
Cognitive Behavioral Therapy (CBT) for depressive symptoms.
Psychoeducation on medication adherence.
Family therapy/support.
Lifestyle Interventions:
Sleep hygiene, regular exercise, stress management.
Smoking cessation support.
Safety Planning:
Crisis hotline, emergency contacts.
Monitoring for suicidal ideation.
Follow‑Up:
Regular psychiatric visits.
Medication monitoring (labs for lithium/valproate).
6. Challenges
Medication Adherence: Patient fears loss of creativity.
Stigma: Concerns about identity and creativity suppression.
Risk Behaviors: Hypersexuality, impulsivity during mania.
Substance Use: Nicotine dependence complicates health outcomes.
7. Case Analysis
Petunia’s case illustrates classic bipolar features: alternating mania and depression, hospitalization history, and impaired functioning.
The case emphasizes the importance of psychoeducation, adherence strategies, and multimodal treatment.
Clinicians must balance creative identity concerns with the need for stability and safety.
8. Summary
Petunia Park’s case highlights the complexity of mood disorders in young adults.
Key issues: diagnosis of Bipolar Disorder, adherence challenges, risk behaviors, and need for integrated treatment.
Effective management requires pharmacological, psychotherapeutic, and lifestyle interventions, plus strong patient engagement.
📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.
Petunia Park is how old? a) 20 b) 25 c) 30 d) 35
How many psychiatric hospitalizations has Petunia had? a) 2 b) 3 c) 4 d) 5
Her most recent hospitalization occurred in: a) Fall 2019 b) Spring 2020 c) Summer 2021 d) Winter 2022
Which symptom did Petunia report during “high” periods? a) Fatigue b) Hypersexuality c) Anhedonia d) Poor concentration
Which disorder best fits Petunia’s presentation? a) Major Depressive Disorder b) Bipolar I Disorder c) Cyclothymic Disorder d) Substance‑induced mood disorder
Why does Petunia stop medications? a) Cost b) Side effects suppress creativity c) Forgetfulness d) Lack of access
Which substance does Petunia use daily? a) Alcohol b) Marijuana c) Nicotine d) Cocaine
Which screening tool is most appropriate for bipolar symptoms? a) PHQ‑9 b) GAD‑7 c) MDQ d) HAM‑A
Which therapy helps address negative thought patterns? a) CBT b) DBT c) IPT d) Family therapy
Which medication is a mood stabilizer? a) Fluoxetine b) Lithium c) Sertraline d) Bupropion
Which risk is associated with manic episodes? a) Suicidal ideation b) Hypersexuality and impulsivity c) Fatigue d) Social withdrawal
Which intervention is NOT recommended for bipolar disorder? a) Antidepressant monotherapy b) Mood stabilizers c) Antipsychotics d) Psychoeducation
Which lifestyle intervention is important for Petunia? a) Sleep hygiene b) Irregular exercise c) Excessive caffeine d) Social isolation
Which lab monitoring is required for lithium therapy? a) Liver enzymes b) Thyroid and renal function c) Blood glucose d) Vitamin D levels
What is the primary challenge in Petunia’s case? a) Lack of diagnosis b) Medication adherence due to creativity concerns c) No risk behaviors d) Absence of depressive symptoms
Answer Key: 1‑b, 2‑c, 3‑b, 4‑b, 5‑b, 6‑b, 7‑c, 8‑c, 9‑a, 10‑b, 11‑b, 12‑a, 13‑a, 14‑b, 15‑b
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