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Case Presentation

The following case study illustrates how prolonged extreme feelings, functional impairment, and vegetative functioning overlap to form a clinical picture.

 

Maya Rodgers is a 24-year-old college student whose mood is generally euthymic with stable affect. Her energy level, thinking, and mood fluctuate normally throughout the day. Ms. Rodgers has been struggling academically. She is informed by a course instructor that she must do well on an upcoming major exam or is at risk of failing the course. There is a lot riding on this exam, and Ms. Rodgers cannot stop thinking about the exam. Her vegetative functioning is affected, manifesting as insomnia at night and fatigue in the day. On the day of the exam, Ms. Rodgers has a bright affect although her mood is anxious. Her energy and thinking are also elevated, although these fluctuations occur within the euthymic range.

 

The following day, Ms. Rodgers learns that she has failed the exam and may fail the course (Figure 33-5). Her mood begins to deteriorate through the euthymic range. Eventually, Maya Rodgers feels melancholic and appears affectively unstable. She experiences insomnia because of worried thoughts (elevated cognition) and experiences agitated energy that fluctuates wildly from agitation to lethargy (Figure 33-5).

 

Case Analysis

The preceding case is an illustration of exogenous factors in affective instability. It also illustrates the assessment of the student’s mental status. When affective instability is caused by exogenous factors this means there are identifiable causes for the instability, such as failing an exam or having financial or relationship problems. In some therapeutic approaches, the therapist may assist the patient to recognize unidentified exogenous factors. After they are identified, the patient and therapist can then work to resolve them and hopefully resolve the mood disorder.

 

Affective instability can also be caused by endogenous factors. Endogenous affective instability is very disturbing because mood, energy, or cognitive processes fluctuate from neurochemical imbalances. Specifically, the neurotransmitters dopamine, serotonin, or norepinephrine become imbalanced for unknown reasons as already discussed. Neurotransmitters may also be affected by hormonal shifts. An individual with endogenous affective instability may, for example, suffer the same or worse agitation as an individual with exogenous instability, but with no externally known cause. This is very frightening and can become extreme, including perceptual disturbances and suicidal ideation.

 

 

 

How should the term melancholic be interpreted in this case study?
 

 

 

 

The case study states that Ms. Rodgers appears affectively unstable. What could you observe that would support this statement?
 
SCIENCE
HEALTH SCIENCE
NURSING
BSN 246

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