CASE STUDY
Gary (bipolar disorder)

Gary is a 19-year-old who withdrew from college after experiencing a manic episode during which he was brought to the attention of the Campus Police (“I took the responsibility to pull multiple fire alarms in my dorm to ensure that they worked, given the life or death nature of fires”). He had changed his major from engineering to philosophy and increasingly had reduced his sleep, spending long hours engaging his friends in conversations about the nature of reality. He had been convinced about the importance of his ideas, stating frequently that he was more learned and advanced than all his professors. He told others that he was on the verge of revolutionizing his new field, and he grew increasingly irritable and intolerant of any who disagreed with him. He also increased a number of high-risk behaviors – drinking and engaging in sexual relations in a way that was unlike his previous history.  At the present time, he has returned home and his been placed on a mood stabilizer (after a period of time on an antipsychotic), and his psychiatrist is requesting adjunctive psychotherapy for his bipolar disorder.  The patient’s parents are somewhat shocked by the diagnosis, but they acknowledge that Gary had early problems with anxiety during pre-adolescence, followed by some periods of withdrawal and depression during his adolescence.  His parents are eager to be involved in treatment, if appropriate.