Clinical Child Psychology Case Study: Cyclothymia Report Analysis

This report presents a case study of a 14-year-old girl, Jessica, admitted to CAMHS due to fluctuating moods indicative of cyclothymia. The report begins with an introduction to Jessica's symptoms, including mood swings and behavioral changes, and the mother's concerns. Part I focuses on the diagnostic process, including physical examinations, laboratory tests, and psychological evaluations, and explores the diagnostic criteria for cyclothymia, referencing DSM-5 and ICD-10. It contrasts cyclothymia with major depressive disorder and discusses the prevalence and treatability of cyclothymia. Part II examines potential factors contributing to Jessica's condition, such as the loss of her father and the mother's behavior, and explores the role of genetics and adolescence in the development of the disorder. The report uses the predisposing, precipitating, maintaining, and protective factors framework, drawing from the case study and relevant research. The conclusion summarizes the key findings and implications of the case study, including the importance of early diagnosis and intervention.

Running Head: CASE 0
Clinical Child Psychology
Cyclothymia

CASE 1
Contents
Introduction................................................................................................................................2
Part I...........................................................................................................................................2
Part II..........................................................................................................................................5
Conclusion..................................................................................................................................8
References..................................................................................................................................9

CASE 2
Introduction
This case talks about a teenage girl of fourteen years of age named Jessica. She is
being admitted to the Child & Adolescent Mental Health Service abbreviated as CAMHS. It
has been reported by her mother that Jessica has been suffering from abnormal and drastic
changes in mood behavior from quite some time. She also looks depressed at some time and
full of energy at the other time which seems to be distinct and irregular in her behavior. These
prevalent changes within her behavior is odd because she has always been an active and
dynamic child all throughout her childhood and has always been the achiever of her dreams.
She adds that Jessica’s condition has caused her to have distant relation with her classmates
as well as with her mother and brother, due to her unintentional impulsive behavior.
However, she has only one good friend who also seems to be quite unhappy about her
behavior and impulsive attitude. Jessica is well aware of her situation and finds it
uncontrollable and involuntary from her side and considers it to be active at the moment.
Being an extrovert and having a bubbly kind of personality throughout her childhood, the
transition from past some time is very disturbing for her mother and at last she decided to
look for the mental health center for the further diagnosis and medication for any underlying
problem that can turn out to deteriorate the life of Jessica and to avoid the imbibement of this
conduct as a routine behavioral habit and to prevent its harmful results in future.
This report comprehensively diagnoses the underlined psychological disorder that has
caused the mentioned changes in the mental health of Jessica. This report also discusses the
factors that could be the potential reasons for this disorder and the treatment that can be
provided for the same.
Part I
The initial step which is involved after the referral of Jessica to the healthcare center
is the diagnosis of the reasons for these changes and finding out the underlined disorder, if
any, by the medical practitioner or nursing staff. It involves various tests and procedures such
as physical examination, medical laboratory tests and evaluation of the psychological state
and health. The physical examination focusses on screening the patient with visible and
obvious symptoms, which looks abnormal and cause the person to draw their attention.
Symptoms such as disrupted sleep cycle patterns, underweight or overweight due to disturbed
eating habits, scars or marks due to self-harm or violence, and other visible symptoms.
Further, suitable laboratory tests are performed by the medical laboratory practitioner on the

CASE 3
person's blood, urine, or stool sample to know about their health and illness. It involves
testing the insulin or the thyroid which could have caused the previously mentioned
symptoms of under or overweight. Deficiency in iron or hemoglobin, RBC or other vital
blood component count changes in the hormonal balance and many more which can
effectively contribute to the disorder. Lastly, the psychological well-being or mental state of
the person is tested using the personality, logical, reasoning and interpretation-based
questionnaire. Finally keeping the physical symptoms, lab test, and mental health results into
consideration, the underline disorder is analyzed and recorded. The consultant or
psychotherapist is involved which helps in treating the mental disorder and will help in
effective recovery from the disturbed mental health (Mayo Clinic, 2020).
The technique that is being used by the scientist or the researchers to investigate the
mental state of the person involves the use of molecular or biochemical methods that involve
genes in the neurons that gives explicit results. However, these practices are not used in
diagnosing the pertinent illness or disorder, it is functionally used to learn the brain
functioning. Positron Emission Tomography abbreviated a PET is extensively used to study
the activity of the brain and the changes in the mental state of the person. It measures the
distribution of the radioactive substance which is used as the isotope which works as the
atoms and helps in recording the signaling of the brain.
Cyclothymia is reported to be prevalent in only 0.4 percent to 1.0 percent of the
population and it usually overlaps the personality disorder or bipolar disorder (Cleveland
Clinic, 2018). It is highly treatable and the severity of the symptoms can be easily reduced. It
is often considered as long-lasting mental illness and the attitude or insight of people towards
the person suffering from the same is demeaning. They consider them unfit for the social
responsibilities and activities. They boycott the person who has acquired any mental illness
due to lifestyle changes or stress-related changes. Instead of judging them, for their condition,
people must support them and must provide effective care. They must be made aware of their
rights, and responsibilities that will create and strike their conscience and would work as a
motivating factor to start afresh (Winchester Hospital, 2020).
There are several policies and programs set up by the health organization in every
country that takes measures to aware people of these mental issues and provides them with
medical aids to get it treated. The motto behind it is to preserve the wellbeing of the
population in the society and the country as a whole. Metal health interventions of various

CASE 4
disorder has become a lot more approachable and effective due to the increase in
advancements and mobile health facilities (Kochman, et al., 2005).
According to the ISD, the symptoms in the condition of Jessica indicates the
persistent mood disorder called as Cyclothymic. Cyclothymic disorder involves several
features and symptoms that can be diagnosed in the person to claim for the cyclothymic
condition. It includes severe mood swings accompanied by the several episodes of the maniac
and depression episodes which instantly looks unfamiliar and distinct from the normal human
behavior. The cyclothymic person usually feels major depression and the maniac condition in
the initial couple of years of the disorder (ICD, 2020). The cyclothymic diagnosis cannot be
just drawn due to just the mood swings but must be accompanied by the other symptoms such
as sleep disturbance, mania or depression and drastic change in the normal behavior. It causes
the functional and emotional breakdown. However, it is not related to the substance or drug
abuse like any other psychological or depression disorder. In the case of Jessica, she also
suffers from severe and frequent mood swings which clearly denotes that this case is related
to the cyclothymic (Cagliostro, 2020).
Alternatively, another disorder that is diagnosed by looking at the symptoms of
Jessica is the Major or Severe Depression disorder. In Major depression Disorder, the
condition of the person involves low mood and a persistent feeling of sadness and irritability.
The person usually does not enjoy or indulge themselves in the activity that once was their
enjoyment. Depression affects the mind and specifically the mood controlling factor in the
mind of the person. This can be triggered by the traumatic or stressful condition and hovers
around the person until they become capable to cope with the situation. It may occur once or
repeatedly depending on the degree of stress or re-experiences. In the most extreme case, a
person even suffers from hallucinations and flashbacks (DSM, 2013). The most common
depression disorder can be observed post-pregnancy or childbirth during the initial couple of
months which is termed as postpartum depression. Major depression disorder can occur to all
genders and to all age groups. However, young females and women are more susceptible to
influence, since their mind and body involve more frequent hormonal or emotional changes
and they are less capable to cope with the extremely stressful situation (Harvard Health
Publishing, 2018).
The symptoms are more similar to the Cyclothymic such as disturbed sleep cycle or
the urge to sleep for longer hours, low energy, feeling low and disinterested in the work or

CASE 5
the daily routine, unlikeliness towards the work. The point of distinction which rejects this
case is that Jessica also experiences the maniac condition, in which sometimes she feels too
excited and happy which seems abnormal. But in the case of major Depression disorder, the
person only feels low and depressed. Hence, the case of severe depression disorder is ruled
out (Kerr, 2017).
Part II
According to Jessica’s mother, the underlined factors that could have affected
Jessica’s mental behavior could be the loss of her father, with whom she was quiet and close
and friendly. Another potential reason could be the snapping behavior of her mother towards
Jessica. Although she does not have any complaints against Jessica but the instant outburst
might be the reason for Jessica’s unpredictable behavior. Moreover, the case of the maniac
disorder in Jessica’s great aunt could be the reason, but the disorder could have transferred to
the immediate generations as well but that is not the case.
Cyclothymic condition is quite an uncommon type of mental disorder, but it affects
the men and women equally. So far, there is no evident cause for this disorder. It is usually
recorded to be passed on to the coming generation and is found to be hereditary in most
cases. It accounts for only one percent of the total population. It is also noticed that the
cyclothymic usually comes in association with insomnia or the substance abuse disorder
(American Addiction Centers, 2019).
In a study conducted at Columbia University, it was revealed that the sudden death of
the loved one leaves a great impact on a person’s mind. It causes the traumatic situation and
the sufferer might go into depression and they are incapable to cope up with the loss and
sudden shock (ScienceDirect, 2019). In another study where around 27,000 participants were
surveyed, out of which 20 percent to 30 percent of the participants stated that they had
traumatic experience due to the sudden death of their loved ones usually at a very young age,
and it took them lots of time and effort to overcome the traumatic situation (Keyes , Pratt, &
Galea, 2014). Thus, case can be applied to Jessica as well, where she lost her father at a very
young age, and that left a great impact on her mental state and she has been unavailable to
cope with the situation, unlike her brother or mother. This reason could be a factor for her
current mental behavior.
Additional reason that can be focused on while handling the case of Jessica, is that she
is being frequently snapped by her mother which can also exaggerate the situation and give

CASE 6
unwanted promotion to the aggressive behavior of Jessica which results in loneliness and
isolation. According to a study it has been recorded that children who get smacked or
snapped by their parents are more vulnerable to get the psychological disorder. However,
smacking, snapping is an offensive act regardless of the fact the parents indulge in showing
their aggression in this form (Bazian, 2017).
Jessica’s mother has claimed that she has been handling her two children as a single
mother, and the responsibility has been increased due to the loss of her husband and she is
struggling during this phase. This could possibly be the reason as she is not providing enough
attention to Jessica’s condition as she is a growing teenager, which lots of emotional and
hormonal changes. It might be possible she is deprived of the emotional support that was
once in bulk when her father was alive. Moreover, instead of having one to one
conversational with Jessica she is avoiding her indulgence for her aggressive behavior such
as locking away herself in the room.
Another supportive factor for change in Jessica’s behavior is due to her stepping into
the adolescence or the teenage group. This phase of life is like a roller-coaster ride which
involves the drastic change in the hormones such as oxytocin, estrogen and estrogen level in
females while testosterone in males and in turn the psychological behavior of the individual
(Downs, et al., 1985). They must be handled with utter sensitivity and responsibly as they are
more vulnerable to trap into wrongful deeds. The psychological changes cause emotional
imbalance and give rise to aggressiveness, which can result in psychological disturbances if
not handle with care. Hence, the same goes for Jessica as well, she is not well understood by
her peers and friends at school, which is causing the mental depression (Aviles, Anderson, &
Davila, 2005).
There are several interventions that must be taken to improve the cyclothymic
condition of Jessica. In her case, she shows up bipolar behavior which means both maniac
and depressive nature coupled with aggressive behavior. Thus, she needs a mixture of
treatment to control both the behaviors effectively. The most implemented and reliable
psychotherapy is cognitive-behavioral therapy abbreviated as the CBT (Totterdell & Kellett,
Restructuring mood in cyclothymia using cognitive behavior therapy: An intensive time-
sampling study, 2008). It helps in stabilizing the person's psychological response towards the
stimuli which is usually reciprocated in the form of aggression or anxiety. It calms and

CASE 7
soothes the person’s mental state and enhances the level of patience and boosts the mind.
Excessive and frequent aggressive behavior results in the retardation in interpretation
abilities. Hence this therapy enhances cognitive health (Totterdell, Kellett, & Mansell,
Cognitive Behavioural Therapy for Cyclothymia: CognitiveRegulatory Control as a Mediator
of Mood Change, 2012).
At the initial level of intervention, chemical treatment in the form of chemical drugs
and medicines also called chemotherapy is provided to the person. It includes antidepressants,
anti-anxiety, and antipsychotic such as olanzapine, risperidone and mood-stabilizing
medication such as lithium, which are used in stabilizing and easing the changes in the mood
and psychological issues such as depression and anxiety. These medications work to a great
extent in simplifying the issues of the low to moderate degree of the maniac and depression
episodes. However, the dosage depends on the age of the person and also on other parallel
complications such as diabetes, respiratory issues and many more that can interfere with the
working of the drug (Hantouchec, Vannucchia, & Perugia, 2017). Apart from this,
psychotherapy is another intervention that can help in efficient recovery if the therapist is
principled and skillful in their work. Lastly, if nothing works then the only option left is brain
stimulation treatment in which the electroconvulsive therapy, magnetic and nerve stimulation
is given which is kind of electrical or magnetic shocks are used to charge of the retarded
neurons or signaling messengers. However, it can lead to unwanted results as well where the
situation can get worsen (NAMI, 2019).
Cyclothymia is an understated disorder and is often ignored. If left untreated, it can
result in the deterioration of adulthood as the person tends to become more aggressive and
makes the implication or the therapy lessons becomes less effective after a certain age. Since,
Cyclothymia is not easily diagnosed and is usually mis understood to be as general
depression issue. It must be recognized in the early stage of life and must be checked
regularly, especially in adolescence. It will prevent unwanted complications and will provide
a supportive recovery (American Addiction Centers, 2020).

CASE 8
Conclusion
This report comprehensively discusses Jessica’s mental state and concludes with the
fact that she is diagnosed with Cyclothymia. Another potential and doubtful condition was
the major or severe depression disorder but it has to be neglected as they were not any clear
and distinct features. However, Cyclothymia, which involves mixtures of changes makes it
clear and supports the prevalence of the Cyclothymia. A few points that rule out depression
disorder is that Jessica also experiences maniac or euphoric condition which in layman terms
is called feeling extremely happy or high without any reasons. But this symptom is not
possible to show up in severe depression disorder. Secondly, Jessica is well aware of the
changes that have shifted her mental wellbeing but she is bound to behave aggressively as it
is uncontrollable for her end and the reaction is quite spontaneous. Aggressive reactions and
attitudes towards intolerance can lead to mis-happening and the reason for self-harm or
suicidal attempts. If not acknowledged initially, it can build up in a person’s mind and can
force them to take steps for such acts. Effective treatments and medications are also available
readily which can be take after the prescription from the medical practitioner. The treatment
and recovery measures are quite essential as the situation cannot be if ignored to a longer
period of time. Parents or guardians must keep a check on their young children regarding
their mental health and must convince the children to open up about their feelings for better
understanding. Parents must be supportive towards their children’s mental state and
emotions, which will help in building the trust and would fill the gap.
References

CASE 9
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(2005, 03). Cyclothymic temperament as a prospective predictor of bipolarity and

CASE 10
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