Training Title 150
Name: Ms. Cheyenne Lisenbe
Gender: female
Age:18 years old
T- 97.4 P- 94 R 22 136/86 Ht 5’2 Wt 121
Background: Currently living with her parents in Locust Grove, Oklahoma along with two
younger sisters and 1 older brother. She is a senior in high school, not currently partnered,
reports she is bisexual, lately hyper-sexual reporting increase of unprotected sex. She has been
stealing money out of her grandmother’s purse to buy clothes, shoes, purses, “and just other
things. She has history of treatment since age 9 for conduct disorder, depression, history of
taking citalopram which worsened her irritability, aggression, impulsivity. She has been in a 90-
day teen residential mental health facility discharged three months ago with lithium 300mg in am
and 600mg at bedtime, aripiprazole 2.5mg in the morning. When discharged, her labs were
within normal ranges and urine toxicology negative. She was positive for cannabis upon
admission. Her parents believe she is hiding her medication as she has made comments “they
slow me down; they make me not think fast” She has hx of domestic violence toward her older
brother with juvenile assault charge. No current legal issues. Her grandmother has hx of bipolar
disorder; her mother and her maternal aunt have anxiety. She is sleeping 2-3hrs/24 hrs. Reports
her appetite “ravishing.” She has no medical issues; has Nexplanon implant; hx of self-harm with
cutting, last engaged in the behavior 6 months ago.
Symptom Media. (Producer). (2018). Training title 150 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-150

1. Introduction
Patient: Ms. Cheyenne Lisenbe, 18‑year‑old female.

Context: Case study from Symptom Media video (2018).

Clinical Focus: Mood disorders in adolescents, diagnostic reasoning, treatment planning.

Importance: Adolescents with complex psychiatric histories, family predisposition, and behavioral issues require careful evaluation for bipolar disorder, conduct disorder, and comorbid conditions.

2. Demographics and Background
Age: 18 years old.

Gender: Female.

Vitals: T 97.4, P 94, R 22, BP 136/86 (borderline hypertensive).

Height/Weight: 5’2”, 121 lbs (BMI ~22.1 → normal).

Family: Lives with parents, two younger sisters, one older brother.

Education: Senior in high school.

Sexual Orientation: Reports bisexual identity.

Relationship Status: Not partnered.

Psychiatric History:

Treatment since age 9 for conduct disorder and depression.

Trial of citalopram worsened irritability, aggression, impulsivity.

90‑day residential mental health facility stay, discharged 3 months ago.

Current medications: lithium 300 mg AM, 600 mg HS; aripiprazole 2.5 mg AM.

Substance Use: Positive for cannabis on admission; negative at discharge.

Medical History: None; Nexplanon implant for contraception.

Family Psychiatric History: Grandmother with bipolar disorder; mother and maternal aunt with anxiety.

Legal History: Juvenile assault charge for domestic violence toward brother; no current legal issues.

Self‑Harm History: Cutting, last episode 6 months ago.

Behavioral Concerns: Hypersexuality, stealing money, impulsivity.

3. Psychosocial Stressors
Family Dynamics: Conflict with brother, parental supervision, sibling relationships.

School Stress: Senior year pressures, possible academic challenges.

Social/Identity Stress: Bisexual identity, hypersexual behavior, risky sexual practices.

Legal Issues: Past juvenile assault charge.

Medication Adherence: Parents suspect she hides medication due to complaints about side effects.

Substance Use: Cannabis history.

4. Clinical Presentation (Mood Disorder Features)
Reported Symptoms:

Hypersexuality, impulsivity, risky sexual behavior.

Stealing money for material goods.

Aggression, irritability.

Decreased sleep (2–3 hours/24 hrs).

Increased appetite (“ravishing”).

History of self‑harm.

Behavioral Indicators:

Impulsivity, poor judgment.

Domestic violence toward sibling.

Medication non‑adherence.

Risk Factors:

Family history of bipolar disorder and anxiety.

Early onset of conduct disorder.

Substance use history.

Poor adherence to treatment.

5. Mental Status Examination (MSE)
Appearance: Normal grooming, appropriate weight.

Behavior: Impulsive, restless, hypersexual.

Speech: Pressured, tangential.

Mood: Elevated, irritable.

Affect: Expansive, labile.

Thought Process: Flight of ideas, distractibility.

Thought Content: Grandiosity, impulsive thoughts, risky behaviors.

Cognition: Alert, oriented ×3, poor judgment.

Insight/Judgment: Limited, poor awareness of consequences, medication refusal.

6. Differential Diagnosis
Bipolar I Disorder: Manic episode with impaired functioning, impulsivity, hypersexuality, decreased sleep.

Bipolar II Disorder: Hypomanic episodes with depressive episodes (must assess history).

Conduct Disorder: Persistent pattern of violating rules, aggression, theft.

Substance‑Induced Mood Disorder: Cannabis use history, but currently negative.

Borderline Personality Traits: Impulsivity, unstable relationships, self‑harm.

ADHD: Impulsivity and distractibility, but mood symptoms more prominent.

7. Diagnostic Considerations (DSM‑5)
Bipolar I Disorder: At least one manic episode lasting ≥1 week, with impaired functioning.

Mania Symptoms: Decreased need for sleep, grandiosity, increased activity, risky behaviors, distractibility.

Cheyenne’s Case:

Meets criteria for manic episode.

Family history supports bipolar diagnosis.

Behavioral and legal consequences indicate impaired functioning.

8. Assessment Tools
Mood Disorder Questionnaire (MDQ): Screens for bipolar disorder.

Young Mania Rating Scale (YMRS): Assesses severity of manic symptoms.

PHQ‑9: Screens for depressive symptoms.

C‑SSRS: Suicide risk assessment (given self‑harm history).

Collateral Information: Family reports critical for adolescent cases.

9. Treatment Plan
Pharmacological:

Mood stabilizers: Lithium (currently prescribed), valproate, carbamazepine.

Atypical antipsychotics: Aripiprazole, risperidone, quetiapine.

Address side effects (akathisia, sedation) with alternative agents.

Psychoeducation on adherence and side effects.

Psychotherapy:

Cognitive Behavioral Therapy (CBT).

Family therapy to involve parents and siblings.

Psychoeducation on bipolar disorder and conduct disorder.

Dialectical Behavior Therapy (DBT) for impulsivity and self‑harm.

Lifestyle Interventions:

Structured daily routine.

Sleep hygiene.

Avoidance of substances.

Safe sexual practices education.

Supportive Measures:

School counseling and academic support.

Legal advocacy if needed.

Crisis planning for impulsive behaviors and self‑harm risk.

10. Monitoring and Follow‑Up
Frequent psychiatric visits during acute mania.

Medication monitoring (serum lithium levels, renal/thyroid function).

Family involvement in monitoring adherence.

Suicide risk reassessment.

Coordination with school and community resources.

11. Challenges
Medication Adherence: Hides medication due to perceived cognitive slowing.

Legal Issues: Past juvenile assault charge.

Family History: Genetic predisposition to bipolar disorder and anxiety.

Behavioral Risks: Hypersexuality, impulsivity, theft.

Stigma: Mental health stigma in adolescents.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy, involve family appropriately.

Consent: At 18, Cheyenne is legally an adult, but parental involvement remains important.

Safety: Risk management for impulsive behaviors and self‑harm.

Cultural Sensitivity: Address stigma and family dynamics.

13. Case Summary
Ms. Cheyenne Lisenbe: 18‑year‑old female with manic symptoms, family history of bipolar disorder, and behavioral/legal consequences.

Likely Diagnosis: Bipolar I Disorder, current manic episode, with comorbid conduct disorder traits.

Treatment: Mood stabilizers, atypical antipsychotics, psychotherapy, family involvement, lifestyle interventions.

Outcome Goal: Stabilization of mood, improved functioning, adherence to treatment, prevention of relapse, reduction of risky behaviors.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Cheyenne’s age? a) 16 b) 18 c) 20 d) 22

Which family history is relevant? a) Grandmother with bipolar disorder, mother and aunt with anxiety b) Father with diabetes c) Sister with ADHD d) Uncle with hypertension

Which prior medication worsened irritability and aggression? a) Citalopram b) Lithium c) Aripiprazole d) Quetiapine

Which event led to juvenile assault charge? a) Domestic violence toward brother b) Truancy c) Substance use d) Theft

Which diagnosis requires at least one manic episode? a) Bipolar I Disorder b) Bipolar II Disorder c) Persistent Depressive Disorder d) GAD

Which tool screens for bipolar disorder? a) MDQ b) PHQ‑9 c) GAD‑7 d) MMSE