Case #1: The Case of Joan Joan is a 26-year-old openly gay woman who recently moved to your area to take a job in the publishing business. She comes to your clinic saying she needs medication because she feels "unstable." The history she describes seems to begin about four years ago when she was in college, getting "A's" in most of her classes and having a wide circle of friends. During a particularly stressful period of final exams, she began to feel depressed, had difficulty sleeping and eating, and lost about fifteen pounds. Although she completed her exams satisfactorily, her symptoms continued for about the next two months, during which she became more isolated socially. After she graduated, she felt much better, got a job and felt increasingly energized. She began feeling so energized she didn't seem to need much sleep and would wake up after 3 or 4 hours feeling wide awake and could put in 10- and 11-hour days of work. She would feel her thoughts racing with new ideas and seemed to come up with creative ideas, although she often did not carry through on these, or other people didn't seem to understand them. She was partying and socializing a great deal, and she admitted to excessive use of alcohol. She said that over the next month she found herself preoccupied with sexual thoughts and found sexual implications in whatever people said to her or what she saw on TV. She was also very talkative and felt euphoric except at times when she became extremely irritable and "cranky" towards people. She found herself striking up conversations with complete strangers. She began to feel like she could hear people talking to her that weren't there and began to think that her apartment could be haunted. They would sometimes tell her to do things, like line objects up in a certain order, or take a different route home, or start saying certain words aloud. She also felt like she could read other people's thoughts and was sure they could read hers and they would answer her thoughts even when she didn't say them out loud. "I'm sure I've always been psychic," she said, "but it just really took off. I could sense all kinds of things." She said her friends became concerned and took her to an emergency room. She was hospitalized for several days and put on lithium. Most of her symptoms seemed to abate. Her sleeping pattern improved and appetite increased, although she felt more fatigued and "slowed down." In the course of the move, she had discontinued her use of the medication she'd been given--the prescription had run out and she had lost contact with the prescribing psychiatrist. She says that she has been drinking heavily on a daily basis to calm her nerves but it did not resolve her emotional issues. She has been noticing that she had been having difficulty sleeping, feels "jittery," has been getting concerned about what other people are thinking, and is having difficulty focusing on work projects because her thoughts are racing.

Please provide principle diagnosis. There is more than one correct diagnosis.

Case #1: Joan Principle Diagnosis a) _____ 296.52 (F31.32) Bipolar I Disorder Current or most recent episode moderate b) _____ 295.90 (F20.9) Schizophrenia multiple episodes, currently in acute episode c) _____ 305.00 (F10.10) Alcohol Use Disorder Mild d) _____ 295.70 (F25.0) Schizoaffective Disorder Bipolar type e) _____ 296.54 (F31.5) Bipolar I Disorder Current or most recent episode depressed with psychotic features with anxious distress