Case #2: Francesca Peters(Adapted from Morrison, 1995)

Francesca Peterswas 38 years old and ran a catering service with her second husband, Donald, who was the main informant.

Francesca already had two grown children, so Donald could understand why this pregnancy might have upset her. But she seemed unnaturally sad. From about her fourth month of pregnancy, she spent much of each day in bed. She didn't arise until afternoon, when she began to feel a little less tired. Her appetite, voracious during her first trimester, fell off, so that by the time of delivery she was several pounds lighter than usual for a full-term pregnancy. She had to give up keeping the household and business accounts, because she couldn't focus her attention long enough to add a column of numbers. Still, the only time Donald became really alarmed was one evening at the beginning of Francesca's ninth month, when she told him that she had been thinking for days that she would not survive childbirth and he would have to rear the baby without her. "You'll both be better off without me, anyway," she had said.

After their son was born, Francesca's mood brightened almost at once. The crying spells and the hours of rumination disappeared; briefly, she seemed almost her usual self. Late one Friday night, however, when the baby was three weeks old, Donald returned from catering a banquet to find Francesca dressed in nothing but bra and panties, icing a cake. Two other just iced cakes were lined up on the counter, and the kitchen was littered with pots and pans.

"She said she'd made one for each of us, and she wanted to party," Donald told the clinician. "I started to change the baby - he was howling in his basket - but she wanted to drag me off to the bedroom. She said 'Please, sweetie, it's been a long time.' I mean, even if I had not been dead tired, who could concentrate with the baby crying like that?"

On Saturday, Francesca was out all day with girlfriends, leaving Donald home with the baby. On Sunday she spent nearly $300 "for Christmas presents" at an April garage sale. She seemed to have boundless energy, sleeping only two or three hours a night before arising, rested and ready to go. On Monday she decided to open a bakery; by telephone, she tried to charge over $1,600 worth of kitchen supplies to their VISA card. She'd have done the same the next day, but she talked so fast that the person she called couldn't understand her. She hung up in frustration.

Francesca's behavior became so erratic that for the next two evenings Donald stayed off work to care for the baby, but his presence only seemed to provoke her sexual demands. Then there was the marijuana. Before Francesca became pregnant, she would occasionally toke (she called it her "herbs"). During the past week, not all the smells in the house had been fresh-baked cake, so Donald thought she might be at it again.

Yesterday Francesca had shaken him awake at 5 A.M. and announced, "I am becoming God." That was when he made the appointment to bring her for an evaluation.

Francesca herself could hardly sit still when she talked to the interviewer. In a burst of speech, she described her renewed energy and plans for the bakery. She volunteered that she had never felt better in her life. In rapid succession she then described how she was feeling (ecstatic), how it made her feel when she put on her best silk dress (sexy), where she had purchased the dress, how old she was when she had bought it, and to whom she was married at the time.

Case Study Write -up:

Part 1: Diagnosis. In this section provide a description of how you made the diagnosis (i.e. what criteria were or were not met) and how and why you ruled out other disorders. You should describe how the person meets each of the DSM-V criteria for the disorder that you think fits the person.

Part 2: Treatment. In this section provide a description of the types of treatment that might be used to help the person. Also identify the type of treatment that you think would be most appropriate Your answers should be approximately two pages in length