You have to provide a diagnosis and all specifiers, evidence each diagnostic criterion, rule out differential diagnoses,and provide 3 long term…

You have to provide a diagnosis and all specifiers, evidence each diagnostic criterion, rule out differential diagnoses,and provide 3 long term treatment goals.

B.B., a 39 year-old Hungarian opera singer, is readmitted to a psychiatric hospital after keeping her family awake for several nights with a prayer and song marathon. She is flamboyantly dressed in a floor-length red skirt and pheasant blouse, and is adorned with heavy earrings, numerous necklaces and bracelets, and medals pinned to her bosom. She speaks very rapidly and is difficult to interrupt as she talks about her intimate relationship with God. She often breaks into song, explaining that her beautiful singing voice is a special gift that God has given her to compensate for her insanity. She uses it to share the joy she feels with others who are less fortunate.

B.B. has had at least ten admissions to this hospital in the past 20 years, some because of serious suicide attempts made when she was depressed, some because she was manic, and some, in her words, “just because I was crazy.” Although she does have a lovely voice, she has not been able to organize herself to work professionally during the past 15 years, and has spent much of her time at the local community mental health center. She has seen the same therapist weekly for many years and believes that he communicates with her through a local radio station, giving her instructions on how to conduct her life between therapy sessions. She also receives illuminations from Kahlil Gabran and Adel Davis, whose conversations she is able to overhear.

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