Stefanie Decision Tree Case Study Assignment Guide

Notice first what makes this decision tree unusual: the three decisions are not three medication choices. Decision One is a **differential diagnosis**, Decision Two is a **psychotherapy** plan, and Decision Three is **psychopharmacology**. That ordering is the argument the assignment wants you to make — the diagnosis constrains which psychotherapy is indicated, and both constrain what may safely be prescribed. Write it as a chain and the paper coheres; write the three as independent choices and the marker sees three disconnected sections. Say explicitly at each decision what the previous one has ruled out, since that is the only way the dependency becomes visible on the page. The case title calls Stefanie "a young woman with Depression", and treating that label as settled rather than as the thing being tested is the single easiest way to lose Decision One.

Decision One offers Bipolar I depressed, Bipolar II hypomanic, and cyclothymic disorder, and the brief insists you link specific symptoms in the case to DSM-5 criteria. So work the case detail rather than the impression. Stefanie describes recurrent periods of three days on about three hours of sleep without daytime fatigue, bursts of goal-directed activity lasting most of the day, feeling "fantastic and on top of the world", recurring roughly every two to three weeks since college, and low periods she corrects from "depressed" to "sad and empty" with fatigue and poor concentration. Every one of those maps to a criterion, and the discriminators are duration, severity and whether full criteria are ever met. Say which criteria are *not* satisfied as well, because the choice between these three diagnoses is decided by thresholds rather than by the presence of symptoms.

The three options fail in different places and naming that is the analysis. Bipolar I requires a manic episode — marked impairment, psychosis or hospitalisation — and nothing in this presentation reaches it, so ruling it out should be quick and explicit rather than silent. The real contest is between Bipolar II and cyclothymia, and it turns on two things: whether Stefanie's low periods meet full criteria for a major depressive episode, and whether her highs meet the duration requirement for hypomania. Her own correction — "maybe not depressed, but I definitely feel sad and empty" — is a deliberate piece of case construction and deserves explicit discussion rather than a passing mention. Whichever you choose, name what further information would confirm it, because a diagnosis argued from an incomplete history is stronger when it says what it is missing.

Decision Two asks for psychotherapy and the choice should follow from the diagnosis rather than from familiarity. The adjunctive psychotherapy evidence in bipolar spectrum conditions is reasonably specific: psychoeducation, family-focused approaches, cognitive behavioural therapy and interpersonal and social rhythm therapy have each been tested, and they differ in what they target. Stefanie's presentation is organised around sleep and activity cycling, which makes the rhythm-stabilising rationale directly arguable rather than generically appropriate. Say what you expect the therapy to change — episode frequency, sleep regularity, early recognition of a shift — and over what period. Psychoeducation deserves a mention whatever you select, since Stefanie has carried this for over a decade without a name for it and her closing line about relief is a clinical fact about engagement. Say what would count as the therapy not working as well, since the assignment asks you to explain any difference between expectation and result and that comparison needs a stated threshold.

Decision Three is psychopharmacology and the ordering matters clinically as well as structurally. If the diagnosis sits on the bipolar spectrum, the reason the diagnosis had to come first is that antidepressant monotherapy carries a recognised risk of destabilisation — so the earlier decisions are what make this one safe. Name your agent, name its class, and give the property that suits this patient rather than the indication in general. A thirty-two-year-old woman of childbearing potential raises specific considerations that a defensible plan addresses before prescribing, not afterwards. State your monitoring plan alongside the agent, because a prescription without baseline investigations and a review interval is an incomplete answer to a question about a treatment plan. Comorbid physical factors are named in the brief and belong here, because thyroid function and substance use both mimic the cycling Stefanie describes and both change what may safely be started.

Two required elements sit outside the three decisions and both are easy to under-serve. Ethical considerations must cover the treatment plan *and* communication with clients **and their family** — that last phrase is in the brief, and with a working-age adult it raises confidentiality and consent questions that a generic paragraph on autonomy will not reach. Stefanie's Puerto Rican background is relevant to how idioms of distress are expressed and heard, and handling that thoughtfully is stronger than either ignoring it or over-reading it. On mechanics: a minimum of three academic resources, the course text excluded, an introduction and conclusion, and references less than five years old. That five-year rule is the constraint most likely to catch you, since the foundational bipolar psychotherapy trials are older and will need pairing with a recent review to count.