When hypomania surfaces on an antidepressant, the plan changes at its root: MN665's Unit 5 revision stops bupropion, rediagnoses bipolar II and rebuilds care for a composite technician. Searches like "mn 665 unit 5 assignment example", "mn665 unit 5 sample" and "mn665 unit 5 example" land here.
From Major Depression to Bipolar II Disorder: Revising the Plan After Hypomania Emerges on Bupropion
[Student Name]
Purdue University Global
MN665: PMHNP Diagnosis and Management Across the Lifespan II
Unit 5 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Doses are bracketed; nothing here is a prescribing instruction.
The Plan Before and After
Before. Diagnosis: major depressive disorder, moderate, first recognized episode. Medication: [bupropion extended release], chosen for her fatigue and to spare sexual function. Therapy: weekly cognitive behavioral therapy. Follow-up: every four weeks.
After. Diagnosis: bipolar II disorder, current episode hypomanic. Medication: bupropion stopped; no new medication started today; lumateperone named for any return of depression. Therapy: continues weekly, with its focus moved to sleep and daily rhythms. Safety: her partner holds the credit cards by agreement. Follow-up: telephone check in three days, visit in one week.
The New Facts
A composite 27-year-old veterinary technician started bupropion five weeks ago for a depressive episode marked by fatigue, low mood, oversleeping and loss of interest. At today's visit her partner came with her. The new facts, in order:
For four nights she has slept about three hours and says she feels "better than fine."
After closing on Tuesday she repainted the clinic break room without asking anyone.
She has spent about $2,400 online this week on equipment for a dog-grooming business she has just decided to start.
Her partner has noticed that she talks fast and is hard to interrupt.
She denies hallucinations or unusual beliefs and has kept going to work.
Asked directly about earlier periods like this, she described a stretch at 19, during her first year of college, when she slept little for about five days, felt unusually confident and signed up for three extra classes, before crashing into a low mood that lasted most of the semester. She had never mentioned it because "it felt good, not like a problem."
Revising the Diagnosis
DSM-5-TR addresses hypomania that appears during antidepressant treatment: when a fully syndromal hypomanic episode emerges during treatment and persists beyond the physiological effect of the drug, it counts as evidence for a hypomanic episode, although one or two symptoms such as irritability or restlessness after starting an antidepressant are not enough (American Psychiatric Association, 2022). Her current episode has lasted four days and includes decreased need for sleep, pressured speech, increased goal-directed activity and spending with painful consequences, which meets the symptom and duration criteria for hypomania. Because she is still taking bupropion, it cannot yet be shown that the episode would persist without it.
The episode at 19, years before any antidepressant, is what makes bipolar II disorder the better explanation rather than a drug effect alone. It occurred without medication, lasted about five days and was followed by depression. Together with her current episode and her major depressive episode, it supports a diagnosis of bipolar II disorder. She has had no episode severe enough to cause hospitalization, psychosis or marked impairment, so the criteria for mania, and for bipolar I disorder, are not met.
Verdicts on the Old Plan
Bupropion: stopped. The original choice was sound for the diagnosis she was thought to have. Bupropion addresses fatigue and rarely causes sexual side effects, both of which mattered to her. But antidepressant monotherapy is not recommended in bipolar disorder, and continuing it during a hypomanic episode risks prolonging or worsening it. It is stopped today.
Cognitive behavioral therapy: continued, with a change of focus. Her therapist will move toward interpersonal and social rhythm therapy, which aims to stabilize daily routines such as waking, eating and sleeping. In a two-year trial in bipolar I disorder, patients who received it during acute treatment went longer without a new episode (Frank et al., 2005). The evidence is strongest in bipolar I, but the focus on sleep and routine suits her directly.
Four-week follow-up: replaced. A hypomanic episode needs closer contact, so she will receive a call in three days and a visit in one week.
Sleep and Daily Rhythm
Sleep loss both reflects hypomania and drives it. She agreed to a fixed bedtime of 11 p.m. and a wake time of 7 a.m., to stop evening work on the business plan, and to keep a simple sleep and mood chart that she and her therapist will review weekly. If she cannot sleep at least five hours on two consecutive nights, she will call the clinic, and a short course of a sleep medicine will be considered at that point.
Safety
With her consent, her partner will hold her credit cards and she will wait 48 hours before any purchase over $200, which she proposed herself. The equipment orders that have not shipped will be canceled. She was told plainly that hypomania can turn into depression and that the low after her episode at 19 lasted months; both of them have the clinic's phone line and 988, the national crisis line, and know to use either at the first thought of self-harm.
A Named Option for the Next Low
Her most likely future problem is depression, which in bipolar II disorder tends to last longer and recur more often than hypomania. If depression returns, lumateperone is the named first option. It was approved by the FDA in December 2021 for depressive episodes associated with bipolar I or bipolar II disorder, and in a six-week phase 3 trial it improved depressive symptoms more than placebo, with benefit in both bipolar I and bipolar II, and with little change in weight or metabolic measures (Calabrese et al., 2021). Its most common side effects were sleepiness and nausea. Like other drugs of its class, it carries a boxed warning about suicidal thoughts in young adults, which will be discussed with her before it is ever started.
What the Plan Does Not Yet Know
The plan does not yet know whether she needs a maintenance medication to prevent future episodes. That decision depends on how this episode resolves once bupropion is stopped, whether depression follows, and how often episodes have occurred. It will be made at the eight-week visit, with her sleep and mood chart as the main evidence.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
Calabrese, J. R., Durgam, S., Satlin, A., Vanover, K. E., Davis, R. E., Chen, R., Kozauer, S. G., Mates, S., & Sachs, G. S. (2021). Efficacy and safety of lumateperone for major depressive episodes associated with bipolar I or bipolar II disorder: A phase 3 randomized placebo-controlled trial. American Journal of Psychiatry, 178(12), 1098-1106. https://doi.org/10.1176/appi.ajp.2021.20091339
Frank, E., Kupfer, D. J., Thase, M. E., Mallinger, A. G., Swartz, H. A., Fagiolini, A. M., Grochocinski, V., Houck, P., Scott, J., Thompson, W., & Monk, T. (2005). Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of General Psychiatry, 62(9), 996-1004. https://doi.org/10.1001/archpsyc.62.9.996
How this MN665 Unit 5 example is structured
Revision starts at the diagnosis, since everything after depends on it. The plan quotes the new facts, applies the DSM-5-TR note, and records the retrospective episode at 19 as the detail that makes bipolar II the better explanation rather than a drug effect alone. Each old element then gets a verdict. Bupropion is stopped, and the reason it was chosen, energy without sexual side effects, is acknowledged as sound for the diagnosis she was thought to have. Therapy continues but changes focus toward regular sleep and daily rhythms, drawing on interpersonal and social rhythm therapy. Safety gets a paragraph: with her consent, her partner holds the credit cards until the episode settles. The final section says what the revised plan still does not know, including whether a maintenance agent will be needed, and when that gets decided.
Get an MN665 Unit 5 example written to your instructions
What changed in your MN665 Unit 5 case, and at which point? Send the original plan, the new development and the rubric. Written to your instructions, a free first custom revision follows in 24-48h: the diagnosis reopened where needed, each old element given a verdict, and the unknowns dated rather than left open. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN665 Unit 5 questions, answered
What happens to therapy when the diagnosis changes?
It usually continues, with a new emphasis. For bipolar II disorder, approaches that stabilize sleep and daily routines, such as interpersonal and social rhythm therapy, have evidence and fit the revised picture. State what the therapist should now focus on and how that information reaches them, since a diagnosis change that never reaches the therapy is only half a revision.
Is hypomania on an antidepressant always bipolar disorder?
Not always, and the plan should show its reasoning. DSM-5-TR allows a bipolar diagnosis when a full hypomanic syndrome persists beyond the drug's physiological effect, while briefer or partial symptoms may reflect activation. Past episodes, family history and the course after stopping the drug all help decide it. Name the evidence you weighed and what would change the conclusion.
How soon should a revised plan schedule follow-up?
Sooner than the original, when the change raises risk. Hypomania can escalate or turn into depression, so a contact within days is reasonable, and the plan should say what would prompt an earlier one, such as no sleep for two nights or talk of major purchases. Put each interval in brackets as part of the composite and give its reason.