Michelangelo: A Case Study

Psychiatric History
Identification. The patient, born Michelagnolo di Lodovico Buonarroti Simoni (more famously
known as Michelangelo) was born on March 6, 1475; the second out of five children born to
Italian parents in Caprese, Italy. Although not known to have married or have had any children,
the patient was a renowned Renaissance sculptor, painter, architect, and poet.
Chief Complaint.
Patient: “I do nothing but work day and night, and have endured and am enduring such fatigue
that if I had to do the work over again I don’t believe I should survive.”
Patient’s employer: “Michelangelo is impossible and one cannot deal with him.” (Sterba &
Sterba, 1956).
Patient’s biographer: “His nature was so rough and uncouth that his domestic habits were
incredibly squalid, and deprived posterity of any pupils who might have followed him.” (Barocchi,
1971).
History of Present Illness. As an adult the patient would exhibit the same tendency to defy
authoritative figures. This is seen in his relationship with Pope Julius and his consistent refusal
to obey his commands.
The patient was noted to “work with a furious energy, putting in many hours.” He would
exhibit highly goal-oriented activity, often avoiding taking time off to care for himself. According
to the account of one of his biographers, Ascanio Condivi, Michelangelo would eat only while he
was working, and . Michelangelo exhibited a decreased interest in personal care as he worked
on sculptures. He ate and slept minimally.
The patient showed issues regarding sleep. When trying to fall asleep he would have
headaches that kept him awake and complained of stomach pains when he overslept.
The patient suffered from a depressed mood when he was over-commissioned by the
pope. He expressed feeling fatigued and losing interest in social activities then.
Michelangelo also displayed feelings of inadequacy throughout his life. It is possible that
these feelings are what prevented him from having romantic relationships. Though defiant of his
family's wishes from an early age, Michelangelo was attentive and supportive of his father and
brothers, often sacrificing his own physical and financial welfare for their benefit. He pledged, "I
will send you what you demand of me even if I have to sell myself as a slave."
These feelings of inadequacy plagued Michelangelo until his death, as he expressed on
his deathbed feeling like he had not accomplished enough and that his works were not good
enough.
Medical History.
(+) Nephrolithiasis (1540, 1549) patient had bladder irrigated by physician, Realdo Colombo,
due to the passage of gravel and stones in urine. Physician recommended patient to drink water
from Viterbo, which was known to have beneficial properties such as dissolving uric acid stones.
A second episode of prolonged anuria was experienced during 1549, but was relieved after the
passage of gravel in urine. (Pinals, 2015)
(+) Unspecified rheumatic disease (1555-1564) patient wrote to a relative describing “...the
cruelest pain I’ve had in one foot, which has prevented me from going out...They say it’s a kind
of gout”. Due to the lack of records from physical examinations on the patient, it can only be
presumed that the patient had a type of rheumatic disease, most likely osteoarthritis or early-
onset chronic tophaceous gout. (Pinals, 2015)
Family History. The patient was raised under the care of the family of a stonecutter who worked
at a marble quarry owned by the patient’s father in Florence, Italy. The stonecutter’s wife served
as both the patient’s nanny and wet-nurse due to the history of prolonged illness of the patient’s
mother. The patient’s mother died from an unspecified chronic illness when the patient was six
years old. The patient’s father was described to be a proud man; he was a banker who chose to
hold positions in local government that gave meager income rather than do manual labor upon
his failure to maintain the financial status of the bank which he managed. (McNeese, 2005)

Personal History
Early Childhood. Michelangelo was born to the Buonarroti family of Florence. His father,
Lodovico Buonarroti, was the mayor of Caprese, could hardly be called successful or wealthy.
Although his family descended from the rich and famous among Italy’s important families,
Lodovico Buonarroti, his wife, Francesca, and young Michelangelo lived very modestly.
While little is known of Michelangelo’s upbringing, it is noted that his mother was often sick.
Between 1475 and 1481, Francesca Buonarroti gave birth not only to Michelangelo, but also to
three more sons. It is speculated that Francesca fell from a horse while she was pregnant with
Michelangelo, which was presumably a factor as to why she could not nurse him later on (Stone
& Stone, 1962). Due to his wife’s poor condition and her nearly constant pregnancies, Lodovico
Buonarroti turned Michelangelo over to the wife of a stonecutter who helped raise the young
boy.
Michelangelo would frequently visit the local stone quarries, places where workers cut stone for
buildings, roads, and making statues. Some of Michelangelo’s earliest memories were about
stone. Despite a lack of information about Michelangelo’s early years, we do know that his
mother died when he was only six years old. How much time he had spent with her, or even
how he felt about losing her, remains unknown. It is known that young Michelangelo, once he
came home to live in his father’s house permanently, shared the household with many family
members. There were his four brothers and his father. In addition, an aunt and uncle also lived
in the Buonarroti house, along with Michelangelo’s grandmother.
Late Childhood (Puberty through Adolescence). As was the norm at the time, Michelangelo’s
father probably left much of his son’s teaching to other family members. Despite his limited
funds, he sent Michelangelo to school in 1482. By age ten, Michelangelo was attending Latin
school, where he began noble decorum training. Lodovico Buonarroti intended for his son to
become an important military leader or government figure. In school, according to one of his
later biographers, Michelangelo became well read and he wrote with flowing handwriting. He
enjoyed writing poetry. With such talents, his father thought Michelangelo might become a
learned writer or philosopher. His father did not want his son to become an artist or a sculptor.
Michelangelo’s father did not like artists, and thought such work was beneath his son. While in
school, however, young Michelangelo showed a unique talent for and interest in drawing. When
his interest remained strong, his father tried to steer him into other interests, although nothing
seemed to work, much to his father’s chagrin. To discourage him from taking on art as his life’s
work, Michelangelo’s father beat him several times, but it couldn’t stop him from going after his
dream of becoming a sculptor. Finally, when Michelangelo was 13, his father gave in.
Michelangelo was turned over to a local artist, a painter named Domenico Ghirlandaio, to learn.
The apprenticeship began on April 1, 1488. Ghirlandaio was extremely well known in Florence.
He ran an art school where he taught other young men painting and sculpting. While most boys
started at age 10, Michelangelo was delayed three years. Young Michelangelo’s apprenticeship
was supposed to last for three years, but he remained under Ghirlandaio’s instruction for only
one year. Years later, when he wrote his life story, Michelangelo claimed that he had not
learned much from Ghirlandaio.
Michelangelo became convinced that painting was not one of the nobler art forms. To
Michelangelo, sculpture had no equal in the art world. By 1489, the young artist left
Ghirlandaio’s workshop to take up his studies in the studio of a noted sculptor named Giovanni
di Bertoldo who had studied under Donatello. Under Bertoldo’s direction, Michelangelo became
a skilled sculptor. His talent envied by his peers. One student, named Pietro Torrigiano, became
Michelangelo’s rival. On one occasion, Michelangelo was teasing Torrigiano till, Torrigiano got
fed up and struck him with his fist (Sterba & Sterba, 1978).
Adulthood. In 1590, Medici commissioned sculptures from local artists, wanting to contribute to
the collection, Michelangelo borrowed a piece of marble from the library workers and began
chiseling a sculpture of an elderly faun. Lorenzo de’ Medici loved it but joked that an old faun
shouldn’t have a full set of teeth. After hearing this, Michelangelo removed one of the sculptures
teeth and drilled holes where the roots would have been. Lorenzo was so impressed by
Michelangelo that he took him into his home. Here Michelangelo met several influential people.
He met several of the Medici family’s children, including Giovanni, who later became Pope Leo
X. One of the poets living in the palace, Angelo Poliziano, became a close friend and tutor to
Michelangelo, one who “spurred him on in his studies, always explaining things to him and
giving him subjects.”
After Lorenzo de’ Medici’s death, Michelangelo’s life changed directions.
When the Medici family was driven from Florence into exile, in 1494, Michelangelo decided to
go with them to live in Bologna, another Italian city-state. He stayed for about a year, in the
house of a Medici friend. For the time being, Florence was no longer the center of
Michelangelo’s life, but his study of sculpting and of the human body continued.
He constantly searched for new ways to learn more about the human form. Michelangelo
even visited the Hospital of Santo Spirito, where he was allowed to cut open human corpses to
find out how specific muscles were shaped.
By late 1495, despite his comfortable living conditions and sculpting work in Bologna,
Michelangelo decided to return to Florence. He moved back into his father’s household. But
later decided he needed to leave and he made plans to go to Rome, another important Italian
city-state and art center. Michelangelo did not like religious art. It was not important to him that
art encourage someone to become more religious. Michelangelo once said that religious art was
only good “for women, especially old or very young women, as well as for monks, nuns and
certain aristocrats.” He believed that when he created a sculpture in the form of the human
body, he was closer to God.
Michelangelo had not even been in Rome a week before receiving his first important
offer to sculpt. Ready to prove himself, he set out to carve his largest sculpture to date, a larger-
than-life statue of the mythical Roman god Bacchus, the god of wine. Unfortunately, the cardinal
was not happy with the statue. However, his Bacchus statue was purchased by Jacopo Galli, a
Roman banker. Through Galli, Michelangelo was introduced to Jean Villiers de Fezenzac, a
French cardinal. The cardinal wanted a religious statue carved. He asked Michelangelo to chisel
a marble statue of the Virgin Mary holding the body of her son Jesus.
He wrote that the planned statue, known as the Pieta, would one day be “the most beautiful
work of marble in Rome, one that no living artist could better.”
Some art historians suspect that Michelangelo may have carved his Pieta with himself
and his own mother in mind. She had died young, remember, when he was just six years old.
Art historians have noted that Michelangelo chiseled his Virgin Mary to look young, possibly the
age his mother had been when she died.
One day, Michelangelo found many strangers from praising the Pieta. One of them asked
another who had made it, and he replied, “Our Gobbo from Milan.” This bothered Michelangelo
so later that night he chiseled his name into the Pieta.
After five years in Michelangelo became famous. Friends began urging him to return to
Florence. They convinced him by telling him that he could be the one to fix a famous unfinished
sculpture at the cathedral. For 35 years, the block of marble had stood in the work yard of the
local cathedral as “a ghostly reminder to all young sculptors of the challenge of their craft.” By
early 1504, Michelangelo had largely completed his colossal statue. After his David was
completed, however, he was thought of as the greatest of all Italian sculptors, and would be
thought so for the rest of his life.
Despite the large scale of the statue that Michelangelo intended to carve, he remained excited
by the challenge. Stories recorded how Michelangelo worked with a furious energy, putting in
many hours. He despised taking time out, even to sleep. Sometimes, when he slept, he kept his
clothes on, not wanting to take time out to remove them and put them on the next morning.
Michelangelo wanted nothing to keep him from his work. He ate little and probably slept
even less. His work habits were described by another artist “He has always been extremely
temperate in living, using food more because it was necessary than for any pleasure he took in
it; especially Michelangelo when he was engaged upon some great work; for then he usually
confined himself to a piece of bread, which he ate in the middle of his labor. . . . [He slept little]
for sleep . . . rarely suits his constitution, since he continually suffers from pains in the head
during slumber, and any excessive amount of sleep [upsets] his stomach. While he was in full
vigor, he generally went to bed with his clothes on, even to the tall boots. . . . At certain seasons
he kept his boots on for such a length of time, that when he drew them off the skin came away
together with the leather, like that of... a snake [shedding its skin].”
While he worked on David, Michelangelo was busy with other art projects. He was
described to have a restless nature to move from one project to the next, even before he had
completed the first. Later, Pope Julius commanded that Michelangelo to travel to Rome to work
on commissions for him.
Michelangelo spent eight months climbing up and down the quarries, looking for the best pieces
of marble. “Michelangelo stayed in these mountains . . . with two workmen and his horse, and
without any other provision except his food.” The pope gave him a heavy load of commissions
but Michelangelo believed he could complete it all within five years. Pride and overconfidence
had overtaken Michelangelo. In fact, he was never able to complete the project.
One day, Michelangelo tried to visit Pope Julius, but he was denied entry by guard. This
offended Michelangelo deeply. After writing a short letter to Pope Julius—“I give you notice that
from this time forward, if you want me, you must look for me elsewhere than at Rome”—
Michelangelo left Rome and returned to Florence. Pope Julius was angry with him. He sent
word to Michelangelo to return immediately to Rome. The struggle between the two went on for
several months. Pope Julius sent three separate papal messengers to Florence to demand
Michelangelo leave Florence and make his way back to Rome. By the third contact, the pope
was threatening war between Florence and Rome. The ruler of Florence told Michelangelo,
“You have tried a bout with the Pope on which the King of France would not have ventured. . . .
We do not wish to go to war on your account. . . . Make up your mind to return.”
When Michelangelo returned, he and Pope Julius were still upset with each other. The
pope commissioned a large bronze-cast statue of himself, which he wanted placed in St. Peter’s
Cathedral. In 1506, and the bronze project would occupy Michelangelo for the next two years.
The payment turned out to not be enough, and Michelangelo was soon strapped for money to
live on. He hired three assistants to help him, but only rented one room for the four of them to
share. They slept in the same bed. In time, Michelangelo fired one of them, and a second one
voluntarily left the project. In several letters, Michelangelo complained to family members that
the project was a difficult one for him, saying “I’m busy with nothing but working day and night,
and I have endured and am enduring such labor that if I had another such again I don’t think my
life would be long enough.” However, he completed the bronze statue, by mid-February 1508.
After this the pope asked him to paint the ceiling of the Vatican chapel but when
Michelangelo realized he was being called to Rome to paint, not sculpt, he did not want to go.
Michelangelo even suggested Raphael as a replacement. Originally, Pope Julius’s plan for the
ceiling was for Michelangelo to paint the Twelve Apostles, but Michelangelo, once he was
committed to the project, rejected that idea. “That will be a poor effort, Your Holiness,”
Michelangelo told the pope. Michelangelo “Why?” asked Pope Julius. “Because Apostles are
poor,” explained Michelangelo. The pope gave in without an argument.
The feeling of being overworked led to him often feeling depressed. Writing to his
brother Buonarroto, he claimed, “I live here in great toil and great weariness of body, and have
no friends of any kind and don’t want any, and haven’t the time to eat what I need....” On one
occasion while painting the chapel, Michelangelo slipped from his scaffold and tumbled down a
considerable distance, hurting himself severely.
There are no records of how Michelangelo felt when Pope Julius II died. The two men
had always had a difficult relationship, but Michelangelo said he saw himself in the Pope as
well.
In 1538, three years before completing Last Judgment, Michelangelo met poetess and
lay theologian Vittoria Colonna. Michelangelo and Colonna had a passionate though platonic
relationship of more than ten years, exchanging letters and having discussions about their
beliefs regarding the church, politics, and the arts.
Old Age to Death. In 1541, Michelangelo was 66 years old, but he had not stopped working.
Within months of finishing The Last Judgment, he slept little, choosing to work day and night. He
attached a candle to his cap to help him see while carving late at night.
During his final years, he began to suffer physical problems, including kidney stones and
what was presumed to be gout. He carved less, wrote more poetry, and shared more time with
friends. He became more optimistic and religious than ever before, but in his art, he was still
highly self-critical. Just days before his death, he wrote “No one has full mastery / before
reaching the end / of his art and his life.” He had a full and productive career that spanned more
than 75 years, but at death, he did not feel he had accomplished enough or that his works were
good enough. He died in February 18, 1564. He spent the day chiseling away at his Deposition,
which he had begun 15 years earlier but came down with a fever, presumably from
complications of his nephrolithiasis.

Mental Status Examination

Appearance: Patient appears unkempt, showing little concern over his appearance.
"His nature was so rough and uncouth that his domestic habits were incredibly squalid, and
deprived posterity of any pupils who might have followed him (Barocchi, 1971).”
Behavior and Psychomotor Activity: Patient shows little interest in social interaction; however,
patient’s psychomotor activity does not seem to be impaired, and shows great coordination as
seen in their created works.
Speech: Patient has limited records pertaining to speech, but is not known to have any speech
impairments.
Emotional Expression: Patient has irritable and volatile mood.
Perception: (-) hallucinations, (-) unusual perceptual experiences, (-) depersonalization, (-)
derealization
Thought Form: (-) circumstantiality, (-) flight of ideas, (-) clang association, (-) neologism, (-)
derailment
Thought Content: (-) delusions, (-) ideas of reference, (-) suicidal ideations
Alertness: Patient is awake and capable of sustaining alertness, especially with tasks they have
directed their focus to.
Orientation: Oriented to time, place, and person
Concentration and Calculation: Patient appears to have no impairments with regard to both
concentration and numerical ability, as exhibited in their numerous artistic and architectural
works.
Memory: Patient has no record regarding ability or impairment with immediate, recent, and
remote recall, but is known to have made artistic sketches from memory (Source). Commented [1]: https://www.newworldencyclopedia.or
Fund of Knowledge: Patient had considerable fund of knowledge in different fields, namely g/entry/Michelangelo
visual art, architecture, poetry, and sculpting
Abstract Reasoning: Good
Insight: Fair; patient seems to be only aware of instances or episodes of depression
Judgement: Poor to Fair; impairment in judgement is marked by an instance wherein the patient
left Rome and insisted on staying in Florence despite being called for by the pope thrice and
despite the threat of a possible war due to this action ()
Salient Features
History
(+) decreased need for sleep
(+) unusual fixation on tasks
(+) increase in goal-directed activity
(+) irritable mood
(+) volatile mood
(+) decreased anticipatory pleasure in eating and drinking
(+) difficulty with interpersonal relationships
(-) interest in social interaction
Core Symptoms
Patient has exhibited a decreased need for sleep, an increase in goal-directed activity, and
decreased anticipatory pleasure in food or drink. The patient showed a depressed mood at one
point in their life, as well as expressed feelings of inadequacy regarding their performance and
the quality of their created works. Patient is known to have an irritable and volatile mood, often
marked by verbal aggression and leading to difficulty in establishing and maintaining personal
relationships. Patient also expresses decreased interest in social interaction and expresses
irritation upon being disturbed from his work
Differential Diagnoses
Bipolar II disorder, most recent episode depressed with mixed features. Bipolar II
disorder is characterized by the presence of both hypomanic and depressive episodes,
the absence of a manic episode, the episodes are not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder,
or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
There is also clinically significant distress and impairment in social functioning. The
patient’s symptoms fulfill the criteria of a hypomanic episode, with periods of abnormally
and persistently elevated and irritable mood. With these, he fulfills the symptoms of
inflated self-esteem or grandiosity, decreased need for sleep, and increase in goal-
directed activity (These symptoms are exhibited everytime the patient works on a
sculpture). The changes in his mood are also observable to other people, as there have
been stories recounted about his decreased need for sleep and increase in goal-
directed activity. At the time he was over-commissioned, he also fulfilled the criteria for
a Major Depressive Episode, where he had depressed mood most of the day, decrease
in appetite nearly everyday, diminished interest and pleasure in most of his activities,
insomnia, and fatigue.
Major Depressive Disorder. The patient’s symptoms fulfill the criterion A of Major
Depressive Disorder, with depressed mood most of the day, decrease in appetite nearly
everyday, diminished interest and pleasure in most of his activities, insomnia, and
fatigue. Major Depressive Disorder is characterized by clinically significant distress or
impairment in social and occupational functioning as characteristic, the episode not
being attributable to a substance or to another medical condition, the episode not being
better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder,
delusional disorder, or other specified or unspecified schizophrenia spectrum and other
psychotic disorder. However criterion E of an absence of either a manic or hypomanic
episode is not met as the patient, in fact, had hypomanic episodes throughout his life.
Autism Spectrum Disorder Level 1, without accompanying intellectual or language
impairment. Several accounts involving the patient describe the patient’s marked
disinterest in responding to or initiating social interactions. The patient also exhibited a
tendency to strictly follow routine, as well as unnatural fixation on their interests, namely
sculpting and painting, often engaging in these activities for an unusual amount of time,
often compromising sleeping, eating, drinking, bathing, and engaging in social
interaction in the process. Although records of the patient’s childhood history are limited,
they do describe the patient exhibiting symptoms from criterion A and B of autism
spectrum disorder during childhood and adolescence. These symptoms caused
impairment in social and occupational functioning, often causing the patient to be in
conflict with others. The patient likewise meets criterion E of autism spectrum disorder,
as the symptoms are not better explained by intellectual disability or global development
delay.
Avoidant Personality Disorder. The patient showed inhibition in new interpersonal
situations because of feelings of inadequacy, and an unusual reluctance to engage in a
new activity because of the possibility of being embarrassed. The patient was reluctant
to take up the offer to paint the Sistine Chapel, although he claimed it was because he
saw painting as a lesser form of art, he did recommend a replacement that he thought
would do better than he did. The essential feature of avoidant personality disorder is a
pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to
negative evaluation that begins by early adulthood and is present in a variety of
contexts. The patient only displayed feelings of inadequacy and did not have enough
symptoms to meet the criteria of Avoidant Personality Disorder.
Obsessive-Compulsive Personality Disorder. The patient exhibited behavior that fulfill three out
of eight of the necessary criteria in Obsessive-Compulsive Personality Disorder, namely, (2)
perfectionism interfering with task completion, (3) excessive devotion to work and productivity to
the exclusion of leisure activities and friendships, and (8) showing rigidity or stubbornness.
These symptoms manifested themselves by early adulthood, but were exemplified during late
adulthood.
Schizoid Personality Disorder. Schizoid personality disorder is marked by an individual
exhibiting a pattern of detachment from social relationships and a restricted range of expression
of emotions in interpersonal settings. The patient exhibited four out of the seven criteria, namely
(2) almost always choosing solitary activities, (3) having little, if any, interest in having sexual
experiences with another person, (4) taking pleasure in few, if any, activities, and (5) lacking
close friends or confidants other than first-degree relatives. Although these criteria were met,
criterion B of schizoid personality disorder is not fulfilled due to the symptoms being better
explained by an autism spectrum disorder.

DSM-V Diagnosis
● Autism spectrum disorder without accompanying intellectual or language
impairment
● Bipolar II disorder, most recent episode depressed with mixed features
● Obsessive-Compulsive and Avoidant Personality Traits

Psychodynamic Foundation
 Growing up the patient was discouraged by his family to chase his passions. Low
levels of perceived social support are seen to contribute to the development of
depression. (Keltner & Kring, 1998). The presence of critical or hostile comments from
his father may have contributed to the development of the illness (Kring et. al., 2013).
The patient’s issues may come from a lack of support, especially from his father,
growing up. Although he remained affectionate to his father, the patient learned to be
critical of himself and developed feelings of inadequacy because of these events in his
childhood. His episode of depression, which occurred while he was working on the
chapel ceiling , reflected his feelings of inadequacy as painting was a medium outside of
his main focus and he may have felt insecure in this situation although he did not admit
it.
The patient’s issue with the lack of romantic relationships (while they were
desired) may have come from issues developed from losing his mother at a young age.
The patient would often discuss his ideal mate to his platonic friend Vittoria. His ideas of
the perfect partner were described as idea and unattainable, this is possibly a result of
the patient seeking a partner that would fill the wishes he had of his mother since he
was a child.

Discussion of Diagnoses
Bipolar II Disorder. The DSM V requires that a diagnosis of Bipolar II disorder shows
recurrent mood episodes consisting of at least one major depressive episode and at
least one hypomanic episode. Hypomanic symptoms are often overlooked as they may
not be seen as pathological by patients and generally do not cause severe impairment.
There may be heightened levels of creativity in some individuals with bipolar disorder.
However, that relationship may be nonlinear; that is, greater lifetime creative
accomplishments have been associated with milder forms of bipolar disorder, and
higher creativity has been found in unaffected family members. The individual's
attachment to heightened creativity during hypomanic episodes may contribute to
ambivalence about seeking treatment or undermine adherence to treatment.
There is a strong genetic component for bipolar II disorder, as it has the highest
risk for relatives of patients for bipolar II disorder as compared with other affective
disorders (American Psychiatric Association, 2013). The common age of onset reported
for bipolar spectrum disorders is before the age of 25 (Kring et al., 2013), but earlier
onset is becoming increasingly common (Kessler et al., 2005). There is little evidence
for gender differences in the prevalence of bipolar II (American Psychiatric Association,
2013). Suicide risk is high for bipolar II disorder, as about one-third of individuals will
report a previous suicide attempt (American Psychiatric Association, 2013). Individuals
with bipolar II disorder perform more poorly than healthy individuals on cognitive tests
and, with the exception of memory and semantic fluency, have similar cognitive
impairment as do individuals with bipolar I disorder. Cognitive impairments associated
with bipolar II disorder may contribute to vocational difficulties.
Autism Spectrum Disorder. The DSM V requires the presence of persistent deficits in
social communication and interaction across multiple contexts, as well as restrictive,
repetitive patterns of behavior, interests, or activities in the diagnosis of an autism
spectrum disorder. The deficits in social communication brought about by the disorder
may present those diagnosed with difficulties in establishing, developing, and
maintaining interpersonal relationships. Those diagnosed with autism spectrum
disorders may also score low on standardized intelligence tests due to deficits in
communication, making it difficult to differentiate from or determine the presence of
intellectual disability. Although individuals diagnosed with autism spectrum disorder may
have difficulties in verbal communication, they may perform better with activities
involving the use of visual-spatial skills. Autism spectrum disorder is highly heritable,
with heritability estimates being 0.80 (Kring et al., 2013). The most promising efforts to
alleviate negative effects of the disorder do not involve medication, and instead involve
treatments that are psychological in nature. Operant conditioning-based programs were
found to make sustained gains in IQ levels of children diagnosed with autism spectrum
disorder.
Treatment Plan
Medication. The patient may take mood stabilizers such as lithium (Lithobid), valproic
acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro,
others) and lamotrigine (Lamictal) in order to manage hypomanic episodes. The patient
may also take antidepressants prescribed along with the mood stabilizers in mind in
order to manage the depressive episodes.
Cognitive Therapy The largest issue for the patient is being able to cope with the
different hypomanic and depressive episodes. Mindfulness-based cognitive therapy
(MBCT) is an 8-week group treatment that teaches patients mindfulness meditation and
cognitive-behavioral skills to prevent relapse of depression. Specifically, it combines
practices to promote mindfulness (nonjudgmental self-observation) with traditional
cognitive therapy techniques (e.g., observing thought-feeling links, activity scheduling).
Williams et al. (2008) reported that immediate treatment with MBCT protected against
increases in anxiety in bipolar patients, and was associated with improved depression
scores in both bipolar and unipolar patients relative to a wait-list control group.

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