Find the diаgnоsis fоr Mr Z: include аll numbers, subtypes аnd specifiers 4 pоintsMr. Z is a 45-year-old married business administrator who is admitted to a psychiatric unit at a teaching hospital for evaluation. He has had two psychiatric hospitalizations elsewhere for depression and suicidal ideation during the preceding 2 years. At the time of this admission, as in his earlier admissions, he denies having any psychiatric illness but claims that he is dying from a mysterious disease of aging that no one has been able to diagnose. His admission complaints include, 'I’m dying,” “I’m mentally retarded," 'I’m going blind/ "My bowels are shut down," "My skin is coming off in clumps," and 'I’m losing my hair." During the 2 weeks before this admission, Mr. Z has spent most of his time lying in bed ("because of his illness"), expressing guilt for (the impending) widowing his wife and orphaning his daughter. He has refused to go to work, complete any activities, or participate in his family's life in any way. His wife reports that his mood has been persistently gloomy and pessimistic and that he has frequently become irritable with her when she suggested possible courses of action that might be helpful to him. According to his wife, throughout their marriage Mr. Z has always fluctuated between periods of dejection and depression in which he seems to have a hard time doing anything and sudden bursts of high self-esteem and excessive energy that usually last from a few days to several weeks. During his energetic periods, he rarely sleeps, stays late at work, often keeping several secretaries busy with his productivity. He also plunges into volunteer activities--most recently, writing speeches for local politicians- and designs and began elaborate exercise programs. During some of these episodes, Mr. Z has suddenly announced that he has planned an exotic and elaborate family vacation for which they are to leave almost immediately. Although his wife and daughter almost always agree to accompany him on these jaunts, he vacations at such a vigorous pace-mountain climbing in Europe or scuba diving in the Caribbean--that his family struggles unsuccessfully to keep up with him. It was after returning from one of these whirlwind vacations that Mr. Z impulsively bought an expensive piece of land because it was similar to an Austrian farm he had admired. Mr. Z's wife estimates that he has five or six episodes a year, each lasting between 3 days and 2 weeks. She also reports that this pattern of behavior was already established when she first met Mr. Z in college. He did fairly well in school but would fluctuate between irritable "glum" periods, when he would sleep in and miss classes, and marathon 2 or 3-day study binges. Mr. Z's wife says that his brief bursts of energy tend to vanish as suddenly as they come and that Mr. Z then lets his projects lapse, often becoming gloomy and pessimistic about them. Beginning when he was 32 years old, Mr. Z was treated on four occasions for a full Major Depressive Episode, each of which lasted approximately 4-5 months. He was hospitalized for two of these episodes in the past 2 years, on one occasion following a serious car accident that was judged to be a suicide attempt, although he denied this. His wife reports that his severe depressions have always occurred in the fall and winter, whereas his really energetic periods have been especially common in spring and summer. She says that she has come to dread the winter, which she associates with the possibility of her husband having yet another depressive episode. When questioned about his energetic periods, Mr. Z says that, although he realizes that he sometimes goes too far and loses control, he much prefers these times because he feels so intensely alive, has so much fun, and accomplishes so much. He says that he can remember having such brief bursts of productivity since he was in his early teens or even earlier and that he has always been a flighty person whose moods fluctuate quickly.