Olivia Millsop: Mental Health Case

Study

Olivia Millsop
Mental Health Case Study
Youngstown State University
02/27/1017

Abstract
 Olivia Millsop: Mental Health Case
Study

The purpose of this paper is to discuss and explore in depth a 40-year-

old female that has been diagnosed with Major Depression Disorder. The

paper will explore many subtopics including family history, ethnic, spiritual

and cultural influences among other things. This will help readers understand

how and what people with depression experience on a day to day bases.

Objective Data
 Olivia Millsop: Mental Health Case
Study

Day of care 02/14/2017. Patient was admitted to the behavioral health

unit on 02/13/17 for attempted suicide. The patient had a plan to kill herself

using pills from her home. According to the patient this would be the first

time that she has wanted to take her own life. Prior to wanting to self-harm

herself the patient got into an altercation with her significant other, that lead

to a physical fight. Patient came into the Emergency Department with a

complaint of hand pain, after learning about how the patient had received

the injury, and the plan to harm herself, the patient was admitted to the

Behavioral Health Unit. Patient first admitted that she brought herself to the

hospital to be voluntarily admitted but after discussion with nursing staff,

patient was pink slipped, and involuntary admitted to the unit.

While speaking with the patient, I could observe that she was anxious.

Her appearance was unkempt, her hair a mess and her clothing looking like

they havent been washed in a couple of weeks. Another observation I made

from looking at the patient was the injury to the patients hand all bruised up

Talking to her she was friendly and at first was very open about the events

that occurred with me and why she brought herself to the emergency

department.. While on the unit the patient was placed on Ativan, and Vistaril

for anxiety. The patient was prescribed Halodol, and Zyprexa for agitation,

and she was also prescribed Latuda for agitation and anxiety. Patient stated

that she was not feeling any relief from the medications and that she only

wanted pain pills for her back pain. Using the DSM IV-TR model patient had

Axis 1- MDD, and Axis III- Chronic back pain.

 Olivia Millsop: Mental Health Case
Study

Summarize
Almost 250 million around the world suffer from depression (Temel,

M., & Kutlu, F. 2015). Upon being admitted to the behavioral health unit the

patient was diagnosed with Major Depression Disorder. Depression is a

serious mental health disorder with high risk of relapse and can become

chronic which can lead to a high risk of suicide (Barrett, K., MS, DNP, FNP/BC, &

Chang, Y., PhD, RN. 2016). According to Psychiatric Mental Health Nursing-

Concepts of Care in Evidence-Based Practice Major Depression Disorder is

characterized by depressed mood or loss of interest or pleasure in usual

activates. Patients will experience impaired social and occupational

functioning that has existed for at least two weeks, no history of manic

behavior, and symptoms that cannot be attributed to the use of substance or

general medical conditions. The diagnosis of Major Depression Disorder is

specified to whether it is a single episode or recurrent episode. Depression

can range from transient depression which can include lifes day to day

problems or disappointments to severe depression which would include the

diagnosis of major depression disorder.

According to Psychiatric Mental Health Nursing- Concepts of Care in

Evidence-Based Practice symptoms of depression can include any of the

following feeling of sadness, hopelessness, slowed physical movements,

anorexia or overeating, insomnia, worthlessness, flat affect, slumped

posture, confusion, feeling worse in the morning, headaches, back aches,

and many other physical and behavioral symptoms.

 Olivia Millsop: Mental Health Case
Study

Chronic pain is defined as pain last longer then 3 months, and with a

patient diagnosed with depression it has shown to intensify the pain, which

can lead to debilitating the patient even more than they already are (Barrett,

K., MS, DNP, FNP?BC, & Chang, Y., PhD, RN. 2016 ). Depression and inflammation

are traveling companion that can induce central nervous system changes

that result in increased pain sensitivity (Barrett, K., MS, DNP, FNP/BC, & Chang,

Y., PhD, RN. 2016).

According to Batterham, Christensen, & Calear (2013) there is considerable

evidence that patients with anxiety disorders are at increased risk of suicidal

thoughts and attempts. Depression and suicide attempts are more attributed to

anxiety symptoms rather than depression symptoms (Batterham, Christensen, &

Calear 2013).

Identify
When talking with the patient, I could tell that she was experiencing a

large amount of stress day in and day out. I first started off asking the

patient about the altercation between her and her partner but she was not

forth coming with the reason behind the altercation, all she would say was

that the altercation became physical which led to her hand injury. Following

the altercation, the partner kicked her out of the house which the patient and

her family were currently living in at the time. Now her and her family have

no place to live. The patient also currently has so job and unable to pay for

food. The patient only has a high school education, and did not attend

college because of her back injury. Patient states that she has not applied for
 Olivia Millsop: Mental Health Case
Study

food stamps because the paperwork is too time consuming for her at the

current moment.

Her older child was diagnosed with being bipolar and her younger son

was diagnosed with autism. Because of the altercation her children had no

place to go, but a friend of the patients did offer to take her children in while

she was at the hospital. The patient was worried about her children because

they are younger, and have special needs and that only she feels

comfortable taking care of. The patient currently has no job, patient stated

that she injured her back at work, and since that time has had chronic back

pain that makes her unable to work. Depression have shown to exist in 72%

of patients with a diagnosis of chronic pain (Barrett, K., MS, DNP, FNP/BC, &

Chang, Y., PhD, RN. 2016). Chronic pain has shown to lead to poor perception

of health, poor social relationships, and financial difficulties (Barrett, K., MS,

DNP, FNP/BC, & Chang, Y., PhD, RN. 2016). This statement is true for my patient.

Because of her diagnosis of chronic back pain, she has been unable to work

and is currently struggling with her finances. The patient knows that not

having job is a problem, but is not actively looking a job at this time. The

patient does have a vehicle that is in working condition to get her children to

and from school. Because of all of these stressors in the patients life, she

decided that she wanted to take her own life.

Discuss
The patient was not very open when discussing the topic of her family.

The patient stated that her family is not from around the area, and that it is
 Olivia Millsop: Mental Health Case
Study

only her and her two children. The patient had never been admitted to a

behavioral health unit before, and that she had no past suicide attempts. The

patient did disclose that her one child was diagnosed with bipolar and that

has been a stressor on her life. Other than her child the patient has no other

history of past mental illness. The only medical condition that the patient has

currently is chronic back pain from a work-related injury many years ago.

Describe
When talking with the patient about her time on the behavioral health

unit, she described it as bad. Patient only attended the group therapy

session because she didnt want to look bad. The patient said that the

group therapy session were not helpful to her, and that she only wanted to

be back with her children. Patient kept mentioning her children and that she

needed to leave in order to go help them, even though her friend was

taking care of them. She was not using her milieu therapy to her full

advantage. In the beginning of the discussion the patient stated that she had

voluntary admitted herself to the unit, because she needed help coping with

her stressors at home. After following up with the staff regarding the

statement the patient had made, the truth was that the patient had been

pink slipped to the unit for a suicide attempt. The patient was not lying in

regards to not being admitted to a behavioral health unit before.

Analyze
 Olivia Millsop: Mental Health Case
Study

Moving on in the conversation with the patient, we came across the

topic of religion or spiritual beliefs. The patient talked about how she and her

family have never been a family to go to church. Even when the patient was

younger, they did not go to church. The patient does believe in god, but does

not practice any type of religious beliefs at this time. The patient is unaware

of what her ethnic background is, states that she is from a mixed family.

Evaluate
The outcomes for this patient should be focused on building effective

coping mechanisms. The patient demonstrated that she does not have the

adaptive coping mechanisms to function through her current stressors. A

more important goal for the patient would be to prevent suicide attempts

from occurring in the future. The patients goals can include: Patient will

verbalize two stressors at the end of shift; Patient will inform the nurse or

other health professional of feelings of self-harm or mutilation; Patient will be

able to verbalize two coping mechanisms at the end of shift.

Summarize
When looking at the plans for discharge the patient seemed to be very

understanding that she has a problem with depression and that she does

need help coping with the stress she has in her life. Patient states that she

does want to see a doctor and get the therapy that the doctors have

recommended. The patient is willing to corporate with out patient therapy

that had been recommended to her by the team of doctors. The patient also
 Olivia Millsop: Mental Health Case
Study

states that she had been seeing a therapist before this event and that she

would be willing to continue with the treatment. The patient is now at

greater risk of relapse and with that relapse of depression the patient is at

risk for a decrease in psychosocial functions and functionality (Temel, M., &

Kutlu, F. 2015).

The patient does have the means in order to get to the outpatient

therapy with owning a car. The only problem that arises without patient

therapy is having money in order to pay for gas to get to the therapy

session. Upon discharge it is important to discuss suicide risks and when to

contact the doctor. Since she will now have a history of suicide attempt, the

patient is likely to try and attempt suicide again. It is important that the

patient have a home for both her and her children. But the patient will need

to fill out the application for food stamps, and will need help following

through with this plan. The patient will need to have a defined support

system that will be able to help her after leaving the behavioral health unit,

and will need to be able to verbalize this to the unit staff.

Prioritized
Risk of suicide related to major depression disorder as evidence by
suicide attempt
Ineffective coping related to maladaptive coping skills as evidence by
suicide attempt
Self-Care Deficit related to poor income as evidence by unkempt hair
and clothing

List
Risk for suicide
 Olivia Millsop: Mental Health Case
Study

Low self esteem

Insomnia
Fatigue
Self-care deficient
Caregiver role strain
Anxiety
Ineffective coping
Fear
Stress overload
Chronic pain

References
 Olivia Millsop: Mental Health Case
Study

Barrett, K., MS, DNP, FNP?BC, & Chang, Y., PhD, RN. (2016). Behavioral
Interventions Targeting Chronic Pain, Depression, and Substance Use
Disorder in Primary Care. Journal of Nursing Scholarship, 48(4), 345-
353. doi:10.1111/JNU.12213

Batterham, P. J., Christensen, H., & Calear, A. L. (2013). ANXIETY SYMPTOMS

AS PRECURSORS OF MAJOR DEPRESSION AND SUICIDAL IDEATION.
Depression and Anxiety, 30(10), 908-916. doi:10.1002/DA.22066

Temel, M., & Kutlu, F. (2015). Gordon's model applied to nursing care of
people with depression. International Nursing Review,62 (4), 563-572.
doi:10.1111/INR.1221

Townsend, M. C. (2017). Essentials of psychiatric mental health nursing:

concepts of care in evidence-based practice. Philadelphia: F.A. Davis
Co.