Psychiatric Case Study 1

Psychiatric Mental Health Case Study

Joe Wrask

Youngstown State University

Abstract
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In this case study, it will focus on a patient that was diagnosed with depression, bipolar

disorder, and anxiety. It will discuss various things like patient history, summary of diagnoses,

precipitating factors, and more. In this case study, the patient is a female and will be referred to

her initials as M.S. As this study continues, it will explain how all of these factors come together

to cause her mental illness and mental state at present time. With all information given to the

staff, objectively and subjectively, it can help the patient and staff move forward to the end goal

of leaving the unit and continuing the path of becoming more mentally stable. Mental illness is

mostly caused by neurotransmitters in the brain that are not working correctly and traumatic

events that happen in a person’s life. In this patient’s case, she experienced both of these causes

in her situation. As the study moves forward, it will keep the patients information confidential

and will respect her situation regarding the material covered.

Objective Data:
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M.S. was involuntarily admitted on September 11, 2018 and the date of care was on

September 13, 2018. According to the DSM-5 she is diagnosed with depression, bipolar disorder,

and anxiety. During the date of care, I sat down with her and we talked mainly about why she

was brought to the unit, but also her history. During the conversation, she was withdrawn and

very down emotion wise, but she made a couple friends that seemed to brighten her mood. As

time went on, M.S. opened up more and more and felt comfortable telling me her past history

which will be discussed later on on this case study. At one point during the conversation, she was

called to the side and was told she needed to stay one more night because of a new medicine that

was started. This, in turn, led her to become very sad and emotional and she withdrew herself

from the conversation. As far as medical conditions, she was diagnosed with cervical cancer, but

she beat it and is now cancer free. I used that information to try to uplift her emotions and give

her a sense of accomplishment.

Prescribed Psychiatric Medications:

M.S. was prescribed a numerous amount of medications. One medication was

aripiprazole (Abilify) and it is an antipsychotic that is used to treat bipolar disorder. She took 10

mg by mouth, two times per day. Another medication that she was taking is extended release

aripiprazole (Aristida), which is given intramuscularly at 675/ 882 mg once monthly. This is just

like Abilify, but in an extended release, injected form. To help her with depression, she takes

citalopram hydrobromide (Celexa). This medication is taken by mouth at 40 mg once per day.

M.S. also takes hydroxyzine hydrochloride (Vistaril). She takes this PRN (as needed) for her

anxiety issues. Another PRN medication she takes is haloperidol (Haldol) and is used for times

when there is a psychosis event. Cogentin is also prescribed to combat any form of EPS adverse

reactions from the Haldol. Lastly, a Nicoderm Patch is applied everyday for nicotine addiction,
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but needs to be rotated to each arm, each day. These medications are to help the psychiatric

diagnoses that are discussed next.

Psychiatric Diagnoses:

Patient M.S. was diagnosed with depression, anxiety, and bipolar disorder. Many of

psychiatric diagnoses coincide with one another and are prevalent amongst each other.

Depression is characterized by a daily feeling of sadness and loss of interest in daily activities

that were once pleasurable. According to a study done by Shengnan Wei1, Haiyan Li, Jinglin

Hou, Wei Chen, Xu Chen and Xiaoxia Qin, they compared suicide attempts done from people

with major depressive disorder (MDD) and those who don’t. In the findings, it suggested that

people who have MDD are at a higher risk to attempt suicide rather than someone without a

psychiatric diagnosis. This was conducted with a sample of 127 participants. Along with

depression, external stressors like employment status, culture, marital status, past history, gender,

etc. accompanied the risk of suicide attempts. As for M.S., she has a psychiatric diagnosis, is a

female, was raped as a child, takes various psychiatric medications, and is single. She already

has a risk factor by having psychiatric diagnoses, but when there are accompanying factors, it

poses a higher risk. She also is diagnosed with anxiety and bipolar disorder. Anxiety can cause

nervousness and constant worrying. As this continues everyday, it can start to cause physical

signs and symptoms. Bipolar disorder occurs when there are extreme swings in mood as

characterized by very low depressed stages to mania. A study was done by Norm O’Rourke,

Marnin J. Heisel, Sarah L. Canham, Andrew Sixsmith, BADAS Study Team and they researched

the predictors of suicide ideation among adults with bipolar disorder. They found that

depression, substance misuse and other cognitive impairments accompany bipolar disorder. One

interesting finding was that at a younger age, bipolar disorder is a suicide risk factor. O’Rourke
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et al stated, “This may suggest that older adults with BD have acclimated to their diagnosis and

symptomatology, and have devised (effective) coping strategies over time.” With all three of

these diagnoses together, it is important for anyone to follow a strict medication schedule and

eliminate any external stressors that can spike these.

Precipitating Factors:

For anyone, something always tends to lead us to make decisions or causes us to think

differently. While talking to M.S., she explained events that led up to her involuntary admission

to the psychiatric unit. She started off by stating that she turned 40 years old on September 10,

2018 and she was looking forward to seeing her friends. Her friends did not show up to the party,

so that made her act out based on how she was feeling at the time. She also included that she was

nervous and did not know what to expect turning 40 years old. With these two situations and her

diagnoses, she took a numerous amount of Tegretol which caused her to overdose. This then

landed her into the unit because she had the intent to harm herself.

While continuing to talk to M.S., she mentioned to me that she was diagnosed with

cervical cancer, but she is now cancer free. She also said that many of friends and family have

died, but she didn't state specifically who they were (best friend, siblings, grandparents). As I

spoke to M.S., she brought up her childhood memories and it seemed that she only had

unpleasant things to share. As a child she had a baby-sitter who raped her. This obviously caused

an unimaginable emotional stress and she went to her parents for safety. When she did this, her

mother did not care to do anything about it, but her father was always there for her. Even till this

day, she does not speak to her mom and only to her dad.

When things like this happen in someone’s life, it can cause so many issues related to

emotions, social belonging, physical health, and much more. For M.S., she had to deal with
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many things that she didn't have control over and it led her down a path that makes her feel that

she shouldn’t be here anymore.

Patient and Family History of Mental Illness

M.S. has been depressed for most of her life and then developed bipolar disorder and

anxiety. She tried to manage her illnesses with medication through out her life and they did

work, but medication management was an issue for her. Like stated before, she was raped as a

child. To have that horrific stressor on top of a mental illness, it can be lead to severe cases. She

also had a previous suicide attempt. As far as any familial mental illnesses, she did not mention

anything and wasn't anything in her chart that had any evidence of mental health disorders in her

family.

Psychiatric Evidence Based Nursing

On the psychiatric unit at St. Elizabeth’s main campus, it does a good job at providing an

environment that allows a patient to have little to no extra stimulation. This allows the patient to

relax and get their mind off of what brought them in or reflect on what happened. Every morning

after breakfast, each patient verbalizes a simple goal that they can complete for the day whether

it is not crying for that day or saying hello to everyone on the unit. The environment also

consisted of “very basic” stimuli. This means things like beige walls, one television in the

common, one bed, and no decorations. Even though this seems like a place that nobody would

want to be in, it allowed patients to be in a place where they didn't have to overload their brain

with extra stimuli that they didn't need. In a study done by Richard E. Boettcher and Roger

Vander Schie, they introduced Milieu therapy to a specific ward in a hospital. Their end goal was

to participate in the program and send them back to the community. They found that of the 58

patients who had left the floor, 3 returned. This study was conducted in 1971 and it goes to show
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that Milieu therapy is an important thing to conduct while in the unit. Nurses and researchers

also learn from evidence based practice, which this study consisted of.

Ethnic, Spiritual, and Cultural Influences

M.S. did not comment on religious except when she said that she grew up in a catholic

family and went to church when she was a child. In the chart on the EHR, it was stated that she

was spiritual. It is unable to determine if spiritualism is a big part in her life, but people who tend

to have no religious views, usually attempt suicide more often and have other issues.

Patient Outcomes

During her time at the unit, she attended groups everyday and made a couple of friends

amongst the patients. Spending time in the unit and talking with others made her think back on

her overdose and was disappointed in herself. Talking with others and knowing that something

similar has happened to someone else gives a person hope that they can get better.

Plans for Discharge

She was supposed to leave on the day of clinical, but spoke to the psychiatrist who told

her that she needed to stay one more night. This news turned her mood around and she exhibited

by anger, frustration, social isolation, and crying. When she does leave, she plans to go back

home to see her daughter.

Nursing Diagnoses

• Risk for self injury r/t feelings of hopelessness AEB overdose on Tegretol, previous

suicide attempt.

• Ineffective coping skills r/t impulsive use of extreme solutions AEB overdose on

Tegretol, smokes marijuana, smokes cigarettes.

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• Disturbed thought processes r/t overwhelming life circumstances AEB raped as child,

history of cervical cancer, many loved ones who have died.

• Self-care deficit r/t substance use AEB smokes marijuana, smokes cigarettes, overdose on

Tegretol.

• Chronic low self-esteem r/t feeling of shame and guilt AEB extreme sadness when

friends did not show up for her birthday, depression.

Conclusion

M.S. was a very kind person and was open to talk about many things that must have been

difficult for her to deal with on a day to day basis. Unfortunately for M.S., she had a very hard

life and with all the stressors that occurred, she developed a mental illness and ineffective coping

techniques that can kill her if she doesn’t continue treatment. M.S. knows that she shouldn't have

done what she did, but when someone has mental illnesses like these and traumatic events that

occur in their lives, it is hard to “beat” those stressors.

Reference Page

Boettcher, Richard E., and Roger Vander Schie. “Milieu Therapy with Chronic Mental Patients.”

Social Work, vol. 20, no. 2, 1975, pp. 130–134., doi:10.1093/sw/20.2.130.

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O’Rourke, Norm, et al. “Predictors of Suicide Ideation among Older Adults with Bipolar

Disorder.” Plos One, vol. 12, no. 11, 2017, doi:10.1371/journal.pone.0187632.

Wei, Shengnan, et al. “Comparison of the Characteristics of Suicide Attempters with Major

Depressive Disorder and Those with No Psychiatric Diagnosis in Emergency

Departments of General Hospitals in China.” Annals of General

Psychiatry, vol. 16, no. 1, 2017, doi:10.1186/s12991-017-0167-x.