1 Mental Health Case Study

Psychiatric Mental Health Comprehensive Case Study

Paige Hawkins

Youngstown State University

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Abstract

This case study focuses on a twenty-three-year-old Caucasian male who suffers from

Depressive Disorder, unspecified, Anxiety, Bipolar, history of suicidal tendencies, and homicidal

ideations. He also suffers from being a Status Epileptic and Tuberous Sclerosis. On January 24,

2017, he was brought to the emergency room at Saint Elizabeths Main, by ambulance, after

calling 911 for himself because he was having homicidal ideations towards his grandfather. He

was admitted to the hospital with homicidal ideations and depression. He was a voluntary

admission to the unit and understood that he needed to get help. When he entered the Mental

health unit he was compliant with the staff and the other residents. He continues to attend group

meeting and therapy sessions. He has numerous stressors, both past and present that contribute

to his problems. Throughout this study his mental health diagnoses along with his past

contributing factors will be elaborated upon that have led him where he is today. Along with his

prescribed medications and appropriate nursing diagnoses will discussed to plan for discharge.
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Objective Data

Patient J.O. presented to the ED on 1/24/2017 and was diagnosed with Depression. On

day of care, 1/26/2017, I got to interview the patient. During the interview process, the patient

had good eye contact, he was relaxed, but he became restless when given periods of silence.

When the patient was restless, he would look down at his fingers, lean forward, and mess with

his hands. Using the DSM IV-TR Axes: Axes (I): Depressive Disorder, unspecified; Anxiety;

Bipolar; history of suicidal tendencies; homicidal ideations; Axes (II): N/A; Axes (III): Benign

tumor of brain; Heart Murmur; Numbness of left leg and foot; Status Epileptic; Tuberous

Sclerosis; Axes (IV): unemployment; Axes (V): N/A. Treatments for the many medical

conditions listed above are taking medications to alleviate symptoms, developing coping

mechanisms to deal with depression and anxiety, practices meditation, listens to music for

relaxation, and talking to friends and family about his depression and anxiety. On day of care,

there were many safety and security measures taken. There were seizure precautions, suicide

precautions, and universal safety precautions considering the patient has anger problems. There

are two prescribed psychiatric medications that this patient is on: hydroxyzine (Vistaril) capsule

50mg q 6 hours PRN for Anxiety; mirtazapine (Remeron) 15mg nightly for Depression.

Summarize

Depression is a mood disorder that causes a persistent feeling of sadness and loss of

interest. Also called major depressive disorder or clinical depression, it affects how you feel,

think and behave and can lead to a variety of emotional and physical problems (Depression).

There are many expected behaviors that come with depression. Some of these behaviors consist

of: Feelings of sadness, emptiness or hopelessness, angry outbursts, irritability or frustration, loss

of interest or pleasure in most or all normal activities, sleep disturbances, lack of energy, anxiety,
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frequent or recurrent thoughts of death, and suicidal thoughts or suicide attempts (Depression).

Anxiety is defined as, intense, excessive and persistent worry and fear about everyday

situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense

anxiety and fear or terror that reach a peak within minutes (panic attacks) (Anxiety). The

behaviors that are associated with anxiety involve all of the following: Feeling nervous, having a

sense of impending danger, increased heart rate, breathing rapidly, sweating, trouble

concentrating or thinking about anything other than the present worry, and sleep disturbances

(Anxiety).

Bipolar disorder, formerly called manic depression, causes extreme mood swings that

include emotional highs (mania or hypomania) and lows (depression). When you become

depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When

your mood shifts in the other direction, you may feel euphoric and full of energy (Bipolar).

Common behaviors that are associated with manic episode of bipolar are: inflated self-esteem,

decreased need for sleep, unusual talkativeness, racing thoughts, distractibility, increased goal-

directed activity, and doing things that are unusual and that have a high potential for painful

consequences (). Common behaviors associated with a depressive episode of bipolar are:

depressed mood most of the day, reduced interest or feeling, significant weight loss, insomnia,

restlessness, fatigue or loss of energy, feelings of worthlessness, decreased ability to think or

concentrate, recurrent thoughts of death or suicide, or suicide planning or attempt (Bipolar).

Identify

On 1/24/2017 patient presented to the ED with worsening depression over the past one

month. Patient stated he came to the ED voluntarily because he felt thoughts of hurting his

grandfather. He reports of having suicidal thoughts over the past week. During the interview, on
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1/26/2017, the patient stated that he was being blamed for damaging his grandfathers new car. I

got so angry, I started punching the concrete. Thats when I called the ambulance, said the

patient.

Discuss

The patient is clinically diagnosed with: Depressive Disorder, unspecified, Anxiety,

Bipolar, history of suicidal tendencies, and homicidal ideations. All of these diagnoses are

described above. The patients family has no history of mental illness.

Describe

There are many psychiatric evidence based nursing care that is provided for this patient.

Starting off right in the morning they meet for what they call therapeutic communication. The

nurse talks about what will be offered during the day and at what times, she introduces all of the

staff members by name, and she talks about creating a personal, achievable, goal that will help

the patient help themselves while they are on the unit. Whether it is cleaning their room, taking a

shower, making a friend, or even attending group therapy. Throughout the day, the facility offers

two classes, psychoeducation and psychotherapy. Psychoeducation involves ways of bettering

the patients homes lives. They talk about how to get and hold onto jobs, how to control anger or

stress, and much more. Psychotherapy is a class where people come to talk about their past

experiences and feelings. It is a safe place for the patients. The nurse stated, what is said in the

room, stays in the room.

Analyze

When asked about spiritual influences, the patient stated that he believed in a God. He

told a story of how his heart stopped and he got to see the golden gates. He said that it must not

have been his time because the gates were closed, and then he woke up.
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As far as cultural influences go, his home life was not easy. He grew up with many health

illnesses, as well as a father who walked out on him and his brothers. He doesnt speak to his

father, and rarely talks to his brothers or his mother. He does not have a good support system. His

only support system, the patient says, is his grandfather.

Evaluate

Patient outcomes related to care is to reduce anxiety and depression, develop coping

mechanisms to help with anxiety and depression, continue to be compliant to medication

regimen, control episodes of anger, and cease suicidal and homicidal tendencies.

Summarize

When asked about plans of discharge, the patient stated that he was going to live with his

grandfather again. He said that he wants to get his life back to normal and find a job. Also, he

stated that he wanted to go to medical school to be a doctor, or go to YSU for nursing. I want to

help people like me. They always need nurses in mental health, he said.

Prioritized

The patient revealed numerous actual nursing diagnoses throughout our interview. The

following list are the nursing diagnoses that I found most relevant to the patient.

Risk of self-harm related to feelings of depression, unemployment, homicidal ideations.

Ineffective coping related to situational crisis and uncertainty as evidenced by him stating

he does not want to harm his uncle or family and he cannot control his anxiety.
Risk for suicide related to unemployment, difficult home life, homicidal ideations, history

of previous suicide attempt.

Spiritual distress related to life changes, as evidenced by unemployment, not talking to

his mother or father, suicidal ideations, homicidal ideations.

List
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Although my patient has numerous nursing diagnoses, he also has potential diagnoses

that relate to his past problems that could become relevant in the future. These potential risk

factors are as followed:

Ineffective health maintenance related to inability to make appropriate judgements as

evidenced by patient admitting to forgetting to take medications.

Ineffective impulse control related to economically disadvantaged and poor control of

anger as evidenced by unemployment and punching the concrete.

Dysfunctional family process related to inadequate coping skills, as evidenced by a

suicidal history and homicidal ideations towards his grandfather.

Conclusion

Mental health affects people in numerous ways. In the case of my patient he suffers from

Depressive Disorder, unspecified, Anxiety, Bipolar, history of suicidal tendencies, and homicidal

ideations. At the time of his admission he was homicidal towards his grandfather and he was

suicidal, with no plan of action, and thought that killing himself was his best way of helping

himself and others. While becoming admitted at the unit, he was compliant with all the staff

members and participated in group therapies to better himself. Upon leaving the patient, he

stated, I feel as though I am getting better, I feel like this is where I needed to be. The patient

needs to continue with his medication therapy and start outpatient counseling to work through his

issues as they will not resolve themselves.

References

Anxiety. (2015, December 31). Mayo Clinic. Retrieved January 26, 2017, from
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http://www.mayoclinic.org/diseases-conditions/anxiety/home/ovc-20168121

Bipolar disorder. (n.d.). Mayo Clinic. Retrieved January 26, 2017, from

http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/definition/con

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Depression. (n.d.). Mayo Clinic. Retrieved January 26, 2017, from

http://www.mayoclinic.org/diseases-conditions/depression/basics/definition/con

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