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Mental Health Case Study

Daziana Velasquez
Youngstown State University
Professor Flamino
October, 2017.
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Abstract

Schizoaffective Disorder, Bipolar Type is a chronic mental health condition characterized

primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a

mood disorder, such as mania and depression. (“Schizoaffective Disorder,” 2017). To be

diagnosed with schizoaffective disorder, the patient has to have either a manic or major

depressive episode. The person on the mental health floor was experiencing a manic episode. His

decrease need for sleep, distractibility, and his anger towards no one believing him is what

caused himself to check in at the psych unit.

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Objective Data

On October 18, 2017 I got to meet E.S. He was admitted to Youngstown St. Elizabeth on

October 16, 2017. His psychiatric diagnosis is Schizoaffective Disorder, Bipolar Type. He was

diagnosed with paranoid and grandiose. Someone who is paranoid does not trust anyone, they are

very suspicious of people, don’t attach well to others, hold grudges, and act aggressively if their

character is threatened. Someone with grandiose believes that they have some great but

unrecognized talent/insight or a special identity. They might even think they are in a relationship

with someone famous or think they know God. Needless to say, the person I was speaking with

was dating Taylor Swift. They recently just broke up, because he couldn’t take her insecurities.

He was at a party in California called the “Burning Man party”. This is where a celebrity hosts a

party in the hills and afterwards they go party with every famous person you could imagine in

these mansions. That is actually where he met his new girlfriend, who is famous as well. Her

name is Carly Kloss, whom he said is an amazing girl, a lot nicer and not as crazy as Taylor. She

actually understands him. He told me I had to hear the way they met, because it wasn’t all fun

and games. He also stated that he would tell me how he ended up in California, how this all

started, and why he is here now, but I had to wait until the end for those explanations. He jumped

from story to story, talked very fast, and spoke to me for 3 hours and at the end of our

conversation he still was not finished. He told me to grab a piece of paper and write down all this

information. He went on to tell me that his parents sent him out to California to live with his

cousins. They are pretty known out in the Venice Canal area. His cousin (whom he gave a

specific first and last name) worked for Markers studio. They were very wealthy. His cousin is

the one who took him to this party in the hills. He mentioned he was there with Miley Cyrus,
Puff Daddy, Lil Wayne, Drake and so many more; but they were all uncertain of him and why he
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was at this party. He said, they all acted very friendly and tried getting to know him, Carly Kloss

who he is dating now introduced herself by bringing him a corona and having small talk. He said

that she drugged him, he only had one corona and then the next day he woke up out in the hills,

by himself, they stole his wallet and phone. He found out this all happened because Carly

brought the identity and phone back to him. He was very angry and wanted to know why she did

that and she had told him she did it because they wanted to know why someone like him was

partying and going out trying to get to know people like them. They were not doing it be mean

he said, they were just doing it to make sure he was an okay guy and wasn’t out to harm any of

them. Eventually he forgave her and a couple months later after hanging out for a while they

started dating. He said another bad thing that happened at that party, he thought he was shot with

a pellet gun. He pulled his pant leg up to show me that it was not a pellet in his leg, what was in

his leg was even worse, it was a microchip. I asked him why he thought that, because I of course

was only seeing either a pimple or an ingrown hair. He said he had an x-ray done and nothing

showed up, but he said he knows they are making a mistake and just don’t see it, either that or

the people who put the chip inside of him were smart enough to make it now come up on an x-

ray; so once he gets off the psych floor he will get it out himself. He said he thinks Taylor Swift

is the one behind that cause, because she is obsessed with him. Everywhere he goes she is

following him, stalking him, or watching him. She even wrote one of her songs called “wildest

dream” about him. Most people think the song is about Scott Eastwood he said, but it is not. She

just didn’t tell people it was about him because it looked bad that she wasn’t dating someone

famous, so she kind of had to keep him a secret, which is another reason why things did not work

out with them. He brought her up several times. He kept looking at all the cameras on the unit
and he would tell me those were all installed to watch him. Then he would look at all of the
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people in the room and then look back at me and say these people were all sent in here to spy on

him for Taylor. She only knew where he was at because of that chip that is located inside of him.

She knows his every move he said. Anytime a patient would look over at him, he would ask

them what they were looking at or he would say I am not giving you any information for her,

nice try. When I went to go ask him a question, his face got real serious and he looked

suspicious. He said, oh my god; you are one of them too. That is why you are the only one who

has wanted to listen to my whole story and I said no, I am just a nursing student. Then he got

upset and told me not to lie to him. I stated a few times to him that I promised I wasn’t lying and

he kept telling me my voice sounded familiar, a voice of one of Taylors friends. He touched my

hair and my face and said that I wasn’t fooling him with my mask and wig on. I once again told

him that I promised I am not involved with anything going on. He said alright whatever you say,

then began telling me more. Finally, he said, so don’t you want to know why I am in here? And I

said yes. He said well I am sure you already know a lot about me from my charting. I told him

that I didn’t even get to look at the charts yet and he insisted that I was lying and already looked

at his charts. I did look at some of the doctor notes, before I went on the floor to meet him and I

was able to see how E.S’s behaviors were on the date of admission. The notes had mentioned

how he smiled when not appropriate (which he did several times) mostly when he thought I was

lying even though I wasn’t. A couple of times he said sorry that I am laughing, my life is funny

after everything that happened. I read that when he was admitted he felt people were planning on

murdering him and that everyone was out to get him. Once we got back on topic and he let go

that I wasn’t spying on him he told me what brought him here. He said that his family wanted

nothing to do with him, didn’t want the responsibility so they sent him on a surprise vacation to
California with his cousins. They bought him a one-way ticket and told him that he could just
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buy the other one whenever he wanted to come back. Well his cousins out in California set him

up with a bunch of famous people in California, because he had the potential to become famous

with his talent as a guitar player. He got sick of the famous life, they were very controlling, just

wanted his money from fame, and at one point they shut off his phone bill so that he couldn’t get

a hold of people back here in Ohio. To sum it all up, it was all a set-up he said. His mom and half

sibling sold his house back in Ohio, they planned on leaving him with the cousins out in

California. The cousins just wanted his money and wouldn’t let him return home, because he had

hook ups from meeting so many famous people out in California. He eventually got to meeting

people from the government. He told them all about it and said he needed help. He got every

government service involved and they got a hold of our president Obama. Obama felt so terrible

this had happened to him that he personally flew him back home to get him out of that mess.

Once he arrived home, he saw that his home was sold. He no longer has a house because his

mom sold it and took off somewhere. Now he is homeless. He has been living on the streets for a

little bit now, he was getting so angry that no one believed any of his stories that it all lead up to

so much anger that he had to bring himself to the psych unit. Once he checks out, he said he is

taking all this information to CNN and he is going to write a novel and become so famous that

people are going to regret not listening. He was so happy and thankful that I listened, he

personally wanted to take me to CNN with him. He went up to the nurse’s station once I said my

goodbyes and asked if he could have my contact information to show me all the proof he has and

then he also wanted me to stand by his side and tell CNN that I believe him and know he isn’t

lying.
 Effective psychological treatments include: assertive community treatment, supported
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employment, skills training, token economy interventions, and family-based services. Intensive

case management (ICM) reduces hospitalization, improves adherence to care, and improves

social functioning. (“SCHIZOAFFECTIVER DISORDER, 2017”).

A few of the medications they had him on were; Cogentin and Haldol. Those were both

being used to treat his agitation. He was prescribed Vistaril for his anxiety and also Desyrel to get

him to sleep.
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Summarize

Schizoaffective Disorder, Bipolar Type is a chronic mental health condition characterized

primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a

mood disorder, such as mania and depression. To be diagnosed with schizoaffective disorder, the

patient had to meet all of the following criteria. Had to have at least one of these symptoms for at

least one month: delusions, hallucinations, disorganized speech, grossly disorganized or

catatonic behavior, and negative symptoms. Also had to have active-phase symptoms, either a

manic or major depressive episode. If the person is having a severe manic episode they are losing

touch with reality which causes them to become delusional or have bizarre behavior. If they are

having a major depressive episode they will experience a depressed mood most of the day, they

will have markedly diminished interest or pleasure in almost all activities, significant weight loss

when not dieting, insomnia or hypersomnia nearly every day, psychomotor agitation or

retardation nearly every day, fatigue or loss of energy, feelings of worthlessness, diminished

ability to think or concentrate, or recurrent thoughts of death. They will have five or more of

those symptoms for a 2-week period if they are experiencing a major depressive episode.

(“SCHIZOAFFECTIVE DISORDER, 2017”)

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Identify

As previously mentioned, when talking to E.S, I had asked him what brought him here.

He said, “what like my stressors?” he already knew what I would be asking him it seemed.

Almost as if he did some research on what to expect being on a psych unit. He had so much to

talk about that he had me wait until the end to tell me what brought him here, at the end he

finally told me that he was so frustrated that no one believed him, that is why he decided to

check into the hospital. He said he was beginning to get angry and he was tired of people

thinking what he was saying wasn’t true, because every bit of information he was giving me was

true. He said he admitted himself on the psych unit because he wanted to get the whole

experience so that he can take it to CNN once he checks out of here. He said he had all the proof

he needs, it is all in his phone, he has witnesses who are going to back him up and he has it all

written down so that once he gets out of here he can take it to CNN. Then after all is said and

done he will write a novel and become famous.

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Discuss

E.S, has no previous history of psychiatric hospitalization and had no family history of

anyone with mental illnesses. This was his first visit to a psychiatric hospital and he voluntarily

checked himself in.

Describe

As I was talking to my patient at a table, I had recognized milieu therapy going on

throughout the floor. Milieu therapy is where nurses help improve psychological health, the

purpose of milieu therapy is to provide for patients’ optimal safety and healing, to provide nurses

with a healing surrounding in which to practice, enabling them to care for themselves, and help

and support one another to practice together well, to engage and support everyone concerned

with patients’ care; patients’ family and friends, other health professionals, and assistive

personnel. Out on the floor the nurses were making sure all of the patients were doing okay, they

made sure if patients wanted to socialize they were there to talk to them, they encouraged group

therapies which is a great nursing priority, but my patient did not want to participate, because he

thinks the people here are all involved and out to get him. He believes that everyone is in

disguise and setting him up. Out on the floor the nurses also set up games for the patients to play

and they made sure the patients had a say so in things if they were appropriate. The nurses were

very big on safety, however my patient was harmless, he did not need close to the nursing

station, or need to be in a gown, but he was observed to make sure he had nothing harmful on

him that could hurt him or others, his room was in a very safe environment, nothing sharp and no

objects that could hurt anyone.

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Analyze

I tried getting my patient to speak more on this, but all he would tell me was that he did

believe in God and that he was catholic. Any time I would try to bring up the religion topic or

what his beliefs were, he said that there was not much more to know other than that he believed

in God.

Evaluate

E.S, was very talkative and wanted to engage in conversation. There were a few times

while he was speaking, that he would get angry because no one else wanted to listen to his

stories. He was very harmless and very nice, but you could tell he was a little off. He cooperated

very well, did what he was asked too, and definitely had respect towards all the nurses. He took

his medications without any trouble and participated in group therapies as

Summarize

The plan for discharge starts the minute the patient sets foot on the floor. For E.S, he was a

voluntary admission. He was going to be leaving in 2 days. In the charts, the goals for E.S were:

- Patient will demonstrate appropriate interaction, communication and develop insights of

ways to improve interactions with others.

- Patient will develop ways to increase positive communication and improve relationships.

- Patient will learn 5 new ways to increase happiness and to be able to identify bad

communication principles that they engage in and identify positive communication

principles they could use instead.

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Prioritized

1. Violence: self-directed related to impaired sensory perception secondary to

schizophrenia.

2. Disturbed thought process related to mental disorder.

List

1. Anxiety

2. Bathing or hygiene self-care deficit

3. Disabled family coping

4. Disturbed body image

5. Disturbed personal identity

6. Disturbed sensory perception (auditory, visual, kinesthetic)

7. Disturbed sleep pattern

8. Disturbed thought processes

9. Dressing or grooming self-care deficit

10. Fear

11. Hopelessness

12. Imbalanced nutrition: Less than body requirements

13. Impaired social interaction

14. Impaired verbal communication

15. Ineffective coping

16. Ineffective role performance

17. Powerlessness
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18. Risk for injury

19. Social isolation

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References

K., Y. (n.d.). Schizoaffective Disorder: An overview. Retrieved November 20, 2017,

from http://article.sapub.org/10.5923.j.ijcp.20140201.03.html

(n.d.). Internet Mental Health. Schizoaffective Disorder. Retrieved from

http://www.mentalhealth.com/home/dx/schizoaffective.html

SCHIZOAFFECTIVE DISORDER. (n.d.). Retrieved November 20, 2017, from

http://www.mentalhealth.com/home/dx/schizoaffective.html