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Cheyenne Kirkwood

Youngstown State University

Mental Health Comprehensive Case Study

Instructor Patricia Flamino

September 27, 2018


The patient this week at clinical was a 45-year-old male suffering from Psychosis NOS, Bipolar

1 Disorder, Anxiety, Depression, and Panic attacks. With a history of a head trauma and TBI

causing an increase with psychiatric problems. The patient’s current disability and rising

psychiatric problems is the reason he reached out for care. During his stay on the psychiatric unit

the goal is to reorient him back to stability. A focus on medication therapy to function in and out

of the hospital. With the patient and the staff having an equally understanding for this plan of


Mental Health Comprehensive Case Study

Objective Data

On September 27, 2018 at Saint Elizabeth Mercy Health Hospital on the psychiatric unit,

the patient for today was a 45-year-old male. He was diagnosed with Psychosis NOS, Bipolar 1

Disorder, Anxiety, and Depression, and Panic Attacks with a history of a TBI and head trauma.

The patient was admitted on September 24, 2018 for an increase of anxiety and depression, due

to improper medication therapy. He currently is medicating with medical marijuana prescribed

by a physician currently not his PCP. He sought out medical help at Saint Elizabeth due to

running out of marijuana due to an inconvenience of location and cost. He claimed it is the only

thing that works for him and followed with stating, “I ran out of marijuana and my anxiety and

depression is back, and I just want to get better.” Currently, according to the DSM 5 axis scale

the patient falls under axis one, two, and three, based off current diagnoses.

Communications during interactions was well he was able to answer all direct questions,

open to talk about his problems and had no hesitation or diversions. His affect was pleasurable

with a touch of sadness but friendly. His body posture was relaxed with periods of slouching

away and had proper gross and fine motor skills. He had an appropriate and neat appearance

without any experiences of adverse side effects related to body mechanics. Overall, his behavior

was pleasurable despite his health consisting totally of his psychiatric problems, head trauma,

TBI, hyperlipidemia, AC joint arthritis, migraines, and post-concussion syndrome. During his

treatment therapy safety measures were taken to avoid harm to self or others. The patient has a

history of a suicide attempt with cocaine, lacks impulse control that could have any end results,

and experiences auditory and visual hallucinations. His medication therapy is currently

250mg/daily of Depakote (Divalproex) for bipolar 1 disorder, Haldol (Haloperidol Lactate)


10mg/q PRN for agitation, and Vistaril (Hydroxyzine) 50mg/q 6 PRN for anxiety. To help

improve proper functioning in and outside of the hospital.


Psychosis is defined as a severe mental illness with the presence of delusions,

hallucinations, and other associated cognitive and behavioral impairments that interfere with the

ability to meet the ordinary demands of life. Fergusson, M. D. et al (2006) With characteristics

ranging from a flat, bland, and/or inappropriate tone, maladaptive behavior that the individual is

unware of, experience anosognosia, and exhibit a flight from reality into a less stressful world or

into one in which they are attempting to adapt. Townsend, C. M., Morgan, I. K. pg. 9 (2017).

Those diagnosed with psychosis have a complex disease associated with TBI that is not fully

understood even though an individual can experience substantial distress and disability. Batty, A,

R. et al (2013).

While depression in on a completely different spectrum defined as an alteration in mood

that is expressed by feelings of sadness, despair, and pessimism. There is a loss of interest in

usual activities, and somatic symptoms may be evident. Townsend, C. M., Morgan, I. K. pg. 378

(2017) Bipolar 1 Disorder is a diagnosis given to an individual who is experiencing a manic

episode or has a history of one or more manic episode, with episodes of depression. Townsend,

C. M., Morgan, I. K. (2017) Symptoms are characterized by recurrent episodes of elevated mood

and depression, which are accompanied by changes in activity or energy and associated with

characteristics of cognitive, physical, and behavioral symptoms. Anderson, M. I., et al. (2013)

Anxiety goes along with a lot of psychiatric problems and is a diffuse apprehension that is vague

in nature and is associated with feelings of uncertainty and helplessness. Now panic attacks are

manifested by intense apprehension, fear, and/or terror, often associated with feelings of

impending doom and accompanied by intense physical discomfort. Showing manifestations of

palpations, sweating, shaking, chest pain, and etc. Townsend, C. M., Morgan, I. K. pgs. 420, 6,

and 449-450. (2017).


In addition to gathering information on various aspects of the client’s health history there

was a focus on his reason for seeking help. The patient disclosed that his way of coping was

using medical marijuana. This prescription was being provided to him by a physician located in

Cleveland. He stated that it is the only thing that works to take away not only his psychiatric

problems but his chronic medical problems, related to a previous head trauma. Research shows

that after an individual experience a TBI, there is a dysfunction in neuropsychological aspects,

which have a negative effect on a personal and social life (Yousefzadeh-Chabok, S. et al (2015).

This aspect of his life left him having to be on multiple medications that gave him side effects

that he couldn’t stand. Resulting him to seek out medical marijuana in Michigan, the closest state

to provide medical marijuana near our region. Upon, seeking medical help the patient was going

through a loss of his grandfather, attempted a suicide a week prior, and ran out of marijuana

resulting in an increase with problems. He no longer could take it and unavailable finical funds

led him not to be able to obtain more medical marijuana, that he decided to come in and seek



Based off interviewing and researching the chart, there was no family medical history of

any psychiatric problems. His personal medical history was a different story his problems started

back in 2012. When he was a truck driver and experienced a horrific tractor trailer accident. It

resulted in him rolling his trailer leaving his face partly scalped with him stating “I kept having

to move it back to see.” Resulting in head trauma, TBI, migraines, post-concussion syndrome,

with no prior psychiatric problems prior to this incident.


During the stay on a psychiatric unit evidenced based care is provided to the patients by

physicians, social workers, psychiatrists, and nurses. It is not only one person’s responsibility for

the care of the patient, it is a team process. The care provided is to help stabilize a patient for a

short period of time with the stay on the floor, usually being three days. These days are spent

rebuilding each individual in order for them to try and function outside of the hospital.

Psychiatrists help reach the core problem the individual is experiencing and develops coping

measures they can use. Social workers provide resources the patients can go to once outside of

the hospital, for instance AA. Nurses spend time making sure the patients are following the

proper care plan, taking medication, and are safe.

Safety, is one the first priorities taken into effect when on a psychiatric floor. There are

checks of patients every 15 minutes, personal belongings kept locked up to prevent injuries,

rooms setup to prevent any suicide attempts, proper medication administration to prevent

pocketing and more. In addition, milieu therapy is another component factor helping with care.

At the beginning of each shift the nurse has individual time with their patient. Allowing them to

have insight into how their patients are functioning. Along, with group therapy multiple times a

day to allow patients their feelings to be heard and to know they’re not alone.


Patient defines his ethnic background as Caucasian white no affiliation in a spiritual

background. One subject during discussion was politics, even though the patient claimed he was

not very political. He had a lot of information and followed closely on the legislation of

marijuana in the state of Ohio. This is due to the case being close to him due to his medical

conditions and it being his only escape route. He expressed his precisely and coherently as to

why the drug should be legalized in the state of Ohio. He described his usage of marijuana as

appropriate and followed the exact regimen prescribed by the physician.


Overall, care provided to the patient is the standard of care on a psychiatric unit.

Rehabilitation of any patient is usually short lasting usually three to five days. The care consists

of individual therapy, group therapy, medication therapy, and help outside the psychiatric unit.

The patient in this case had a higher focus on medication therapy due to their lack of none. The

medical staff had the patient on three new medications to help with his problems. There was a

focus on individualize therapy sessions due to patient having a problem with impulse control

during group therapy. With the patient responding to both changes and looking forward to being



Communication between all members of the multi-disciplinary team on the psychiatric

unit agreeing that the patient will be discharged the next day, September 28th. The patient is

going to continue on his prescribed medication regimen with continue therapy outside the

hospital. He will also attend meetings due to his history of drugs and alcohol use. There will be

an emphasize on him seeing his PCP to help with his current medical problems, related to his

accident. That way he can have a balance of medications and therapy for him for both psychiatric

and medical problems. Lastly, the patient was adamant on being back on medical marijuana with

instructions to contact the physician in Cleveland who prescribed him it. Overall, the patient is

optimistic for his future and is looking forward to being back home with his wife and children.


1. Risk for violence: self-directed or other-directed related to bipolar disorder as evidenced

by suicide attempt with an overdose of cocaine.

2. Ineffective impulse control related to anxiety as evidenced by outburst during group


3. Risk for suicide related to depression as evidenced by suicide attempt.


1. Risk for post trauma syndrome related to events outside the range of usual human

experience as evidenced by tractor trailer accident in 2012

2. Disturbed though processes; impaired memory related to head trauma, TBI as evidenced

by memory deficits

3. Disturbed sensory perception related to cerebral trauma as evidenced by auditory and

visual hallucinations.


In conclusion, this patient had a complex history with both his medical and psychiatric

history. With cases showing that an individual having a TBI and psychotic disorders sharing risk

factors to explain one’s diagnosis. Batty, A, R. et al (2013). With his past medical history

possible causing his current psychiatric problems, due to his problems not starting until this

accident. Despite his history the patient shows positive results with following medication

therapy, individual therapy, and scoring a 26 out of 30 on his Mini-Mental State Examination

making him fall in the mild cognitive impairment column. The patient is following all

recommendations of the medial staff at this time and is hopeful for his future.


Anderson, M. I., Haddad, M. P., Scott, J. (2013). Bipolar Disorder, BMJ: British Medical


Batty, A. R., Rossell, L.S., Francis, J.P.A., Ponsford, J. (2013). Psychosis Following Traumatic

Brian Injury, Cambridge University Press on behalf of Australian Academic Press.

Fergusson, M. D., Poulton, R., Smith, F. P., Boden, M. J. (2006). Cannabis and Psychosis, BMJ:

British Medical Journal

Townsend, C. M., Morgan, I. K. (2017). Essentials Of Psychiatric Mental Health Nursing:

Concepts of Care in Evidence-Based Practice 7th Edition, Philadelphia: F.A. Davis


Yousefzadeh-Chabok, S., Ramezani, S., Reihanian, Z., Safaei, M., Alijani, B., Amini, N., (2015).

The role of early posttraumatic neuropsychological outcomes in the appearance of latter

psychiatric disorders in adults with brain trauma, Asian Journal of Neurosurgery.