Running head: PSYCHIATRIC MENTAL HEALTH CASE STUDY 1

Psychiatric Mental Health Case Study

Amanda Verterano

Youngstown State University

PSYCHIATRIC MENTAL HEALTH CASE STUDY 2

Abstract

In Trumbull Memorial Hospital on October 23rd, 2018 I cared for a patient by the initials CF who

was admitted for an intentional overdose due to his depression. This patient was also diagnosed

with bipolar disorder and post-traumatic stress disorder. A wide variety of mental illnesses were

taking a part in the overload which he described feeling prior to his attempted overdose.

Depression causes feelings of hopelessness and despair which were evident in this man not only

at the time of his overdose but also during my day of care. However, he was in this hospital on

this floor working to overcome these feelings because he knew that he needed to and that he

needed to live. This patient also had a family history of illnesses which could be linked to his

current condition. Life had been particularly stressful in the past couple weeks due to multiple

events which all added to his stress levels. This case is a perfect example of how stressors can

cause mental illnesses to go into periods of exacerbation.

PSYCHIATRIC MENTAL HEALTH CASE STUDY 3

Psychiatric Mental Health Case Study

Objective Data

The patient was seen on October 23rd after having been admitted to the psychiatric care

floor on October 22nd. The patient was originally seen in the emergency room after ingesting a

large amount of brothers Trazadone. From the emergency room he was pink slipped meaning

that he had to involuntarily be admitted to the hospitals psychiatric floor. Patient stated that he

just felt overwhelmed in life and had enough of the feeling that everyone was judging him,

which together pushed him over the edge. The patient would not acknowledge or admit on the

day of care, but he had recently been removed from his home by his wife after her eight year old

daughter had accused him of rape. Granted the patient’s fond words about his wife, this would

have been a major stressor. However, on the day of care patient acknowledged no problems

between him and his wife over any of this in stating, “all I want to do is get out of here and go

home to the arms of my loving wife.” The patient had been staying with his brother and his

girlfriend in what the patient described as “a shack,” since he had been kicked out of his home.

The patient had five children living in his home between him and his wife’s children to others,

and those they had together. When questioned on whether or not he wanted to get better for his

children, to watch them grow up, the patient stated: “no, I don’t want to get better for them and

that’s the truth. I only want to get better for myself.” Another problem for CF was that he was

the main bread winner in his home and prided himself on that. However he know his job was in

jeopardy and was fearful of who would pay the bills. In their study Kim, Hong, Yook, & Kang,

(2017) found that “Our findings suggest that low job security is associated with a higher risk of

new development of depressive episode, suicide ideation, and decline in self-rated health.” The
PSYCHIATRIC MENTAL HEALTH CASE STUDY 4

patient understood that he needed help and voiced that he wanted to learn new coping strategies

and get his mental health under control so that he could live a normal life.

The patient had been diagnosed with depression on admission. He also carried diagnoses

of bipolar disorder, post-traumatic stress disorder and attention deficit disorder with

hyperactivity. The most relevant mental illness in this admission would be his depression, which

caused him to attempt an intentional overdose, the reason for which he had been brought to the

hospital. It would appear that CF has either a bipolar II disorder or cyclothymic disorder,

although it wasn’t yet specified in his charting, due to the fact he suffers mostly from depression

and most definitely not manic episodes. His form of bipolar disorder differs from others in that

he more often and consistently suffers from depressive moods rather than commonly

experiencing the extreme highs of mania. However, because he had just been admitted to the

floor the doctors had not yet specified in his charting which type of bipolar disorder he was

suffering from as far as I could see.

For his own safety CF was on suicide precautions. This means he needed to be seen every

15 minutes and in the case he got worse may require a 1 on 1. CF was compliant with group and

singular therapy which was beneficial to his recovery. For his anxiety he was prescribed Atarax

every 6 hours as needed and for his agitation he was prescribed Haldol every 6 hours as needed.

He had not yet been established on any medications to control his depression and bipolar

disorder on the day of care. CF also wore a Nicoderm Cq 21mg patch to keep him from going

into nicotine withdrawals during this time of care.

CF is in good physical health. Motor skills and coordination are all appropriate. Skin is

appropriate for ethnicity. No physical disabilities were observed. The only problem he may have

if not taken care of is his lack of self-hygiene. However this is likely due to his depression, the
PSYCHIATRIC MENTAL HEALTH CASE STUDY 5

lack of interest in self-care, and will be reversed in his time here. He is also diagnosed with

genital herpes. A QT prolongation and leukocytosis were noted in his chart but appeared to be

giving him no acute problems on the day of care.

On the day of care CF seemed to have a semi optimistic attitude. While he was excited to

be receiving help and optimistic he could get better, he still however came across as very

depressed and anxious. While he didn’t actively voice his anxiety and depression it was evident

in certain ways he talked, his lack of eye contact and the way he continuously fidgeted with a

paper and excused himself from the table a few times. He voiced during conversation that he

always felt as if people were judging him for not being okay and we reestablished many times

that we weren’t there to judge him at all but rather to try to understand and help him. 0v +

Summarize

This patient’s diagnoses are actually all quite commonly linked together. Depression is a

result of bipolar disorder while other mental disorders like bipolar disorder are commonly sprung

from post-traumatic stress disorder. CF suffered from these three mental illnesses contributing to

his attempted intentional overdose. Depression leaves its sufferers feeling a sense of

hopelessness and despair, like nothing they say or do matters to anyone, like they don’t matter to

anyone. As cited by Bozorgmeh, Alizadeh, Ofogh, Hamzekalayi, Herati, Moradkhani and

Ghadirivasfi (2018), “According to the Diagnostic and Statistical Manual of Mental

Disorders (DSM-V), the main signs and symptoms of MD are sadness, loss of interest in

pleasurable activities, fatigue or loss of energy, feelings of worthlessness or guilt, disturbed

concentration, insomnia or hypersomnia, anhedonia, restlessness or feeling slowed down,

significant weight loss or gain, and suicidal ideation.” However, in bipolar disorder people can

experience episodes of mania mixed in with the depression where they instead feel extreme
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energy. Mania is the complete opposite of depression where people are overly enthusiastic and

may do things without thinking because they’re thoughts are just racing too fast. Post-traumatic

stress disorder in this individual can likely be linked to the traumas he experienced as a child. In

their research on the link between childhood trauma and later mental disorders Agorastos,

Pittman, Angkaw, Nievergelt, Hansen, Aversa and Baker (2014) discovered that, “In sum, this

study provides evidence for a dose dependent relationship between the number of different CT

types experienced and both psychopathology scores and incidence of adult depression and PTSD

symptoms, and poor mental and physical HRQoL. There was a significant increase in the

independent risk of these four outcomes with increasing number of CT types experienced, with

relatively weak independent association of a single CT type, but significant effect of multiple CT

types.” CF experienced multiple kinds of trauma in his childhood between his biological family

and those he spent time living with in foster care. A large number of incidents contributed to his

particular PTSD.

Identify

There were a large number of stressors pushing CF to this current hospitalization. He

has had a rough life all along and it seems as if it only continued to pile up for him until he felt

overwhelmed. It started out with alcoholic parents who neglected to be parents to their children

as well as a father who beat the mother in front of their children. From here he was separated

from all but 1 of his 8 siblings and moved around from foster home to foster home. So an

unstable childhood set the tone from the beginning of CF’s life. However the stressors which he

personally identified as most relevant right now were the fear of bills piling up and worrying

how he would support his family, and living in a “shack” with his brother and his girlfriend

which he evidently was not very fond of. Aside from those reasons to which he admitted to, we
PSYCHIATRIC MENTAL HEALTH CASE STUDY 7

also know that he had recently been kicked out of his home by his wife because her eight year

old daughter had accused him of raping her. It is apparent that his wife means a lot to him so the

stress of her being so upset she did not even want him living under the same roof as her

would’ve created a lot of stress for CF. There is also a lack of socialization for CF as he didn’t

report having many friends which he could speak to and he only currently associates with one of

his eight siblings, of which he is not even very fond of that one. His biological father also

recently passed, although he reports having a sense of peace about that. The biological mother

doesn’t speak to him much and he reported that when she heard of what had happened to him she

replied with, “You should’ve taken one more pill.” CF was reportedly “going through a lot of

shit” all of which had just completely overwhelmed him to the point of an intentional suicide

attempt.

Discuss

With this patient being so newly admitted to the floor not too many notes had yet been

put in on his history as far as past hospitalizations or rehabs, but it was noted that he was a thirty

day readmit. In talking to the patient he at first claimed this was his first hospitalization for

mental health but then later revealed that it actually wasn’t, rather it was his third. With the past

two he had gone to rehabilitation afterwards but reports that he doesn’t intend to this time.

Patient denied seeing a counselor outside of the hospital but was inconsistent with this story in

reporting how he was on medication for his mental health problems until he had stopped seeing

it. In order to have been taking the medications he claimed he was, he would’ve had to have been

seeing a psychiatrist. It was really hard trying to piece together his mental health history without

the notes in the chart to do it yet. However, from what I gathered CF has had a life long struggle

with mental illness and had various forms of help in the past. It seems as if he cannot remain
PSYCHIATRIC MENTAL HEALTH CASE STUDY 8

compliant in any of these methods however and that is why he is back here in the hospital again.

Mom and dad both suffered from alcoholism as well as physical abuse. CF also reports that his

father was a workaholic and in turn he has retained the attributes of one in himself. CF self-

reports an addictive personality. It was also noted in his chart that he suffered from ADD with

hyperactivity, likely as a child. This was most likely his first form of mental illness that broke

out in the time he was being sent from home to home, as this commonly causes behavioral

disorders like such to exacerbate in children.

Describe

The patient was quite complaint with milieu activities on the day of care and happy to

participate in his own recovery. Activities which CF participated in on this day were two group

therapy sessions, to my observation, as well as a one on one discussion with his assigned nurse

during medication pass. Later on in the day he reported he was supposed to talk with his doctor

about the medications he would be put on aside from the PRN’s he had already been prescribed.

CF did not need either of his PRN medications for agitation or anxiety during my time of care

but reported when asked that he was willing to take whatever medications the doctor would

prescribe to help him. Group therapy on this day focused on communication which was a

beneficial topic for CF because he described often secluding himself for fear of judgement when

he spoke to others. Communication tools presented on this day could prove useful in helping him

to feel as if he could better communicate with those around him. CF also voiced that he would

later participate in phone time to call home to his wife, something that he said gave him hope and

made him feel happy to know he had her to go home to. One on one time with the patient is a

very important piece of nursing care in the psychiatric setting because patients will voice more to

one person than they will in a room of people. It is easier for someone who gets anxious such as
PSYCHIATRIC MENTAL HEALTH CASE STUDY 9

CF to describe his feelings without feeling that sense of judgement to a nurse who is showing

nothing but compassion and care for his well-being. Between therapies verbally and through

medication patients will see the best outcome on a psychiatric floor. A later coping strategy

group therapy discussion would also prove beneficial to CF who claimed he currently had none,

good or bad.

Analyze

CF reported being a Wiccan. When prompted on what exactly being a Wiccan meant to

him CF described it as “we are more in touch with the natural process of things, and see

everything as being part of that nature. We actually just recently celebrated a feast that was

supposed to bring fertility to our families and to our lives.” He reported that he and his wife and

children all take part in this religion and they all feel it quite strongly. He spoke of them as if

they belonged to a community of other Wiccan families that share their values and beliefs. It was

quite apparent that this religion meant a lot to CF and he put a lot of faith into his practices with

being a Wiccan.

Evaluate

The ultimate outcome for this patient would be to get his depression under control to a

point where he could maintain a normal, functioning life. Outside of the hospital a plan needs to

be in place with a counselor that CF can begin to see on a regular basis to avoid another overload

feeling. A lack of evidence of intentional suicides needs to be achieved in the future for CF. An

absence of wish to harm himself or a wish to end his life needs to be achieved before discharge.

Medications need to reach a therapeutic level ultimately, patient needs monitored for anti-

depressant action onset due to the energy that comes first on these medications. To summarize it
PSYCHIATRIC MENTAL HEALTH CASE STUDY 10

CF must be properly medicated with a plan for seeking out care from counseling outside of the

hospital before discharge while lacking any desire to harm himself or anyone else.

Summarize

A plan hadn’t quite been established among the health care team on the floor for CF’s

discharge due to the fact the day of care was only his second day since admission. In the past CF

has left the hospital and gone to Riverbend Rehabilitation Center but he voiced that he doesn’t

wish to do so again. CF wants to go home to his wife from here, so he may not be compliant with

any plan for a rehab like such. However, he is open to the idea of seeing a mental health

professional for counseling and medication adjustments as needed outside of the hospital so this

needs to be established prior to his discharge.

Prioritized

The first diagnosis to be addressed on CF would be his intentional overdose. This is

evidenced by his ingestion of a large amount of Trazadone with intent to end his life.

Interventions for this would be to remove means of self-harm from CF’s surroundings, to

provide counseling and to administer anti-depressants as ordered. Outcome should be an absence

of another intentional overdose. Second would be CF’s depression as evidenced by feelings of

hopelessness and worthlessness. CF requires counseling on his feelings as well as coping

strategies for dealing with these feelings, and a medication plan. Outcome would be a lack of

feelings of hopelessness and worthlessness. Third would be the bipolar disorder which

contributes these depressed moods. Once again medication and counseling would be the

intervention with an outcome of mood stabilization. Last would be his PTSD. CF doesn’t speak

much of the traumas that cause his PTSD so that needs to be addressed in counseling largely to
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get his feelings off his chest. Outcome should be that his traumas become manageable for him

and that he feels comfortable talking about these feelings from them.

List

CF’s major problem is his depression which is contributing to or resulting from all of his

other diagnoses in part. One major nursing diagnosis on him would be the risk for self-directed

violence as we have already seen him do so. Another major problem would be the risk for

chronic low self-esteem which it was evident he has some traces of already. CF is also at risk for

spiritual distress, impaired social interaction and disturbed thought processes. With depression he

also runs risk for a self-care deficit. On the day of care it appeared as if though CF hadn’t

showered or performed any personal hygiene in a few days which is evidence of lack of self-

care. Most importantly we need to monitor his risk for self-directed violence and low self-

esteem, while encouraging him to start taking part in self-care.

Conclusion

In conclusion CF is really a common case. All of his diagnosis including the PTSD and

bipolar disorder run in parallel with his depression. There’s also the fact that his depression is the

cause behind his intentional overdose attempt. In his stay at the hospital CF needs to find a

medication regimen that controls his symptoms for his diagnoses as well as receive the

counseling he needs before leaving with a plan to continue receiving more counseling outside of

the hospital. The number one outcome to be prioritized is a lack of desire to self-harm and an

absence of intentional overdoses from here out. CF served as a good subject to be studied as far

as mental health cases because of his combination of diagnoses.

PSYCHIATRIC MENTAL HEALTH CASE STUDY 12

References

Agorastos, A., Pittman, J. O. E., Angkaw, A. C., Nievergelt, C. M., Hansen, C. J., Aversa, L. H.,
Baker, D. G. (2014). The cumulative effect of different childhood trauma types on self-reported
symptoms of adult male depression and PTSD, substance abuse and health-related quality of life
in a large active-duty military cohort. Journal of Psychiatric Research, 58, 46–54.
https://doi.org/10.1016/j.jpsychires.2014.07.014

Bozorgmehr, A., Alizadeh, F., Ofogh, S. N., Hamzekalayi, M. R. A., Herati, S., Moradkhani, A.,
Ghadirivasfi, M. (2018). What do the genetic association data say about the high risk of suicide
in people with depression? A novel network-based approach to find common molecular basis for
depression and suicidal behavior and related therapeutic targets. Journal of Affective Disorders,
229, 463–468. https://doi.org/10.1016/j.jad.2017.12.079

Kim, M.-S., Hong, Y.-C., Yook, J.-H., & Kang, M.-Y. (2017). Effects of perceived job insecurity
on depression, suicide ideation, and decline in self-rated health in Korea: a population-based
panel study. International Archives of Occupational & Environmental Health, 90(7), 663–671.
https://doi.org/10.1007/s00420-017-1229-8