Psychiatric Mental Health Comprehensive Case Study

Mike Audi

Thursday 7:00-1:00
Objective Data

The patient I cared for on October 4, 2018 was a thirty-one-year-old female who was

involuntarily admitted to the unit on October 3, 2018. She was diagnosed with Major

Depressive Disorder and Alcohol Abuse Disorder without psychosis. The patient was brought to

the emergency department in custody of the police around nine o’clock at night. Upon

admission, the patient was extremely intoxicated and aggressive toward police and medical

staff. A “spit guard” had to be worn by the patient while she was in the custody of police and

she made multiple verbal threats towards police officers and healthcare providers. When the

police arrived at her house, she also displayed suicidal intentions. The patient slept in the

emergency department that night and was brought to the floor in the morning. The patient

states that she does not remember any of the night, and that she consumed an entire bottle of

vodka before authorities arrived at her home. The morning after the patient’s erratic and

aggressive behavior, she was very calm and cooperative and displayed an absence of alcohol

withdrawal symptoms. The patient states that she understands she has an alcohol problem and

is ready to take the necessary steps towards beating her addiction. The patient is prescribed

perphenazine 2 mg PO 2x/day, naltrexone 50 mg PO nightly, and Geodon 10 mg IM once.

Summarize

One diagnosis the patient received was Major Depressive Disorder. “Major depressive

disorder (MDD), also known as clinical depression, is a profound depressed mood that persists

for longer than 2 weeks, severe enough to cause noticeable problems in the patient’s ability to
maintain personal relationships, meet work or school obligations, and participate in previously

enjoyable social activities” (Davis, 2017). Some common symptoms of Major Depressive

Disorder include feelings of sadness, feelings of worthlessness and guilt, and changes in

appetite. Next, her second diagnosis was Alcohol Abuse Disorder without psychosis. This

disorder is characterized by a dependency to alcohol which can affect the patient’s social life,

work, health, and personal relationships.

Identify

The patient had multiple stressors that precipitated her hospitalization. The patient was

a Physicians Assistant, but her license is currently suspended for one year because she was

caught drinking between patients. She is currently required to go to treatment and take

multiple urine tests for drugs and alcohol. The patient also lost her marriage due to her alcohol

addiction, and currently alternates between living in a house on her own and staying at her

current boyfriend’s apartment. The patient stated that she would drink alcohol immediately

upon waking up in the morning and continued to drink throughout the day. She stated that she

had lost many friendships due to her alcohol use, and it has also had a major effect on her

family relationships.

Discuss

The patient comes from a good family with a solid support system. Her father is a

physician, and she grew up around a family that always got along and maintained stable

relationships. The patient’s family history of mental illness consists of her mother and maternal

aunt who are both diagnosed with Generalized Anxiety Disorder and Depression. The patient
has a medical history of alcohol dependency, anxiety, and depression. This past year, on the day

her mother took the breathalyzer out of her car, she was charged with driving under the

influence and possession of an open container. The patient denied previous psychiatric

hospitalization, but has a history of treatment including rehab and participation in alcoholics

anonymous.

Describe

The patient attended multiple group meeting on the floor and stated that she thought it

was very helpful. She stated that she can speak more freely in a group setting and did not feel

any judgement within the group. Nurses and other healthcare professionals also did a good job

of facilitating the conversation. This type of therapy helped the patient feel like she is not alone

and helped her realize that people were willing to help her.

Analyze

The patient is Caucasian and does not describe herself as religious, but states that she is

spiritual. She had grown up as a Catholic but stated that she stopped identifying with the

religion when she moved out of her childhood home. Since then, she has remained spiritual and

reads books that guide her in a positive moral direction. The patient identified reading as a

positive coping mechanism and motivation to change her behavior.

Evaluate

One possible patient outcome related to alcohol abuse is verbalizing the awareness that

the patient does indeed have a substance abuse problem. This outcome was efficiently met, as
the patient stated multiple times she knew she had a problem and wanted to actively take

steps toward becoming sober. Another patient outcome is engaging in therapeutic programs.

This is currently required by the state, so she can get her license back, but she stated that she is

finally ready to take the program seriously. The patient has been to rehab on three separate

occasions this year and has never made it past step three of alcoholics anonymous. “Made a

decision to turn our will and our lives over to the care of God as we understood Him” (Strobbe,

Hagerty, Boyd, 2012). The previous quote is the third step of alcoholics anonymous. The patient

plans on reading more and getting in touch with her spiritualty to make it past this step. She

stated multiple times that this attempt will be different, and she is finally ready to take the

program seriously.

Summarize

The patient’s discharge plans include finding new coping mechanisms to deal with her

daily stress. The patient has identified activities such as reading and spending more time with

her family to achieve this outcome. Another discharge plan is to continue her treatment for

alcohol abuse. The patient plans to finally complete the twelve steps of alcoholics anonymous

and lead a sober life.

Prioritized

1. Risk for suicide related to diagnosis of major depressive disorder as evidenced suicidal

ideation.

2. Ineffective coping related to alcohol abuse as evidenced by relapse.

3. Sensory perceptual alterations related to alcoholism as evidenced by severe intoxication.

List

- Anxiety related to abstinence of alcohol.

- Risk for impaired liver function related to alcohol abuse.

- Risk for loneliness related to failed relationships.

- Imbalanced nutrition related to insufficient dietary intake.

- Low self-esteem related to social stigma attached to alcohol abuse.

- Risk for self-harm related to suicidal ideation.

- Altered family process related to inadequate coping skills.

Conclusion

“The 2010 National Survey on Drug Use and Health: Mental Health Findings estimated

that 3.4 million (16.9%) of the 20.3 million adults who met criteria for past-year SUD reported

also experiencing a major depressive episode (MDE) during that same period” (Devido, Weiss,

2012). The previously stated statistic does not come as much of a surprise after meeting with

this patient. The patient believes that she drinks because she is is frequently depressed. Alcohol

abuse is a harmful coping mechanism for the patient, so the goal is to find healthier options to

deal with her stress. The patient has lost a lot in her life because of her alcohol abuse disorder,

and she seems to realize how severe her addiction is. The patient seems motivated to turn her

life around by actively participating in therapy and working toward getting her license back.
 References

Davis, C., & Lockhart, L. (2017). Not just feeling blue. Nursing Made Incredibly Easy, 15 (5), 26-

32.

DeVido, J.J., & Weiss, R.D. (2012). Treatment of the Depressed Alcoholic Patient. Curr Psychiatry

Rep, 14(6), 610-618.

Strobbe, S., Hagerty, B., & Boyd, C. (2012). Applying the Nursing Theory of Human Relatedness

to Alcoholism and Recovery in Alcoholics Anonymous. Journal of Addictions Nursing, 23(4), 241-

247