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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Psychiatric Mental Health Comprehensive Case Study

Anna Ohlin

March 31, 2022

Mrs. Phyllis Defiore-Golden, RN

NURS 4842L Mental Health Nursing Laboratory

Youngstown State University

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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Abstract

P.M. is a 28-year-old female patient admitted to the psychiatric unit following a severe psychotic

episode and thoughts and feelings of suicide. She has a mental health diagnosis of

schizoaffective disorder, bipolar type. She has both visual and auditory hallucinations the

religious relation. P.M. has a previous diagnosis of anxiety, obsessive-compulsive-disorder, and

schizoaffective psychosis. She currently has a medication regimen of antipsychotics, mood

stabilizers, and benzodiazepines to maintain her disorder. With the use of her medications, P.M.

states that her symptoms have become more manageable, however have not improved her daily

functioning and require her to seek recurrent hospital intervention. Nursing care provided on the

unit is focused on symptom management through therapeutic groups and pharmacologic

methods.
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Objective Data

Patient identifier P.M.

Age 28

Sex Female

Date of admission 3/26/2022

Date of care March 31, 2022

Psychiatric diagnosis Schizoaffective Disorder, Bipolar Type 1

Other diagnoses Anxiety, OCD, Schizo-affective Psychosis

Behaviors on admission

P.M. presented to the ED via ambulance due to increased hallucinations and psychosis.

Patient’s mother called EMS after she was hearing voiced of angels and expressing that she

believes she is a rapper. P.M. also made suicidal comments and nonsensical comments while

meditating. Patient was laughing hysterically and states “I believe in the illuminati and do not

think you are real.”

Behaviors on day of care

P.M. was hesitant to speak, but agreed after allowing more time to sleep. She was active

and participated in group therapy sessions. She changed her sweatshirt multiple times during the

day of care. She expressed extreme mania and anxiety while speaking. She expressed her fear of

doctors and the NP. She had an extreme flight of ideas and jumped from topic to topic. She

expressed her sadness and depression toward her home life with her mother. She was becoming

very short of breath while talking due to her rapid rate. She had pressured speech and felt
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

reluctant to share her feelings. She showed me her notebook and her written notes. She stated

that she felt very supported and excited to talk to me.

Safety and security measures

Throughout the inpatient admission there were safety checks implemented around the

clock every 15-minutes. The patient was also not permitted off the unit, and staff was always

present in the milieu. All hazardous items such as shoelaces, razors, pencils, and pens were not

permitted on the unit, and only markers were used for writing. Medications were administered to

the patient by the nurse, and the nurse verified all medications were taken at the time of

administration.

Laboratory results

Lab Value Result

Glucose 96
TSH None
T4 None
RBC 4.2
Hbg/Hct 12.4/37.4
WBC 10.9
BUN/Crea. 8/0.7
QTc 432
Toxicology Positive
Potassium 3.7
Sodium 137
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Psychiatric medications

Generic Name Trade Name Class/Category Dose/ Reasoning

Frequency

Benztropine Cogentin PO Antiparkinsonism 1 mg 2x/Day Relieve

Agent extrapyramidal
symptoms associated
with neuroleptic
drug

Lithium Lithium PO Mood stabilizer 300 mg 2x/day Control and

prophylaxis of acute
mania and the acute
manic phase of
mixed bipolar
disorder

Paliperidone Invega PO Antipsychotic 6 mg 2x/day Control symptoms of

schizophrenic
episodes

Melatonin Melatonin PO Sedative- 3 mg/nightly Treat insomia

Hypnotic

Chlordiazepoxide Librium PO Sedative-hypnotic 25 mg/PRN Treat anxiety

Benzodiazepine

Hydroxyzine Vistaril PO Antihistamine 50mg 3x/day Treat anxiety

Haloperidol Haldol PO Anti-psychotic 5 mg/day Treat major

depressive disorder

Summary of psychiatric diagnosis

Schizoaffective disorder is a mental health disorder that is marked by a combination of

schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

as depression or mania. This disorder has two types; Bipolar and Depressive. In bipolar type

schizoaffective disorder, the patient experiences mood congruent with manic episodes and very

depressive episodes. Untreated schizoaffective disorder may lead to problems functioning at

work, at school and in social situations, causing loneliness and trouble holding down a job or

attending school. People with schizoaffective disorder may need assistance and support with

daily functioning. Treatment can help manage symptoms and improve quality of life. (Markota,

et al. 2019).

There are many signs and symptoms that could lead to the diagnosis of schizoaffective

disorder, bipolar type. Each patient varies in symptoms and may display at least a two-week

period of psychotic behavior. Signs and symptoms of psychosis in people with schizoaffective

disorder include false perceptions called hallucinations, such as hearing voices no one else can

hear or experiencing visions, smells, or tactile (touch) sensations. Strongly held false beliefs

(delusions) are also a characteristic feature. For example, affected individuals may be certain that

they are a particular historical figure or that they are being plotted against or controlled by others

(Cardano, et al). They may also experience periods of manic mood, with an increase in energy

and a decreased need for sleep over several days, and behaviors that are out of character. They

can have impaired occupational, academic, and social functioning, and problems with managing

personal care, including cleanliness and physical appearance (Markota, et al. 2019).

Schizoaffective disorder may be caused by different factors. Researchers have examined

the idea of genetics. Someone with this disorder may have a close blood relative with the same

disorder. Other causes may be stressful and traumatic events. This disorder can be developed

from repression of certain events and feelings. A person may develop hallucinations and
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

delusional thoughts due to the repression of anxiety and underlying conditions. Mind-altering

drugs may worsen symptoms of this disorder. Drug abuse and use can alter the way a person

thinks, therefor intensifying hallucinations.

Identification of stressors and behaviors precipitating current hospitalization

Prior to admission, P.M. had previously been a patient on the unit a week before. She was

noncompliant and not satisfied with her current medications. She was feeling very stressed and

anxious about her Adderall prescription and stated that it was being withheld from her. She was

using tarot cards and chanting religious tunes. She felt that angels were speaking to her. She also

felt that she was a rapper and the only way that she could talk was through rap. She stated that

her hallucinations were real and was not willing to speak of them. She had become suicidal and

made suicidal comments to her mother and EMS. She was expressing very manic behavior as she

was laughing and screaming hysterically. While in the BAC, she decided to place herself on

voluntary hold and recognized her need of help.

Patient and family history of mental illness

P.M. did not state her first time of being diagnosed with schizoaffective disorder. She is a

recurrent patient in the unit as well as Sunrise Mental Health facility. She has an extensive

history of psychosis and hallucinations. Patient stated that she was on multiple medications to

control her mood, including Adderall. She stated that she hallucinated for as long as she can

remember and blames her mother for raising her to believe in the delusional thoughts. P.M.’s

family history shows that her mother and father have history of mental illness, not specified.
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

P.M. currently lives alone in a trailer park due to the fact that her mother evicted her from

her home. She confirmed that her father lives in Florida. She blames many of her psychiatric

actions on her mother for preaching religious ideas to her as a young child.

Psychiatric evidence-based nursing care provided

During her stay on the inpatient unit, P.M. received nursing care from the mental health nursing

staff. P.M. was assigned a nurse each shift that she built a relationship with and brought any

concerns about her care to. Her nurse would then use the nursing process to assess, diagnose,

plan, implement and evaluate P.M. on a daily basis. The nurse would also administer daily

medications and ensure that P.M. was not pocketing her pills for later use. She was placed on

several mood-stabilizing medications. She was placed on anti-psychotic medications to control

her rapid mood changes. The nurses that provide care are aware of what the medications are used

for, typical side effects, and with the antipsychotic medications.

At first P.M. was very reluctant about joining the group and wanted to stay in her room

and sleep, however she decided to come out and talk. Individual cognitive behavioral

therapy and family-focused therapy can help individuals with schizoaffective disorder manage

and learn to cope with their symptoms. Group therapy helps decrease social isolation (Hurley,

2021). This individual was encouraged to P.M. to decrease her social isolation and therefore

decreasing her hallucinations. She attended group therapy sessions and even participated in

voicing her thoughts and opinions on the topics.

Ethnic, spiritual, and cultural influences

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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

P.M. is a single Caucasian woman that currently resides in a trailer. She in not employed

and is on disability due to her mental illness. P.M. states that she was brought up in an

unspecified religious household. She states that her mother believes in demonic presences. She

admits to frequently using tarot cards and believes in “energies” within people. She believes in

God, angels, and the practices of the Illuminati. Her hallucinations are often religious.

Evaluation of patient outcomes

Some outcomes were met by P.M. on the day of care. She was able to remain free from

harming themselves or others, perceiving themselves in a realistic manner and performing self-

care activities appropriately. On the day of care, P.M. showed no indications of thoughts of self-

harm and expressed excited and happy feelings. She was able to express her feelings of stress

and anxiety to me and how to use healthy coping techniques. She was able to state many positive

affirmations within her life and show an optimistic view on her discharge. She was able to

perform self-care activities, such as performing oral hygiene, showering, and wearing clean

clothing.

Some other outcomes were only partially met on the day of care, such as P.M.’s ability to

recognize distortions in reality and her perception of herself. She stated that she would continue

to experience hallucinations when she would leave the unit. She stated that she did not

experience hallucinations during her stay on the unit. She denied any voices and denied seeing

any unreal characters. She stated that she would become disorganized and feel the same when

she would be discharged. She would not fully meet this goal because although she did not

experience delusions while in the care of the unit, she expressed that they would return after

discharge. She continued to experience anxiety on the day of care.

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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Plans for discharge

There is no current active discharge plan for P.M. She may return to her trailer home or

attempt to move back in with her mother. She plans to visit her primary care physician to make

changes to her medication regimen. She is encouraged to attend group and personal therapy

sessions on a regular basis. She will be expected to continue her medication compliance.

Education material will be provided on her medications, possible side-effects, and adverse

reactions that can occur

Prioritized nursing diagnoses

The following are prioritized nursing diagnoses for LL:

1. Disturbed sensory perception related to psychological stress as evidenced by auditory

hallucinations.

2. Disturbed though processes related to mental illness as evidenced by non-realistic

thinking and delusions.

3. Anxiety related to discharge as evidenced by patient verbalizing worry over discharge

time and date.

4. Risk for suicide related to previous suicidal ideation and attempt, and hallucinations.

5. Risk for violence related to delusions and hallucinations.

6. Risk for self-harm related to delusions and hallucinations.

Potential nursing diagnoses

1. Ineffective coping

2. Ineffective activity planning

3. Impaired verbal communication

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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

4. Deficient diversional activity

5. Ineffective health maintenance

6. Impaired memory

7. Impaired individual resilience

8. Self-care deficit

9. Impaired social interaction

10. Social isolation

Conclusion

P.M. is a 28 year old female with a diagnosis of schizoaffective disorder, bipolar type.

This disorder is a mental health disorder that is marked by a combination of schizophrenia

symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression

or mania. The bipolar type of schizoaffective disorder may show symptoms of very energetic and

manic episodes, followed by very depressive and reclusive behavior. A patient with this disorder

may have severe self-care deficit, as well as being unable to become re-orientated with reality

and themselves. They may become dangerous to others if experiencing homicidal and suicidal

ideations.

P.M. experienced severe auditory and visual hallucinations on a daily basis, as well as

thoughts and feelings of self-harm. She experiences grandiose delusions that involve the spiritual

hallucinations. She is at risk for self-care deficit, as well as suicidal thoughts. P.M. has no

discharge plans yet, however, has many goals for when she leaves the unit. She plans to seek her

primary health care physician to adjust her medication regimen. She also plans on attending
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

group and personal therapy on a regular basis. She will recognize warning signs for an

exacerbation in her symptoms as well as when to seek care.

References

Article by: Katie Hurley. (2021, May 14). What is schizoaffective disorder & how can I treat it?

Psycom.net - Mental Health Treatment Resource Since 1996. Retrieved April 1, 2022, from

https://www.psycom.net/depression.central.schizoaffective.html

Markota, M. (2019, November 9). Schizoaffective disorder. Mayo Clinic. Retrieved April 1,

2022, from https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/symptoms-

causes/syc-20354504#:~:text=Schizoaffective%20disorder%20is%20a%20mental,such%20as

%20depression%20or%20mania.
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Cardano, A. G. (2020, August 18). Schizoaffective disorder: Medlineplus genetics. MedlinePlus.

Retrieved April 1, 2022, from https://medlineplus.gov/genetics/condition/schizoaffective-

disorder/#synonyms