Mental Health Case Study

Justin Marrie

Student of the Nursing Program at Youngstown State University

NURS 4842: Mental Health Lab

Elizabeth Stanford RN

February 29th, 2024

 Abstract

The following case study describes the disease process of a patient with schizoaffective disorder

as well as the treatments and care provided. A.K. is a 27-year-old male patient admitted to the

inpatient psychiatric unit following a suicide attempt. He experiences symptoms from major

depressive disorder as well as his primary diagnosis of schizoaffective disorder. His medication

treatments include antipsychotics, antihistamines, and anticonvulsants. This medication regimen

has his symptoms under control, and he is functioning at his baseline again. Nursing care

provided while he was there focused on symptom relief through pharmacologic methods, as well

as therapeutic group sessions.

 Objective Date

Patient Identifier A.K.

Age 27

Sex Male

Date of Care: February 15, 2024

Psychiatric Diagnosis Schizoaffective Disorder

Other Diagnosis Anxiety, suicide attempt, major depressive disorder

Behaviors on Admission A.K. made a 3cm cut on his left wrist with a knife in a suicide attempt.

He waited 6 hours after the cut to come to the emergency room. When the nurse asked why he

was bleeding, he stated, “The cut is nothing,” in an attempt to blow it off. Nurses asked him why

he cut himself, and he said, “I am very sad”. He also stated “I want to meet Ala” which is the god

of his Muslim religion.

Behaviors on Day of Care: A.K. was calm and quiet, sitting by himself most of the day. He was

willing to speak openly when asked questions. With English being his second language, it made

communication harder than expected. He was very friendly and participated in the group therapy

for that day. A.K. was anxious about leaving that day because he could not understand the

discharge papers and stated that the interpreter did not have his language. A.K. had heavily

accented speech but answered orientation questions correctly. He explained that cutting himself

was terrible, but he had good thoughts now and a positive outlook. He overall had a depressed

affect, very quiet and hesitant while using hand gestures to make sure I could understand what he

meant.

Safety and Security Measures A.K. was pink-slipped due to the suicide attempt. He was held in

the psychiatric unit for at least three days without being able to leave the unit until after he had
been discharged. Staff was present to watch over the patients at all times in the Milieu. All

potentially harmful items like razors, shoelaces, pens, and pencils were prohibited on the unit;

only markers and crayons were allowed for writing and drawing. The nurses also verified that all

medications were taken during administration by having the patient open his mouth to ensure the

pill was swallowed.

Lab Results

Lab Value Results

K+ 3.7

Glucose 94

Hgb/Hct 15.8/44.1

BUN/Creatinine 13/0.7

RBC 5.3

WBC 9.2

AST/ALT 15/17

QTC 400

Toxicology Negative

A.K. was not using any substances not prescribed to him. His labs showed he is a healthy 27-

year-old male with no lab values outside of the normal ranges.

Psychiatric Medications

Generic Name Classification Route Dose/ Frequency Reasoning

Depakote Anticonvulsant Oral 250mg/ Bid Treats bipolar

Invega Antipsychotic Oral 3mg/ Bid Schizoaffective

disorder
 Hydroxyzine Antihistamine Oral 50mg / Tid PRN Anxiety

A.K. was on minimal meds with low doses. This allowed his thinking to improve and realized

that cutting himself was a bad decision.

Summary of Schizoaffective Disorder

Schizoaffective disorder is a mental health disorder where the patients can show signs of

schizophrenia-like hallucinations and mood disorder symptoms like mania and depression. There

are two types of schizoaffective disorders. A bipolar type, which means the patient has more

episodes of mania than major depression. A.K. presents with the depressive type; this is where

the patient only has episodes of major depression (“Schizoaffective disorder,” 2019). These

symptoms can often lead to loss of job. Luckily for A.K., he works for DoorDash, which means

he can come and go as he pleases and does not have a direct boss who can fire him. This job,

along with his diagnosis, also makes feeling alone very common. He does not speak English very

well, he has a job where driving a car around town is all he does, and he has multiple mental

health disorders. These all came together and made him not want to live anymore.

To be diagnosed with schizoaffective disorder, the depressive type, you must show these signs

and symptoms. One criterion is to have a major depression episode, which he did by cutting

himself. Then, the patient must also have two weeks of psychotic symptoms, not during the

major depressive episode. Although A.K. did not show the psychotic symptoms while in the

hospital this time, he might have had the psychotic break while in one of his other stays at a

psychiatric unit. Other signs and symptoms that are very common are Hallucinations, impaired

communication, bizarre actions, or self-worthlessness, to name a few (“Schizoaffective

disorder,” 2019).
 Schizoaffective disorder is still being studied as to why someone might get the disorder.

It is thought to increase your chances of having it if you have a close-blooded relative who also

has mental health problems. Stressful events in someone’s life are thought to be a significant risk

factor for becoming depressed. A.K. moved to America when he was 19 with his parents,

brother, and sister. He came over not knowing much of the English language. He tried teaching

himself by watching T.V. shows and movies. He would also use a translator app on his phone.

His parents have since divorced; his mother lives in Michigan, and he does not get to visit much.

He lives with his brother and brother’s girlfriends and visits his dad regularly.

Another common symptom of schizoaffective disorder is suicidal ideation. A.K. likes his

home country of Yemen better than the U.S. He states that the food and culture are better, and

the rest of his family still lives there. He cut himself and said the reason he did it was because he

was so sad. He told the nurse his depression was a 10/10 on the day he was admitted.

Stressors and Behaviors that Precipitated Hospitalization

A.K. has been treated before with a hospitalization in Virginia. This is where the doctor

put him on a shot of Invega 546mg every three months. The current episode of depression

happened less than one month before his next dose. It could mean that it is no longer a large

enough dose to keep the symptoms away. He also said in the interview that he works seven days

a week and is very tired. He said he needs to work that much because he needs the money and

has nothing else to do. He makes his schedule as a DoorDash employee but stated he works from

9 am to 6 pm daily. He vapes a lot because he does not want his car to smell like cigarettes. He

also drinks multiple cups of coffee and tea to keep him awake during the day. This, along with

being alone every day in the car, could have increased his depression symptoms, which could

have ultimately led to this hospitalization.

 Patient and Family History of Mental Illness

A.K. has had mental health issues for many years now. He stated that this is his fifth time

in a mental health facility. He could only tell me that he was in the other facility from being sad.

He did not understand the question have you had another suicide attempt besides this one?

Virginia is the only place on the chart that showed he got medication prescribed. That was his

most recent hospitalization prior to this one. He stated in the interview that he lived in California

and Texas when he first moved to the US when he was 19. He stated he was in a hospital in

Texas for his mental health, but he could explain what for. This is his first time on this unit in

this hospital. To his knowledge, there is no other family member with mental health issues. He

also comes from a Middle Eastern family, which tends not to share many personal problems with

others.

Psychiatric evidence-based nursing care provided

During his stay in the inpatient unit, A.K. received nursing care from the mental health

nursing staff. A.K. was assigned a nurse each shift to talk to about any problems or concerns he

had. His nurse would then use the nursing process to assess, diagnose, plan, implement, and

evaluate his current condition on the day of care. The nurse would also administer daily

medications and ensure that A.K. took all the tablets when they were given and not pocketed for

later use. A.K. was placed on antipsychotic medications. Along with a mood stabilizer and an

anxiety medication to help treat all of his symptoms. The nurses caring for A.K. knew what the

medications were used for, the typical side effects, and how the medication should improve his

condition.

A study in Finland found that schizoaffective disorder is rare. Only 3 out of every 1000

people have it, which is just 0.3% of the population (“What is Schizoaffective Disorder?”, 2023).
It is also a challenging disorder to diagnose because of how many of the symptoms overlap with

other diagnoses. The most common way to diagnosis schizoaffective disorder is to eliminate

other diangnoses first (“What is Schizoaffective Disorder?”, 2023). Common ways of treatment

are medications and therapy. Therapy with a consoler is helpful because it can be personalized.

They can teach the patient about their disorder and ways to help their quality of life. Skills like

establishing personal goals and managing everyday challenges will help the patient cope with the

symptoms.

Another aspect of treatment that was utilized in this unit was group therapy. Every patient

is encouraged to participate in group therapy. It is a way to express emotions and talk about what

is happening to them. A.K. seemed to only participate in a few group therapy activities. It was

hard for him to understand the purpose of it. He needed the therapy, but we could not provide it

to him in the exact ways that would benefit him the most. They also have a set schedule, like

when visitors are allowed, times to eat, and times to sleep. This takes stress off of the patients

because they do not have to make any decisions for the time they are in there.

Ethnic, spiritual, and Cultural Influences

A.K. is Middle Eastern and came over to America from Yemen when he was 19. In

Yemen, he practiced the Muslim religion, which has influenced many decisions in life. He

considers himself religious. Upon coming to the E.D. the night of his admission, he did this to

see Ala. Which is the god in the Muslim religion. It is forbidden to commit suicide in the Muslim

culture. He was not able to explain why he wanted to meet Ala. During the interview, he

verbalized that he was not thinking right back then and thinks much better now.
 Evaluation of Patient Outcomes

Some of the desired outcomes for patients with schizoaffective disorder are to keep

attending therapy, whether it is group or individualized, stay in contact with your provider, and

take medications as prescribed (“What is Schizoaffective Disorder?”, 2023). This is a lifelong

disorder and can not be cured. The main goal is to keep symptoms low and reach out to get extra

help before suicide is thought about. This disorder also tends to make activities of everyday life

harder. So, we want him to have good hygiene and continue to be able to eat appropriately.

A.K. was able to recognize that his thought process was wrong at the time of admission and

verbalized that this is the last time he wants to be in a hospital, with his depression being a 10/10

on admission. He has made significant improvements because, on the day of care, it was only a

3/10. He believes the medication is the reason he is starting to feel better.

Plans for Discharge

A.K. was discharged on February 15, 2024, the interview day. He was being discharged

to his home, where he resides with his brother and his brother’s girlfriend. His brother was there

to pick him up on the 15th. The staff decided he did not need long-term care, and this was just a

quick episode. A.K. was discharged with instructions on how and when to take the medications.

Education material on possible side effects and adverse reactions was also provided. He was

encouraged to attend regular appointments with a consoler to continue growth in his mental

illness. A.K. understands that staying on the medication regime is essential to staying healthy in

the future. Education material was provided on his medications, possible side effects, and

adverse reactions that can occur.

 Prioritized Nursing Diagnoses

The following are prioritized nursing diagnoses for A.K.:

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

thinking

2. Anxiety related to discharge is evidenced by the patient verbalizing not understanding the

discharge paper and medication instructions.

3. Risk for suicide related to previous suicidal ideation and attempt

4. Lack of motivation for ADLs due to severe depression

5. Impaired social interaction is evidenced by language barrier and depression symptoms.

6. Ineffective coping due to the suicide attempt.

7. Spiritual distress from the state in the E.D.: “I want to meet Ala.”

Potential Nursing Diagnoses

1. Interrupted family process

2. Fatigue

3. Ineffective impulse control

4. Hopelessness

5. Ineffective activity planning

6. Reduced emotional expressions

7. Lack of motivation

8. Impaired cognition

9. Social isolation

10. Impaired decision-making

 11. Sedentary lifestyle

Conclusion

Schizoaffective disorder is a complex disease that comes with exacerbations and

remissions. This is often associated with noncompliance with medications. During the

exacerbations, the patient seemed to experience severe depression and hopelessness. He saw no

way out and thought meeting Ala was the only way. The patient becomes a danger to themself,

and his risk of a suicide attempt is much higher since he just recently had an attempt. Another

complication of his case is the communication barrier because it is there regardless if he is in a

exacerbation or remission. All the skills taught in the unit and the discharge teaching set A.K. up

for success. With medication compliance and keeping up with his appointments, we should be

able to prevent another attempt at taking his life. With this regular and consistent treatment, we

should lessen the exacerbations, and A.K. should have a better quality of life.
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Professional, C. C. M. (n.d.). Schizoaffective disorder. Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/21544-schizoaffective-disorder

Schizoaffective disorder - Symptoms and causes - Mayo Clinic. (2019, November 9).

Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/

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