PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

Psychiatric Mental Health Comprehensive Case Study

Kailee Shumaker

November 16, 2023

Dr. Teresa Peck, DNP, RN

NURS 4842L Mental Health Nursing Laboratory

Youngstown State University

PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

Abstract

The following case study focuses on CM, a 28-year-old Caucasian male patient admitted to the

inpatient psychiatric unit due to auditory hallucinations and nonsensical speech that started three days

before brought to emergency room. CM has a mental health diagnosis of acute psychosis with auditory

command hallucinations and delusions. Nursing care provided on the unit specific to CM consisted of,

pharmacological treatments such as antipsychotics, as well as non-pharmacological treatments such as

group therapies, spiritual care and re-orientation to reality.

PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

Objective data

Patient Identifier: CM

Age: 28

Sex: Male

Date of Admission: 11/7/23

Date of Care: 11/9/23

Psychiatric Diagnosis: Acute Psychosis

Other Diagnoses: Cerebral Palsy

Behaviors on admission: CM presented to the psychiatric unit with pressured speech and tangential

thoughts. CM was having auditory command hallucinations, stating that his ears are connected to the

Wi-Fi and people are telling him hurt himself through the Wi-Fi.

Behaviors on day of care: CM was isolative and kept to himself most of the day. when asked if he wanted

to talk, he was willing to talk with me and cooperative about it. CM was an active listener and

participated in both group activities as well as participated in spiritual care with the chaplain. CM was

not able to accurately tell me how many days he has been on the unit and the accurate reason of why he

was there. CM was having paranoid delusions along with an anxious mood, stating he was not allowed to

go back to his brothers house and that his brother does not want to speak to him or see him ever again.

CM was alert with nonsensical speech, avoided eye contact most time and gazed around, depressed

mood with delayed response and slurred/garbled speech, attention span was very low and showed signs

of a thought process of flight of ideas.

PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

CM’s Laboratory Results:

Lab’s Result’s
Potassium: 33
Glucose: 171
BUN: 9
Creatinine: 0.80
RBC: 4.40
Hbg/Hct: 13.5/38.8
Lymphocyte 18%
:
WBC: 4.53
TSH/T4: N/A
AST/ALT: N/A
Toxicology: Neg.
UA alcohol: Neg.
QTC/ECG: N/A

CM’s Psychiatric Medications:

Generic/trade classification route Dose/Frequency Reason pt.

name receiving RX
Risperidone Antipsychotic PO 1mg b.i.d Psychosis
Divalproex GABA inhibitor PO 250mg q12h Mania
(Depakote) b.i.d
Benztropine Antiparkinsonis PO 1mg b.i.d Cerebral
(Cogentin) m pasly/suppression
Agent/ of tremors &
Anticholineric rigidity

Safety and security measures: On the unit, throughout the day they do patient safety checks every 15

minutes by going around the unit and to each room to make sure everyone who is supposed to be on the

unit, is there. Staff implements safety and security by having scheduled, monitored visitations as well. All

of the exit and entry way doors are locked and monitored, there are alarms on the tops of the doors-

that will alarm if someone presses on them to prevent suicide by strangulation/hanging, patient phones

are on the wall with cords less than 12 inches long to prevent strangulation, patient gowns are without
PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

strings, drawstrings on clothing and shoelaces are prohibited. Pencils and pens are not permitted on the

unit- only markers and crayons for patient use. Staff on the unit, washes all clothing items on the unit to

prevent bed bugs as well as having all of the cupboards and cabinets locked- not permitted for patient

use.

Summary of psychiatric diagnosis

Acute Psychosis is also known as Brief Psychotic Disorder, an acute mental health condition

where there is a loss of contact with reality. The DSM-5 states that, brief psychotic disorder is the sudden

onset of psychotic behavior that lasts between one day and one month but not less than one day and

not more than one month with remission within one month and possible future relapses (Anu &

Forishing, 2023).

The diagnosis of brief psychotic disorder is made when there is a sudden onset of one or more of

the following positive psychotic symptoms: delusions, hallucinations, disorganized speech, or

disorganized behavior or catatonic behavior. For the diagnosis to be made- if one or more of those

symptoms are present, they cannot last more than one month. A diagnosis of “Psychotic Disorder- not

otherwise specified”, may be given prior to remission of the present symptoms. (Anu & Forishing, 2023).

Hallucinations are false/abnormal sensory experiences or misperceptions that do not really exist-

no external stimuli. Hallucinations can be any of the five senses: auditory hallucinations (hearing voices)

which is the most common type of hallucinations, visual hallucinations (seeing things that do not exist)

which is the second most common type, olfactory hallucinations, gustatory hallucinations and tactile

hallucinations. Patients with hallucinations do not recognize them as hallucinations, but as real

experiences to them.(Videbeck, S. L., 2022). Interestingly enough, you can have more than one type of

hallucination at a time. Command hallucinations are voices that one hears demanding that they take

action often to harm themselves or others.

PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

Delusions are fixed false beliefs that persist despite of evidence to the contrary.

Persecutory/paranoid delusions are the most common delusions. They involve the patients belief that

others are out to harm them, spying on them and/or following them. Most of the time the patient

cannot explain who those “others” are. “Clients with delusions of persecution are probably suspicious,

mistrustful and guarded about disclosing personal information” (Videbeck, S. L., 2022).

CM showed signs of auditory hallucinations by saying that his ears are connected to the Wi-Fi as

well as command hallucinations saying that the Wi-Fi is telling him to hurt himself. CM also showed signs

of paranoid delusions with an anxious mood and poor judgment stating that his brother put him in the

hospital because he did “something he was not supposed to do”- such as watch pornographic videos on

his brothers phone. CM also stated during our conversation that he had a friend who was now circling

the building after him.

Stressors and behaviors precipitating current hospitalization

CM was brought to the emergency room by his brother- stating that CM has been hallucinating

for 3 days prior to bringing him. CM lives with his brother and his brothers three young children in his

brothers home. It has been documented that his brother stated that, his main concern is his three

children in the home with CM. When asking CM about his brother- he kept saying that he has to find a

job now because his brother doesn’t want him back in the house or to speak with him ever again but

didn’t state any stressors with their relationship prior to this incident. During conversation with CM- he

would look out of the window and say words but it wasn’t clear as to what he was saying- when asking

him about it he said that he has a friend that he talks to here and there that only he can see and hear. He

stated that his “friend” has been around for a long time but just recently started hearing more voices

telling him to hurt himself- but this time it wasn’t his “friend” telling him to do that, it was the Wi-Fi. CM
PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

was involuntary admitted to the psychiatric unit for being a danger to himself and so gravely ill that he

cannot care for his basic needs.

Patient and family history of mental illness

According to CM’s electronic medial record- there was no history of mental illnesses as well as

no family history of mental illnesses. When asking CM about his medical history he described having

cerebral palsy all of his life and he is not aware of any mental illnesses or illnesses/disorders in general

within his family. CM lives with his brother and his brothers three young children in his brothers home.

CM is the youngest child of 3 children- he has an older brother whom he lives with and an older sister

that when asked about he responded with “I don’t know- haven’t talked to or seen her for years”. Both

of CM’s parents are deceased- but could not tell me how they passed or when they passed. CM

expressed having no relationships with any other family members besides his brother and brothers three

children.

Psychiatric evidence-based nursing care provided

While CM was on the psychiatric inpatient unit, multiple psychiatric evidence-based nursing

interventions and care was provided to him by the nursing staff. Some of the evidence-based nursing

care consisted of, but not limited to, patient safety checks every 15 minutes, vital signs, ensuring the

patient is safe, interacting gently with patients and speaking to them in a calm, slow manner. The

psychiatric inpatient unit also followed a structured schedule that had mealtimes on it, times for

visitation, times for group therapy- they also provided time for “rest and relaxation” where it would be

quiet on the unit as well as having the lights dim. Rest and relaxation was utilized by the patients by

coloring, walking around the unit with their new friends, taking naps, and talking with either the nurses

or other patients.

Ethnic, spiritual and cultural influences

PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

CM is a Caucasian, single male from a lower-middle class family. He is un-employed and relies on

his brother for financial assistance as well as disability from the state due to his medical diagnosis of

cerebral palsy. When we first arrived on the unit, CM was participating in a spiritual care lesson with the

chaplain. When asked how it went and what his feelings were on it- he replied “good”. CM did not

discuss much about his religion or any spiritual beliefs.

Evaluation of patient outcomes

Some of the expected outcomes for a patient with acute psychosis include but are not limited to,

showing improvement in their cognitive function, understand that hallucinations are not reality based,

remain free of injury and self-harm, incorporate techniques that improve social skills and have remission

within one month of symptoms. On the day of care, CM showed an improvement in his social skills by

attending and participating in two group therapy sessions as well as participating in spiritual care with

the chaplain. After group therapy sessions- he said he wanted to keep the handouts that were given to

him to better help him manage his thoughts. He was also able to carry on conversations with his nurse as

well as myself. CM remained free of injury and self-harm on the day of care. CM only partially met the

expected outcomes of an improvement of his cognitive function and understanding that hallucinations

are not reality based. While speaking with CM- he was actively hallucinating but understood that he was

the only one that could see and hear them.

Plans for discharge

CM’s plans for discharge is to discharge home with his brother with support form the city’s

county board of developmental disabilities. Per the EMR notes, his brother is working on guardianship

and considering placing CM in a day program to help him positively interact with others. Patient

education will be provided to CM regarding his medications, possible side effects & possible adverse

effects that can occur with his medications as well as given information regarding his diagnosis.
PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

Prioritized nursing diagnoses

Prioritized nursing diagnoses for CM:

1. Disturbed sensory perception related to altered sensory perception as evidence by auditory

hallucinations.

2. Impaired social interaction related to disturbed thought process as evidence by disorganized

speech and thought.

3. Risk for self-harm related to command hallucinations and delusions.

4. Risk for others-directed violence related to hallucinations and delusions.

5. Risk for social isolation related to disturbed thought process as evidence by delusional thinking.

Potential nursing diagnosis

Potential nursing diagnosis for CM:

1. Self-neglect

2. Impaired mood regulation

3. Risk for disturbed personal identity

4. Anxiety

5. Hopelessness

6. Impaired memory

7. Ineffective coping

8. Risk for suicidal behavior

9. Interrupted family process

PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

10. Impaired verbal communication

Conclusion

Acute psychosis is a transient mental health disorder characterized by a disconnection from

reality. It has a sudden onset of psychotic manifestations that lasts less than one month, potentially

followed by recurring episodes. Acute psychosis is often accompanied by hallucinations (false sensory

misperceptions that do not really exist) and delusions (fixed false beliefs). During an acute psychosis

episode, the patient may need hospitalized due to being a danger to themselves, to others and/or

cannot care for their basic needs due to the clinical manifestations of psychosis. An acute psychosis

diagnosis was new to CM, due to the fact that he has never experienced It up until the week he was

brought to the hospital for evaluation. CM had auditory hallucinations while also realizing he was the

only one who could hear them. Even though he was somewhat aware that he was the only one who

could hear them, he still couldn’t differentiate it between reality and non-reality. CM is at an increased

risk for a continuation of impaired social interaction, altered sensory perception and risk for self-harm

due to the auditory hallucinations, becoming commanding hallucinations. The goal for CM is to show

improvement in his cognitive function, understand hallucinations are not reality based and remain free

of injury and self-harm. With consistent follow up from the city’s county board of developmental

disabilities, regular psychiatric appointments and a possible day program to help positively interact with

others- CM should be able to have a better quality of life.

PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

References

Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2021).

Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I®

Updates - E-Book. Elsevier Health Sciences.

Calabrese, J. (2023, May 1). Psychosis (Nursing). StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK568796/

Schizophrenia Nursing Diagnosis & care plan. (2023, January 9). NurseTogether.

https://www.nursetogether.com/schizophrenia-nursing-diagnosis-care-plan/

Stephen, A. (2023, June 25). Brief Psychotic Disorder. StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK539912/#:~:text=Brief%20psychotic

%20disorder%20(BPD)%20according,remission%20with%20possible%20future

%20relapses.

Videbeck, S. L., PhD RN. (2022). Lippincott Coursepoint enhanced for Videbeck’s Psychiatric-

Mental Health Nursing.