Mood Disorder: Comprehensive Case Study

Mood Disorder: Comprehensive Case Study

Nicholas B Esmail

Youngstown State University

Mental Health Clinical

Elizabeth Sanford

November 28, 2023

Mood Disorder: Comprehensive Case Study

Objective Data
Patient identifier BA

Age 31

Sex Male

Date of admission: 10/28/23

Date of care 11/2/23

Psychiatric diagnosis Mood disorder

Other diagnoses Antisocial personality disorder, substance-induced mood disorder

Behaviors on admission: The patient was self-admitted to the psych ward because of an acute

period of auditory and visual hallucinations. BA has problems with perceptions, seeing, and

hearing things that are not there. BA stated that “he hears mumbling and sees shadows

sometimes.” BA also exhibited and showed evidence of negative ways of coping with stressors

in his life. BA relapsed on heroin after being clean for a period of six months. The patient

exhibited signs of depression and was off medication for multiple days before coming to the ED

due to not having the money to afford medications. The patient exhibited poverty of speech on

admission. BA has not been sleeping well due to being homeless and is very tired.

Behaviors on the day of care: BA was talkative and flat on the day of care but brightened with

conversation. His voice was calm, but he looked flat and anxious at times. The patient is still

currently having problems with his perception, evidenced by still having mild visual and auditory

hallucinations. While conducting my interview, I mentioned to BA that these hallucinations

were not real, even though the hallucinations felt very real to him. I asked the patient how he was

feeling about the new medication, and he stated, “I think they are helping a lot; I think they will

continue to work for me. I just don’t know how I’m going to continue to get these medications

when I leave here”.

Mood Disorder: Comprehensive Case Study

Objective data: The patient lives alone and is currently living in Youngstown. BA does not

currently hold a job and is unemployed due to problems stemming from substance abuse. To my

knowledge, BA grew up in Florida and still has family, such as his mother and father. He has no

children or serious relationships with a significant other. BA has never really had a real job

besides landscaping. When he lived in Florida, he spent most of his life living with his parents,

relying on them for support. BA’s general appearance exhibited that he was clean and

surprisingly well-groomed for his age despite being homeless. He appeared to have a few bruises

and tattoos on his arms. In terms of BA’s emotional state, he was slightly depressed due to being

homeless, relapsing, and feeling alone. He did, however, realize that he needed to seek help. He

mentioned that he wanted to be compliant with his medications while in the hospital and seek

rehabilitation upon his release from the hospital. BA had some problems with being attentive

and easily getting distracted. Moving from one subject to another, with trouble focusing on one

topic at a time.

Safety and security measures

During the admission, safety checks were done around the clock every 15 minutes via

face-to-face monitoring incorporating the use of a tablet. Furthermore, the patient was in a

locked unit and was not permitted off. The patients also had their belongings that could be used

as a device to harm themselves or others temporarily removed. BA was on suicide precautions

and was at risk for elopement. The staff was always present in the common area. In terms of

medications, the medication nurse administered the medications and confirmed that they were

taken at the scheduled time of administration. The main goal was to get him back on a

medication regimen that he could follow to help control some of the symptoms he was

experiencing and for him to understand that what he was hearing and seeing were hallucinations
Mood Disorder: Comprehensive Case Study

caused by not taking medication for his illness and chronically abusing substances. Managing

stress and anxiety with new coping strategies and distraction helped BA get his mind off what

was happening and seemed to make him brighten up on the day of care and be social enough to

perform my interview.

Laboratory results

Lab Value Result

Glucose 77

A1C 5.5

TSH n/a

T4 n/a

RBC 3.95

Hbg 11.7

Hct 35%

WBC 10.2

BUN 14

Creatinine 0.7

Sodium 138

Toxicology Fentanyl, Cannabis, Buprenorphine, Amphetamine

Potassium 4.1

Although there were no laboratory results for my patient’s T3 and T4 levels during my day of

care, elevated TSH levels can be one of the reasons for his depression - hypothyroid signs and
Mood Disorder: Comprehensive Case Study

symptoms are very similar to depression. The patient also tested positive for fentanyl, cannabis,

buprenorphine, and amphetamine. This is very important to note due to the potential of drug-to-

drug interactions and also because drug use can significantly affect and alter a patient's mental

health and well-being.

Psychiatric medications

Generic Name Trade Name Class/Category Dose/Frequency Reasoning

Divalproex Depakote Gaba-Inhibitor 250 mg Dx mood

CNS Agent disorder

Nicoderm CQ Nicotine Smoking 21 mg Nicotine

Deterrent withdrawal
CNS Agent

Olanzapine Zyprexa Antipsychotic 5 mg Pscyh disorder

CNS Agent management

Summary of psychiatric diagnosis

Mood disorder, also called affective disorder, can be any group of mental conditions that

can be characterized by persistent disturbances of mood, including symptoms of depression,

euphoria, mania, or a combination of these. They can interfere with a person's daily life because

of the pervasive alterations in mood manifested by depression or mania, causing one to feel

plagued by long-term sadness, agitation, or elation. Other accompanying symptoms include self-

doubt, guilt, lack of motivation, and trouble with socializing and occupation. Mood disorders are

the most common psychiatric diagnosis associated with suicide; depression is one of the most

important risk factors for it (Black & Adreasen, 2021).

The primary mood disorders are major depressive disorder and bipolar disorder

(Black & Andreasen, 2021). A major depressive episode lasts at least two weeks, where the
Mood Disorder: Comprehensive Case Study

person experiences a depressed mood and loss of pleasure in almost all activities. Other

symptoms may include feelings of worthlessness, guilt, change in eating habits, hopelessness,

hypersomnia or insomnia, impaired concentration, difficulty making decisions, or thoughts of

death/suicide. Bipolar disorder is diagnosed when a person experiences fluctuations in mood

involving extreme depression or mania. Bipolar disorder is also categorized into Type 1 or Type

2. In BA’s case, he does not yet have a diagnosis of major depressive disorder or bipolar disorder

but has been experiencing several symptoms of depression. Upon the date of care, BA expressed

feeling hopeless and depressed and also mentioned having thoughts of suicide.

BA also mentioned having auditory and visual perceptions. Patient BA has a history of

drug abuse, which may contribute to these symptoms. Furthermore, BA has lost pleasure in daily

activities and recently relapsed this year after being clean for six months.

According to the text from “Hallucinations in Psychosis and Affective Disorders,”

Currently, the abuse of substances with psychotomimetic properties, such as

cocaine, amphetamines, hallucinogens, ketamine, and cannabis, represents one of

the main causes of hallucinogen perception disorders(Brambilla, 2018).

In BA’s case, he does not show severe symptoms of hallucinations or psychosis that

would lead to a diagnosis of schizophrenia but is most likely dealing with these perception

problems as a result of prolonged drug abuse. He has been placed on anti-psychotic and GABA

inhibitor medications to help reduce these symptoms. In addition, BA was placed on suicide

precautions due to his ideations and thoughts of suicide in the past.

Identify the stressors and behaviors that precipitated current hospitalization

Mood Disorder: Comprehensive Case Study

Prior to BA’s admission, he had relapsed on drugs after six months of sobriety. BA also

was feeling symptoms of depression and mood swings. He has not been in contact with any

family or siblings, so he was feeling very isolated, which most likely exacerbated his depression

symptoms. BA could also have been hypersensitive to the feeling of being alone because he had

recently moved to Ohio from Florida and most likely does not know anyone here. He also had no

source of income or shelter, which is another significant stressor for him because he had no way

of providing for himself and his daily needs. BA was hearing mumbling and seeing shadows

that were not real. However, these hallucinations and other symptoms ultimately led him to self-

admit himself to the St. Elizabeth psych ward in Youngstown for treatment.

Patient and family history of mental illness

I asked BA if he had any previous mental illness diagnoses, and he said he had a previous

diagnosis of mood disorder and substance-induced mood disorder. BA has struggled with

substance abuse issues for most of his life and also mentioned how he has felt feelings of

depression for quite some time. He mentioned the longest he went without using drugs was about

two years, and this year, he went six months without drug use before relapsing again. BA also

has a recent diagnosis of antisocial personality disorder as of November 2nd of this year.

BA does have a family history of mental illness; his mother and sibling have been

previously diagnosed with major depression disorder, so he is not the first in his family to

struggle with mood disorders. In addition, his mother also has a history of anxiety. My patient

BA did not mention his father or any spouses. My patient also told me he has not been in contact

with any family recently. He did not mention the last time he spoke with anyone in his family.

Psychiatric evidence-based nursing care provided

Mood Disorder: Comprehensive Case Study

During my patient’s stay on the unit, BA was given nursing care by myself, Youngstown

state nursing students, and the psych unit floor staff. During my patient’s stay at the hospital, he

was being treated with medications such as Divalproex, Olanzapine, and Nicoderm CQ. These

medications were all used to help my patient with his mental diagnosis and hopefully control

most, if not all, of the symptoms BA was exhibiting upon admission. Divalproex is an antiseizure

medication that relaxes the brain from hyperstimulation. Olanzapine is an atypical antipsychotic

medication that is used to help manage positive and negative symptoms caused by BA’s

diagnosis. BA mentioned he was seeing shadows and hearing mumbling, so he was most likely

put on this medication to help manage these symptoms he was experiencing involving

hallucinations. The nurses and I educated BA and ensured he understood his medications and

why he was taking them. The med nurse also made sure he was swallowing his oral medications

and not saving them for later.

An additional therapeutic approach involves participating in daily group sessions. These

sessions are facilitated by nurses, social workers, and occasionally nursing students, creating an

environment that encourages patients to engage in conversation and socialize. BA consistently

attended these groups, displaying enthusiasm and increased engagement when given the

opportunity to speak or respond to questions compared to most patients who would avoid

conversations and even group sessions as a whole.

Ethnic, spiritual, and cultural influences

BA is Arabic and grew up in South Florida, living there most of his life. BA mentioned

he was also involved in a lot of partying while living in Florida. He said when in Florida, he

would work many side jobs, mainly landscaping. BA recently moved from Florida to Ohio but

did not tell me an exact date. BA explained how he came here looking for a better source of
Mood Disorder: Comprehensive Case Study

income, but due to his drug use, he has been unable to obtain a stable or long-term job, leaving

him unemployed and homeless. My patient mentioned he had been to jail before, and while

there, the cultural shock of the new environment also impacted BA greatly, so much so that he

made a suicide attempt. BA said he is Christian but does not practice his faith regularly. When I

asked about his spirituality, he did not talk much about it but did say what he practiced. He

mentioned that growing up, he would occasionally attend church.

Evaluation of patient outcomes

Patients with mood disorder diagnoses do have a possibility to recover from their

symptoms, improve in self-care, and remain free from self-harm. As stated in a journal about

patients with mood disorders and their treatment, “Many evidence-supported therapies are

available, but success requires persistence. For example, antidepressant medication regimens

work slowly, and the likelihood of full remission with a first antidepressant medication may be

only 30% after 6–12 weeks of treatment.”(Cordner, Z. A., MacKinnon, D. F., & DePaulo, J. R.,

Jr 2020). These diagnoses are also more challenging to overcome because the treatments rely on

patients' compliance. However, with the correct treatment and combination of medication and

therapy, there is a gratifying hope for the patient to feel relief as long as they stick to their

treatment plan. Also mentioned in the journal, “Absent other complicating factors, an ambulatory

patient who does not respond to the first antidepressant can hope to improve with a combination

of medication and psychological intervention”(Cordner et al., J. R., Jr 2020).

BA has been able to feel some relief from his symptoms while in the treatment center by

getting on a different medication regime. The main goal is for him to understand his illness, be

compliant, and stick with his treatment plan until he is transferred to a continued care facility.

My patient BA did meet the goals of going to the group, caring for himself, using healthy coping
Mood Disorder: Comprehensive Case Study

strategies, and being compliant with his new medication. On the day of care, he did not have any

thoughts of death or suicide and had no plans of doing so. He also mentioned he still has feelings

of loneliness and depression because of “just life” but thinks the medication is helping. With the

new medication plan, he should continue to feel relief and, over time, have less frequent thoughts

like these. BA also understands his hallucinations are not real and knows with the medication, he

should expect a decrease in those as well.

Plan for discharge

BA’s plan for discharge is to be discharged to a rehabilitation or continued care facility in

Youngstown called Meridian Community Care since that’s where he’s currently living. At this

facility, they specialize in the treatment of substance abuse and mental health issues. BA plans to

get clean and get back on his feet to try and live a better life free from substances. The facility

will help my patient detox and hopefully help him accomplish his goal. The facility is filled with

a great staff of nurses, nurse practitioners, social workers, and even doctors who are driven to

help all patients who walk through their doors. I believe at Meridian, BA will learn about his

new medications and start the detoxification process to get his life back on track. After his stay

here, BA wants to try to get a job to afford to stop being homeless.

Prioritized List of Actual Nursing Diagnoses

The following is a prioritized list of diagnoses from highest to l et al.rrent attempt as evidenced

by current and previous attempts and ideation.

1. Risk for self-harm as evidenced by a previous suicide attempt.

2. Risk for violence against others as evidenced by unseen others

3. Disturbed thought process as evidenced by unseen others.

Mood Disorder: Comprehensive Case Study

4. Disturbed sensory perception related to polysubstance use

5. Risk for injury related to destructive behaviors as evidenced by polysubstance use.

6. Impaired social interaction related to social isolation.

7. Risk for elopement

Potential Nursing Diagnoses

1. Self-care deficit

2. Ineffective coping

3. Fatigue

4. Risk for loneliness

5. Impaired social interaction

6. Risk for violent behavior

7. Fear

8. Ineffective impulse control

9. Risky behaviors

Conclusion

Mood disorder is a complex disease that needs to be treated in many ways, including not

only medications but also counseling and therapy due to exacerbations. Typically, these

exacerbations arise from the patient's failure to adhere to prescribed psychiatric medication and

concurrent polysubstance abuse. In BA’s case, the main reason he is at the psychiatric unit is

because he admitted himself due to wanting to seek help after getting out of prison. BA was

experiencing symptoms like restlessness and feeling lonely and was also experiencing visual and

auditory hallucinations prior to admission. He was also not on any medications before admission
Mood Disorder: Comprehensive Case Study

to combat these symptoms and was also a polysubstance user. The absence of medication can

lead patients to pose a threat to themselves or others as they experience hallucinations and

endure overwhelming feelings of loneliness, prompting self-harm urges. Individuals with mood

disorders also exhibit deficits in social communication and self-care and face communication

barriers during these exacerbation phases. Consequently, hospitalization is necessary until they

are reoriented with reality. Through education provided by both the hospital and the inpatient

care facility, BA is expected to regain orientation and adhere to a medication regimen. Effective

treatment can manage these exacerbations, potentially enabling him to secure employment and

transition to a new life, offering a fresh start aligned with his desired way of living.