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Jessica Woods

Mental Health Case Study

Youngstown State University

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Abstract

A large population of people in the United States are being diagnosed with Mental Illness. Many

family members do not understand this diagnosis or are unable to notice the signs and symptoms

that come along with mental illness. The patient V.R. is diagnosed with Depression and Bipolar

1 Disorder. Leading up admission on the psychiatric floor the patient exhibited signs of suicidal

ideation. Symptoms of Bipolar disorder can be hard to recognize because they are constantly

changing. Education is very important when it comes to any mental illness. There is a still a large

stigma on mental illness even though it is becoming more understood in our world today.
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Objective Data

The patient is a fifty-six-year-old female that presented to the emergency room on

Wednesday February twelfth for suicidal ideation with a plan to overdose. The patient had

recently moved from Tennessee to Youngstown. The man she had been living with tried to force

her to have sexual interactions. The patient did not file a police report, nor does she intend to do

so. She stated that she was not actually raped and she has no place to live. The patient then stated

“I’d be better off dead.” She attempted to overdose on Gabapentin and Motrin, however was

stopped by a friend and voluntarily brought herself to the emergency room.

The patient voluntarily admitted herself to the mental health floor from the emergency

department to get some help on February twelfth. To begin our conversation on my day of care

February fourteenth, we talked about things like family, work, education, likes and dislikes that

she had. This got us to begin developing a rapport and the patient felt comfortable opening up to

me. The patient told me that she studied psychology at the University of Cleveland but did not

graduate. She needed to make money so she became a truck driver and went to many different

states before quitting that job and settling in Tennessee where two of her children lived. She then

made the move to Youngstown to be closer to where she grew up and to get a new start. While

talking with the patient, it was not noticeable at all that she had a diagnosis of depression or a

history of bipolar disorder.

The patient had no medical diagnoses when coming into the hospital. However, she does

have a history of cocaine abuse and upon arrival of the emergency department was tested for that

in her system. The results came back positive. Treatment for the patient included group therapy

and individual psychotherapy. While talking to the patient about the psychiatric floor we talked

about how she had seen the psychiatric doctor and some of the medications they had put her on
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during her stay there. The patient was on Abilify for depression, Cogentin for drug induced EPS

symptoms, Neurontin for anxiety, Haldol for bipolar disorder, Ativan for anxiety and Zoloft for

depression. Two of the medications every patient on the floor is prescribed are Cogentin and

Haldol. Cogentin can cause tardive dyskinesia and if this occurs the medication must be

discontinued and the health care provider must be contacted immediately. Haldol is prescribed as

needed for everyone on the unit for agitation and aggression.

The DSM IV is not used at this facility however Axis 1 would be the psychiatric

diagnosis of major depressive disorder and bipolar 1 disorder.

Summarize

According to the Mayo Clinic, major depressive disorder is very common and there are

about 3 million cases in the United States. May clinic also states:

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest.

Also called major depressive disorder or clinical depression, it affects how you feel, think and

behave and can lead to a variety of emotional and physical problems. You may have trouble

doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

To be diagnosed with depression the doctor will do a physical exam, lab tests (including a

CBC and thyroid testing), psychiatric evaluation, and the DSM-5. More women than men are

diagnosed with depression (Mayo Clinic, 2018). Signs and symptoms differ between patient but

most commonly seen are feelings of sadness, fearfulness, emptiness, or hopelessness. Angry

outbursts, loss of interest in most or all normal activities, sleep disturbances, tiredness and lack

of energy, anxiety and agitation, weight loss or weight gain, feelings of worthlessness, guilt,

trouble concentrating, frequent or recurrent thoughts of death, suicidal thoughts or suicide

attempts.
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Treatments for depression stated by Mayo clinic include medications and psychotherapy.

Some common medications include SSRIs, SNRIs, Atypical antidepressants, Tricyclic

antidepressants, MAOIs, and a variety of other medications. Along with therapy, there are other

treatments that have been used as brain stimulation therapy, including, Electroconvulsive therapy

and transcranial magnetic stimulation.

Identify

Although it isn’t stated, the current hospitalization is partially precipitated by cocaine

abuse because the patient was positive on admission. The main stressor that could have led to the

overdose attempt was the man she lived with trying to force her to do things sexually. Along

with that stress, the patient had stress from her recent move, not being able to find work yet upon

moving here, and not having a huge support system here.

Discuss

The patient has a history of cocaine abuse and bipolar 1 disorder. The depression has lead

to suicidal ideation with a plan to overdose. After being in the hospital on the psychiatric unit the

patient has fleeting suicidal ideations with no plan. The patient is aware of her substance abuse

problem and with new stressors such as what she went through with the man she lives with, it

caused her to go back to using cocaine. The patient stated there is no history of depression or any

other mental illness that she knows of in her family.

Describe
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St. Elizabeth in Downtown Youngstown has a psychiatric unit that provides an excellent

milieu. The floor is clean and organized with limited distractions. There are two sides to the unit,

one is adult and one is geriatric. There is a scheduled posted everyday of when important things

are such as group times, meal times, and visiting hours. Starting at about 8:30am a morning

group or staff member will come to the center of the lounging area and ask each patient a goal

for that day that they would like to achieve and they also explain the days’ groups and schedule

of starting times for the groups.

The layout of the floor is a big rectangle, with rooms down both sides. The middle

includes the lounge/community area, nurses station, and a dining area. They also have some

exercise equipment in the community area. Group takes place in the back side of the floor in two

private rooms. While sitting in the community area, patients have options such as watching

television, coloring, talking to other patients, exercising, or using the phone to call family or

friends. This is a nice open room and allows the staff to keep a good visual on the patients.

However, if patients do decide to go in their room or hangout in their room during the day, the

nurses must round on them every fifteen minutes to be aware of what they are doing.

Unlike any other floor, the hospital rooms are set up in a completely different manner.

Everything such as the bed, nightstand, etc. is heavy and bolted to the ground. This prevents

patients from being able to throw objects. The bathroom door is thick, with a slanted top so that

patients cannot attempt to hang themselves. The bathroom features automatic toilets and hand

motion sinks and non-glass mirrors to prevent them being broken and used as weapons. All

patients are required to remove any strings, shoe laces, belts, or other items from clothing that

could be used to harm themselves.

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Analyze

During my conversation with the patient, she did not discuss any cultural, ethnic, or

spiritual influences that impacted her or her decisions that brought her into the hospital. The

patient may want to explore spiritual influences to deal with depression in a positive way, but it

is not required as a treatment for this mental illness.

Evaluate

During my day of care with the patient, she was going on her third day of being on the

unit. She had a list of goals which included making better decisions, finding activities that she

enjoyed doing, and reducing her suicidal ideations. The patient stated that meeting these goals

was going to help her better deal with her diagnoses and live a happier, more fulfilling life. The

patient went to every group and said that she was benefiting greatly in certain ones because they

allowed her to express herself but also see others going through similar situations. One thing that

was a bit concerning was that she did mention she was going to groups at the beginning just to

go home quicker, however after talking to her about the groups and her stating how much they

had been helping, the group treatment had started to be more of a benefit in managing her

diagnoses rather than getting to go home.

Summarize

There were no definitive plans for discharge on the day of care, however there are a few

things that may benefit the patient after discharge. The patient said she planned on returning to

her counselor that she saw every couple of weeks for individual therapy, she stated she had not
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gone in quite a while before coming into the emergency room but it did make her feel better

when she was going. Another thing she may want to consider is an outpatient facility or

outpatient groups that she can continue to go to. A follow-up appointment with the psychiatrist to

talk about how the medications are working for the patient is also a very important thing to be

done after discharge. Finally, the patient should find a positive coping strategy to keep her from

going back to cocaine. Maybe going to a group specifically for substance abuse can help her to

maintain abstinence from this.

Prioritized Nursing Diagnosis

1. Ineffective coping related to substance abuse an evidenced by patient stating “I have a

history of cocaine abuse and evidence of testing positive for cocaine upon admission

2. Self-harm related to depression as evidence by suicidal ideation

3. Chronic low self-esteem related to feelings of shame and quilt as evidenced by negative

view of self and abilities

Potential Nursing Diagnosis

1. Risk for impaired social interaction related to lack of support system as evidence by

living far away from family, not being comfortable with roommate

2. Risk for Disturbed thought processes related to severe anxiety or depressed mood as

evidenced by impaired judgement, perception, or decision making

3. Risk for Self-care deficit related to severe anxiety as evidenced by persistent insomnia.

Conclusion
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In conclusion, the patient V.R. seemed to have been in a good place on the day of care

and was awaiting discharge. She was able to gain some good coping skills and tools in group

therapy that would be used in the future to help with her diagnoses of depression. She also

seemed to be in a better head space about what she needed to do for living situation to be able to

feel safe and comfortable. She was in good spirits about her stay on the unit and expressed how

beneficial it was to her, although she was ready to be discharged. Overall, the unit was a very

positive thing for the patient and it gave her some insight into how to effectively deal with her

diagnoses in a healthy way.

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References

Depression (major depressive disorder). (2018, February 03). Retrieved from

https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

Depression in the United States-an Update. (n.d.). Retrieved from

https://www.psychologytoday.com/us/blog/demystifying-psychiatry/201808/depression-in-the-

united-states-update

Depression: A Symptom, Not a Disorder. (n.d.). Retrieved from

https://www.psychologytoday.com/us/blog/matter-personality/201712/depression-symptom-not-

disorder

Jules Angst. (2013, August 23). Bipolar disorders in DSM-5: Strengths, problems and perspectives.

Retrieved from https://journalbipolardisorders.springeropen.com/articles/10.1186/2194-7511-1-

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Martin, P., & Bsn. (2018, December 07). 6 Major Depression Nursing Care Plans. Retrieved from

https://nurseslabs.com/major-depression-nursing-care-plans/6/

Six Important Truths About Depression. (n.d.). Retrieved from

https://www.psychologytoday.com/us/blog/nurturing-self-compassion/201705/six-important-

truths-about-depression
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