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Shauna Letcher
Abstract
In this psychiatric mental health comprehensive case study, we get a first-hand look into
the long-term effects of lifelong alcohol abuse and various mental illness like major depressive
disorder, anxiety, and bipolar met with noncompliance and lifelong health issues. With
medications, outpatient therapy and compliance, mental illnesses are very manageable, and
individuals can lead very productive lives if they choose to do so. In this case study, multiple
mental health diagnoses, medications and nursing diagnoses will be discussed and explained.
MM’s detailed history of past and current hospitalizations, personal life, family, medications,
Objective Data
On October 23rd, 2018, Patient MM was interviewed for this psychiatric mental health
comprehensive case study. Patient MM was admitted to the psychiatric unit on floor 3 South at
Trumbull Memorial Hospital on October 17th, 2018 through the emergency department after a
failed suicide attempt. MM is diagnosed with multiple mental illnesses which include major
depressive disorder, alcohol dependence, bipolar 2, anxiety, and polysubstance induced mood
disorder. The DSM IV outlines the following criterion to make a diagnosis of depression; The
individual must be experiencing five or more symptoms during the same 2-week period and at
least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day. 2. Markedly diminished interest or
pleasure in all, or almost all, activities most of the day, nearly every day. 3. Significant weight
loss when not dieting or weight gain or decrease or increase in appetite nearly every day. 4. A
slowing down of thought and a reduction of physical movement (observable by others, not
merely subjective feelings of restlessness or being slowed down). 5. Fatigue or loss of energy
nearly every day. 6. Feelings of worthlessness or excessive or inappropriate guilt nearly every
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide
attempt or a specific plan for committing suicide. (“Depression Definition and DSM-5
Diagnostic Criteria”)
On admission MM was very upset with his present circumstances that precipitated his
suicide attempt, voicing his suicidal ideations along with the plans he intended to use to carry out
the suicide attempts. MM rated his depression and anxiety very high upon admission. On the
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date of care, MM’s mood had improved greatly. MM was no longer voicing suicidal ideations
and stated that his depression and anxiety had decreased some since admission. MM was very
open and willing to talk about his mental illness and what lead him to the attempt at taking his
life. MM had preoccupations of thoughts, his thoughts included his financial hardships, loss of
vision, loss of independence and loss of familial support. MM was cheerful on the unit and with
other patients and nurses and attended all groups with eager participation.
patients, meaning patients are not able to leave the floor until they are discharged from the
hospital and no one can enter the floor unless they are allowed on by the nursing staff. A
psychiatric unit differs from a medical-surgical floor in that are unit restrictions with an emphasis
on patient safety from self-harm and harming other patients and staff members. Treatments of a
psychiatric patient and all visitations are to take place in the activity room and/or the common
area. Nurses are observing the activity and common areas at all times with a visualization on
patients at least every fifteen minutes. There are ligature safety precautions taken with all
patients to reduce the risk of an attempted suicide by hanging, and showers are locked until
opened by nursing staff. After medications are handed out to the patient, the nurse checks the
mouth of the patient to ensure that the patient swallowed their medication. If there was not this
safety measure, patients could pocket their medication in their mouth and save the medication
At the time of the interview, MM was currently on seven different medications for his
mental illnesses. Tegretol (Carbamazepine) is an anticonvulsant that MM utilized for his seizure
disorder and mood stabilization. Tegretol (Carbamazepine) stops the rapid firing of neurons in
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY
the brain, this calms the overactive brain to stop and prevent seizures and to stabilize the mood.
MM’s Tegretol (Carbamazepine) blood level was 11.7 mg/L, which is in the therapeutic range of
since his teenage years, although MM had been admitted with a negative alcohol screen, stating
he had not drunk alcohol for three weeks, the physician wanted to take precautions as alcohol
withdrawal can cause seizures. Depakote (Valproic Acid) is another anticonvulsant used for
epilepsy and mood stabilization through the cessation of rapid firing of neurons in the brain,
calming the overactive brain to stop and prevent seizures and to stabilize the mood. MM’s
Depakote (Valproic Acid) blood level was 46.7 µg/mL, which is close to the therapeutic range of
50-125 µg/mL. Within a couple more doses of Depakote (Valproic Acid), MM would be within
the therapeutic range. Every patient on a psychiatric unit has a standing order of Haldol
was prescribed to MM to treat anxiety as needed while on the floor. Every patient on a
antidepressant that is prescribed to all psychiatric patients to treat insomnia as needed. The last
medication prescribed was Thiamine (Vitamin B), although not a psychiatric drug it was
prescribed to MM because of his alcohol abuse which is a mental illness. Thiamine (Vitamin B)
is required in our bodies to properly use carbohydrates and prevents brain disorders in
individuals with alcoholism. Alcoholism usually results in poor diets, where we find Vitamin B,
Major depressive disorder, also known as clinical depression, is one of the most common
mental illnesses in the United States. Major depressive disorder is persistent and intense feelings
of sadness for an extended period, effecting the mood, behavior, and physical function like
sleeping, eating and other activities of daily life. With major depressive disorder the individual
will feel sad or irritable majority of the day, more days often than not, will lose interest in
activities they once enjoyed, will suddenly lose or gain weight, will have a change in appetite,
will have insomnia or hypersomnia, will feel restless, will lack energy to complete tasks, will
have feelings of worthlessness and/or hopelessness, will have difficulty concentrating, thinking,
and making decisions, will have thoughts about harming oneself or committing suicide. The
individual will have five or more of the above symptoms for more than two weeks to be
diagnosed with major depressive disorder. (Kerr & Legg, PhD, 2017)
Alcohol use disorder is described as chronic relapse of alcohol use with loss of control of
alcohol consumption and negative emotional state while using alcohol. Alcohol use disorder can
be diagnosed by experiencing any two or more of the following symptoms; drinking more or
longer than you planned to, tried to cut back or quit drinking with no success, spent long period
of time drinking, spent a long period of time feeling sick after drinking, experience a craving for
alcohol, drinking interfered with school, work, or family, continued drinking even though
drinking was causing problems with school, work, or family, cut back on activities you enjoyed
because of drinking, being in a situation of increased risk for injury because of drinking,
continued to drink even though you felt depressed or anxious, have had to increase the amount of
alcohol consumed to receive desired effect, or had feelings of withdrawal symptoms after
drinking. Mild, moderate or severe alcohol abuse coordinates with how many symptoms the
Bipolar is a mental health illness characterized by periods of extreme high moods and
extreme moods called mania and depression. Mania is a period of extremely elevated moods that
must last at least one week and have at least three of the following symptoms; high self-esteem,
insomnia, rapid speech, flight of ideas, distracted easily, increased interest in goals or activities,
akathisia, or reckless, dangerous behavior. Depression is a period of extremely low moods that
must last at least two weeks and at least four of the following symptoms; weight gain or loss,
harm or suicidal ideation. Bipolar II is when the individual with bipolar has more depressive
moods than they do manic moods or have hypomanic moods which are less extreme than mania.
Generalized anxiety disorder is severe, ongoing anxiety that affects activities of daily life.
To be diagnosed with generalized anxiety disorder, excessive anxiety and worry about a variety
of topics, events, or activities must be present. The excessive worrying occurs more often than
not for at least 6 months and is clearly more excessive than everyday worrying. The worrying in
generalized anxiety disorder is hard to control and may shift from one subject to another easily.
To be diagnosed with generalized anxiety disorder the individual must also present with at least
three or more of these symptoms; edginess or restlessness, more fatigued than normal, difficulty
concentrating, irritability, increase in muscle aches from tenseness, and insomnia. (Glasofer,
PhD, 2018)
MM has had multiple psychiatric commitments throughout his life, many of which were
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY
for alcohol and substance abuse, extreme depression, and suicide attempts with his last
hospitalization prior to the current one being September 2018. This specific hospitalization was
for another failed suicide attempt. MM has suffered from epilepsy since childhood, in May 2017
MM underwent a craniotomy performed at the Cleveland Clinic in attempts to end his seizures.
One of the possible side effects of the craniotomy was loss of vision, because of the surgery MM
suffered loss of peripheral vision in his left eyeball. With the loss of vision, MM has had a
decrease in the quality of his life and loss of independence as he has not been able to work since
the surgery. The loss of independence and quality of life has greatly increased his depressive
state of mind. Prior to the suicide attempt on October 17th, 2018, MM states that he had not left
his residence in two weeks due to his depression. In that two weeks he claims that he had little
to nothing to eat and when he tried to contact his sister for help she did not want him contacting
her. MM decided that he would take his life by overdosing on the Tegretol (Carbamazepine) he
was prescribed for his epilepsy and mood stabilization. MM woke up from the Tegretol
(Carbamazepine) overdose, crawled over to his neighbor’s front porch and waited three hours for
him return from work. When the neighbor got home from work he called 911, police arrived,
and he was taken to Trumbull Memorial Hospital to be committed to the psychiatric unit.
MM has presented to the psychiatric floor numerous times throughout his life with a
history of thirty day readmits, he is well known to the staff at Trumbull Memorial Hospital.
MM’s alcohol abuse began when he was a young teenager caving into peer pressure and
believing drinking would make him popular with the older kids. Having had epilepsy since
childhood, MM was never able to legally drive, resulting in many driving without license and
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY
driving under the influence arrests. MM told a story of the last time he drove drunk, after a night
of drinking MM was driving home when he wrecked his vehicle and flipped the vehicle into
someone’s front yard. A passerby stopped to check on MM when MM asked for a ride home to
his house a couple miles down the road where he called the police and reported the vehicle
stolen. When police arrived at MM’s house they noticed blood on his face, MM lied to the
police and told them that he had been hit in the face with a rock by his nephew. MM claims he
got away with the stolen vehicle report but that was the last time he had drove. MM was very
remorseful about the situation and always wonders what he would feel like if there had been
children playing in that front yard. The accident was enough to scare MM into never driving
again but the drinking continued until his recent sobriety of 3 weeks, the longest he has ever been
MM has been married and divorced twice in his life with no children. His mother
recently passed away in January of 2018, a woman he was very close to. MM’s alcohol abuse
and poor decisions has driven away his two sisters and hindered the relationships with his
nephew. These losses and isolations have pushed MM deeper into his depression every time,
causing more alcohol use and more poor decisions. MM states he is the only one in his family
Describe the psychiatric evidence-based nursing care provided and milieu activities
attended
Upon admission, MM was evaluated, and his needs were assessed. Based upon his
current needs for this admission, MM’s physician made a plan to stabilize MM on his
medications, address his suicidal ideations, depression, and anxiety, and to prepare MM for
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY
future discharge. Since MM was sober, he will be encouraged to reach out to his sisters for
support and will be encouraged to attend AA meetings to be with like peers once discharged.
or manipulated with a view to preventing self-destructive behavior. Patients are involved with
their decision making about their treatment, family visitation is encouraged, provides a
comfortable setting, the rooms are not over stimulating, and communication is encouraged in
group therapy. Group therapies are beneficial to psychiatric patients as it lets the individuals
know that they are not alone in what they are feeling, it promotes improving social skills and it
provides a safe place to share your feelings and thoughts. MM attended all group therapies on the
floor with the other patients and participated eagerly and appropriately. MM was out on the
floor in the common area, trying to engage in conversation with the other patients and staff
members. It is clear that MM does not have support outside of the psychiatric unit, so he uses
his hospitalizations and the staff members as his means of support and socialization.
Analyze ethnic, spiritual and cultural influences that impact the patient
MM is white, middle aged man who has had a long career in the chef business working
for many of the big local area restaurants and catering businesses. He has been lucky enough to
own his own home since his twenty’s and has been financially stable since his surgery. MM
made no mention of any spiritual beliefs that he or his family participated in, when asked about
spirituality and religion MM replied, “I believe there is a God, but I do not attend church or
worship on my own.”.
The outcomes for MM on this hospitalization were to get him past the suicidal crisis, ease
the thoughts of suicide, restart and get stabilized on medication, continue sobriety, try to
reestablish family support and outside socialization, begin government assisted programs for
On the date of care MM was having a court hearing at the Trumbull Memorial Hospital to
be appointed a guardian by the state. A guard who has guardianship over a mental health patient
will make all decisions on behalf of the patient, the patients needs and wishes will be considered
by the guardian. Not only will the guardian make all decisions like where the patient will go
upon discharge, the guardian will be in charge of the patient’s financials. MM was being
appointed a guardian for his history of poor decision making, noncompliance, his financial
situation, and his recent short-term memory loss. MM voiced that he would like to be discharged
to a group home or even a skilled nursing home. A group home or skilled nursing home would
provide socialization and a structured routine with some personal freedoms in which MM would
thrive in with the support. MM also said he would like to return to attending AA meetings. AA
meetings provide camaraderie for those recovering for alcoholism and will be another avenue of
socialization. MM expressed a wish for trying canine therapy since he grew up owning dogs and
has always been around dogs, he believes canine therapy would improve his mood and be
beneficial.
overdose
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY
5. Low self esteem related to feelings of failure related to difficulty accepting loss of vision
feelings of aloneness
1. Imbalanced nutrition, less than body requirements, related to inability to pay for food
desired
Conclusion paragraph
Having MM as a patient gives one better insight into the life of an individual who suffers
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from lifelong mental illnesses like substance abuse and major depressive disorder. MM is the
prime example of noncompliance and the consequences that arise from noncompliance and
substance abuse. MM has pushed his only family away that is only support he has now is the
support he finds within the psychiatric unit at Trumbull Memorial Hospital and will possibly
have all rights taken away from him when he is appointed a guardian. From report, MM appears
to be on a better path now than previous hospitalization, with three-week sobriety and wishful
discharge to a group home, the nurses at Trumbull Memorial Hospital can only hope that MM
continues this sobriety and continued work towards acceptance of his vision loss.
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Works Cited
https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-
disorders
Depression Definition and DSM-5 Diagnostic Criteria. (n.d.). Retrieved October 31, 2018, from
https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria
Glasofer, PhD, D. R. (2018, September 20). Generalized Anxiety Disorder: Symptoms and
criteria-for-generalized-anxiety-disorder-1393147
Kerr, M., & Legg, PhD, T. J. (2017, June 27). Major Depressive Disorder (Clinical Depression).
Krans, B., & Legg, PhD, T. (2017, September 25). Diagnosis Guide for Bipolar Disorder.
disorder/bipolar-diagnosis-guide#mental-health-evaluation
Pedersen, D. D. (2017). Psychnotes: Clinical pocket guide (5th ed.). Philadelphia, PA: F A
Davis.