Running Head: MENTAL HEALTH CASE STUDY 1

Mental Health Case Study

Kara Whitman

Youngstown State University

MENTAL HEALTH CASE STUDY 2

Abstract

“One in six U.S. adults lives with a mental illness (44.7 million in 2016)” (National Institute of

Mental Health, 2017). Mental illness is something that affects almost every American in the

country whether it is a mental illness they are currently suffering with or a loved one with a

mental illness. It affects us all. This particular patient has been diagnosed with Major Depressive

Disorder (MDD) as well as anxiety, insomnia, and panic attacks. Recent changes in her life

relating to housing and loss of loved ones has contributed to her depression. Resolving

underlying issues, use of coping mechanisms, and medication compliance are very important for

the treatment of depression.

MENTAL HEALTH CASE STUDY 3

Objective Data

R.W. is a 68 year old female that came to the emergency department on February 15th

with complaints of worsening depression. I met with the patient on February 20th. She was

previously admitted to the Behavioral Health Institute for 22 days in January of this year for

major depression. She was noncompliant with medication and outpatient treatment which is why

she came back to the hospital. She stopped taking her psychiatric medications a few days after

discharge because she felt she did not need them anymore. She states her mood was stable until

the depression “hit like a ton of bricks”. Patient came to the emergency department voluntarily

this visit. From her first visit to her second, all of her medications were changed. She is currently

taking Wellbutrin XL for depression, Klonopin for anxiety, Ativan as needed for anxiety and

agitation, and Effexor for depression. On the day of care, the patient seemed to be in good spirits.

She was open to talk to me about her condition and precipitating events. I feel that she was more

comfortable with me this time since I had spoken with her before. She was smiling and laughing

more than my previous visit and she was not showing signs of being anxious. She was able to

make decent eye contact with me and was able to make valid conclusions about her condition.

When looking at the DSM-IV, the Axis I psychiatric diagnoses would be major

depressive disorder and anxiety. This patient has a history of fibromyalgia as well as bulging

discs in her back which would attribute to her Axis III diagnosis.

Summarize

According to the National Institute of Mental Health (2018), depression affects the way

you feel, think, and handle daily activities. Symptoms must be present for at least two weeks. If

symptoms last for at least two years then it would be diagnosed as persistent depressive disorder
MENTAL HEALTH CASE STUDY 4

or dysthymia (National Institute of Mental Health, 2018). Common symptoms for depression

include: persistent sad mood, feelings of hopelessness and helplessness, decreased energy,

difficulty sleeping, thoughts of death or suicide, or suicide attempts. As found in an article by

Toro, Rubio, Gili, Roca, Jin, Liu, Bastianoni, and Blanco (2013), chronic depression is closely

related to family history of mood disorders, co-occurrence of mental disorders, and a higher

number of stressful life events. Although it may not seem like a serious problem, depression can

increase the risk of stroke, cancer, diabetes, and heart attack in the elderly population (Fiest,

Currie, Williams, & Wang, 2010).

Identify

R.W. was previously hospitalized in August 2017 as well as in January 2018. In January,

she was admitted involuntary for a suicide attempt. I had the opportunity to have her as a patient

during both of her admissions. During her first admission in January, she told me that there were

a lot of deaths in the family and her living arrangements were not what she wanted them to be.

She said that her brother in law passed away in the fall of 2017 and since 2012 many of her

family members have died. In terms of her living situation, she was living in an apartment in

which she feels she had a good life. She decided to buy a trailer with her boyfriend and it was not

what she was expecting. She was feeling very helpless over the situation and felt that she would

try again to commit suicide if she had to go home to live in that trailer. Feelings of helplessness

can affect the ability to use effective coping mechanisms to deal with stress (Hülsebusch,

Hasenbring, & Rosu, 2015). While reading the notes from social work, I discovered that the

living arrangements were not as bad as what the patient thought they were. The trailer was

inspected and found to be a safe place to reside. This led me to believe that she was having

irrational thoughts about her condition and was not in a state of mind to make appropriate
MENTAL HEALTH CASE STUDY 5

judgments. As stated earlier, she was admitted in February because she stopped taking her

medication. I spoke with her about her depressed thoughts and she told me that her mind is

preoccupied with death because of all the death that has happened with her family. She did,

however, say that her feelings towards her living arrangement were improved from the month

before. The patient also has a significant medical history. She has a history of insomnia, anxiety,

panic attacks, fibromyalgia, chronic headaches, disc degeneration, hypertension, and COPD.

Chronic back pain is a strong predictor for having depression but it is not the pain itself that

causes depression. It is the feelings of helplessness and hopelessness that leads to depression

(Hülsebusch et al., 2015). Along with the feelings of help-/hopelessness, deterioration in health

caused by chronic medical illnesses, creates an emotional strain on the patient that may lead to

the development of depression (Fiest et al., 2010).

Discuss

The patient did not disclose any family history of mental illness to me. There was also no

record of family illness on her medical chart. With the severity of her depression, I believe there

is most likely some form of mental illness that exists within her family that she is unaware of.

Patient was unable to remember exactly when her anxiety and depression started but given the

history of her stressors I would say around 2012 is when it turned severe.

Describe

The Behavioral Health Institute at St. Elizabeth’s Hospital in Youngstown provides a

great environment for patients. Activities and group therapy are scheduled throughout the day to

help patients work on their coping mechanisms and work through their disorders. They have

different rooms to accommodate patient needs. There is a library for patients to read or have a

quiet place to sit. There is also a low stimuli room for patients that may be experiencing mania or
MENTAL HEALTH CASE STUDY 6

agitation. The staff is excellent at working with patients that are having a crisis and need some

sort of intervention. They care about each patient and truly want them to succeed in their

recovery.

Analyze

R. W. was born in Italy and her family moved to the United States when she was a young

girl. She grew up Catholic but no longer goes to church. While speaking to the patient, she thinks

it would be beneficial for her to return to her Catholic faith. After she graduated from high

school, she became a cosmetologist and worked in several salons before her fibromyalgia and

back pain were too much for her to continue working. She is currently on SSI and lives at home

with her boyfriend and does not receive any other federal support. She has an estranged

relationship with her daughter which may also be contributing to her depression. She told me

about an incident that happened many years ago between her father and her daughter. According

to the patient, she had a house that she paid for and her parents lived there with her. At some

point, her father went behind her back and sold the house to her daughter and she ended up being

evicted by the daughter. She disclosed this information to me the first time I spoke with her so

the validity of the statement is questionable.

Evaluate

One goal my patient had was to attend group more to learn about different coping

mechanisms she can use when she is having anxiety or depressed thoughts. After speaking to her

about her goal and reading the notes in her chart, I can see that she is making progress toward

that goal. She has been more involved in group and participating in group discussions. This is

definitely an improvement from when I saw her in January. In January, she would not participate
MENTAL HEALTH CASE STUDY 7

in group and hardly came out of her room. I can tell that she really does want to feel better and is

taking the initiative to get there.

Summarize

The patient should continue taking medications as prescribed once she is discharged. She

should also keep up with outpatient appointments. We discussed techniques to turn her negative

thoughts into positive ones and to focus on doing activities she enjoys. She told me that she

enjoys reading and watching old movies since that is what she used to do with her parents when

they were alive. She also enjoys gardening and being outside during the spring and summer

months. With the change of season approaching, I think this will be very beneficial to her

progress.

Prioritized Nursing Diagnosis

1. Risk for suicide related to major depression as evidenced by depressed moods, feelings of

hopelessness, and history of suicide attempt.

2. Anxiety related to situational crisis as evidenced by feelings of discomfort, helplessness

3. Noncompliance related to lack of knowledge of benefits as evidenced by patient not

taking medication because she “felt better”.

Potential Nursing Diagnosis

1. Impaired Social Interaction related to anxiety and possible lack of support system.

2. Spiritual Distress related to several deaths within the family and recent life changes.

3. Disturbed Thought Processes related to anxiety, life circumstances, depressed mood.

MENTAL HEALTH CASE STUDY 8

Conclusion

Although this patient is still experiencing symptomatic depression, her overall condition

has improved. Her hopeless/helpless thoughts have lessened in severity and she no longer feels

suicidal. She is working on being more involved with her care which is great for her. She

believes that once she is back on a routine with her medication that she will feel a lot better. I

have high hopes for her that she will continue to take her medication as prescribed and continue

using coping mechanisms she has learned during her hospital stay. I also think it would help the

patient to reach out to her daughter and make an attempt to rekindle that relationship. She misses

her grandson and could really use more of a support system. She is fortunate to have her

boyfriend as her main support but I still believe it would be better for her to have familial support

as well.
MENTAL HEALTH CASE STUDY 9

References

Depression. (2018). Retrieved from

https://www.nimh.nih.gov/health/topics/depression/index.shtml

Fiest, K. M., Currie, S. R., Williams, J., & Wang, J. (2011). Chronic conditions and major

depression in community-dwelling older adults. Journal of Affective Disorders, 131(1-

3), 172-178. doi:10.1016/j.jad.2010.11.028

Garcia-Toro, M., Rubio, J. M., Gili, M., Roca, M., Jin, C. J., Liu, S., . . . Blanco, C. (2013).

Persistence of chronic major depression: A national prospective study. Journal of

Affective Disorders, 151(1), 306-312. doi:10.1016/j.jad.2013.06.013

Hülsebusch, J., Hasenbring, M. I., & Rusu, A. C. (2015). Understanding Pain and Depression in

Back Pain: the Role of Catastrophizing, Help-/Hopelessness, and Thought Suppression

as Potential Mediators. International Journal of Behavioral Medicine, 23(3), 251-259.

doi:10.1007/s12529-015-9522-y

Mental Illness. (2017). Retrieved from https://www.nimh.nih.gov/health/statistics/mental-

illness.shtml