RUNNING HEAD: Psychiatric Mental Health Case Study

Psychiatric Mental Health Comprehensive Case Study

Daniel Liptak

Youngstown State University

Patricia Flamino
RUNNING HEAD: Psychiatric Mental Health Case Study

Abstract

This case study is of a patient at St. Elizabeth in the inpatient psychiatric unit who was

cared for on 2/19/19 with admission one day prior on 2/18/19. Covered are the circumstances

regarding this particular admission and the events precipitating the acute exacerbation in this

patient’s depression comorbid of chronic PTSD. A holistic review of the events and details

surrounding the events prior to admission, hospitalization thus far, and discharge planning are to

be included.
RUNNING HEAD: Psychiatric Mental Health Case Study

Objective Data

The patient selected for analysis is a 25 year old Caucasian female mother of three to be

who shall be referred to as SM with a past medical history of depression, chronic PTSD, and

laparoscopic cholecystectomy who presented to SEBY ER on 2/18/19 with chief complaint of

suicidal ideations. Initial labs drawn for T3, T4, TSH, blood alcohol level, and nine panel drug

screen are unremarkable. CBC and BMP results are unremarkable. Patient is not on any

psychiatric medications, takes no medications routinely, and does not participate in outpatient

counseling services. Patient reports a history of physical and sexual abuse during childhood and

teenage years with one hospitalization at Belmont Pines Hospital in 2016. Sexual abuse from a

brother four years older as a child occurred as well as a rape by another man in 2017 with a

subsequent pregnancy and miscarriage are also reported. She is currently unemployed, has no

history of tobacco use, alcohol abuse, or drug abuse, no criminal record, and is of low

socioeconomic status. SM maintains a general diet and has allergies to fish oil, latex, and

penicillins. SM appears appropriately nourished and of a healthy weight.

Summary

One of the diagnoses possessed by SM is major depressive disorder, likely a condition

related to her past history of physical and sexual abuse. According to an academic journal

conducted by JAMA psychiatry, “A major depressive episode was diagnosed when at least 2

weeks of persistent depressed mood or anhedonia were present, accompanied by a total of at

RUNNING HEAD: Psychiatric Mental Health Case Study

least 5 or more of the 9 DSM-IV symptoms of major depression during the episode.” It is

reasonable to surmise that SM was diagnosed with a major depressive episode following the

events preceding her admission into the inpatient psychiatric unit. Behaviors and symptoms

associated with major depressive disorder and major depressive episodes may include markedly

diminished pleasure or interest in all or nearly all activities most of the day nearly every day,

significant weight loss not in the presence of dieting or significant weight gain, decrease or

increase in apatite nearly every day, recurrent thoughts of death, suicidal ideations, or a plan to

commit suicide. For the diagnosis of major depressive disorder to be made, the presence of

symptoms must have a detrimental and persistent effect on the individual’s life. As described by

SM, her life has been complicated by her major depression which appears secondary to

childhood and teenage trauma experienced at the hands of her brother, ex-lovers, and the friend

of a friend who raped her.

Current Hospitalization Precipitating Factors

Prior to admission, the patient reports an argument with current boyfriend who she has

also dated in the past and recently moving in with. She reports recently moving to East Liverpool

from southern Ohio with her 2, 3, and 5 year old children who are of the same father. The father

is not in the lives of the children or SM, although she occasionally speaks with him. SM and her

boyfriend were arguing and police were called by the boyfriend stating he was afraid SM was

going to hurt herself. SM superficially cut the ventral side of her left lower wrist with a razor

several times. Patient says she was not suicidal and was merely looking for a “way out” of the
RUNNING HEAD: Psychiatric Mental Health Case Study

situation at home. Police pink slipped her and brought her to ER after she arranged care for her

three children via a cousin. Patient states there have been ongoing issues with her boyfriend since

moving in with her children.

Familial Mental Health History

SM reports bipolar disorder in her father with no other diagnosed family members with

mental illness. Father daughter relationship is mixed and goes off and on with time although they

currently communicate. SM details characteristics present in her father’s behavior that have

persisted throughout her life and are an accurate depiction of bipolar disorder and the mania and

depression it induces.

Ethnic, Spiritual, Cultural Influences

SM reports being spiritual and is of the Catholic religion of which she was raised by her

parents. She does not attend church or take her children to church regularly but states she is more

so spiritual than one to be constrained by the rules of organized religion, but nevertheless

identifying as a Catholic. SM is of primarily Irish descent and describes little in terms of

traditions and culture that coincide with the Irish heritage. One can deduce that this may be the

resultant of one or more generations of family dysfunction compounded by mental health issues,

low socioeconomic status, and lack of formal education which seem to trend in SM’s immediate

and distant family members.

Care Outcomes
RUNNING HEAD: Psychiatric Mental Health Case Study

Most importantly for a patient such as this, the number one outcome with anyone

presenting to a healthcare facility with a chief complaint of suicidal ideations is to prevent said

individual from having the opportunity to fatally harm themselves. Furthermore, it is the duty of

healthcare professionals to not only prevent them from fatally injuring themselves but to prevent

them from injuring themselves in any way. Although this may seemingly infringe on their rights

as individuals, it is warranted when there is risk for actions that will be detrimental to the patient,

staff, or others.

Discharge Plans

The primary goal of discharge planning for this patient is to set up outpatient counseling

services and establish a medication regimen that will work to reduce symptoms of major

depressive disorder. SM appears very open and willing to better herself and accepts the help of

healthcare workers, so it is likely that she will adhere to counseling services and prescribed

medications for the betterment of her as an individual and as a mother. Throughout the course of

the interview, SM appears highly motivated by her children to be the best that she can. She feels

that this event was merely a low point in her chronic illness to which she would like help

working through. An openness to accepting help is a good indicator of a smooth discharge and

reincorporation into life outside of the acute care setting and there should be optimism for this

patient as such.

Nursing Diagnoses
RUNNING HEAD: Psychiatric Mental Health Case Study

Nursing diagnoses for SM prioritized are as follows:

2: Impaired social interaction related to lack of an adequate support system as evidenced

by frequent relocation of the family unit and dysfunctional interaction with family and

significant other.

1: Risk for further self directed violence related to feelings of helplessness and loneliness

secondary to diagnosis of major depressive disorder as evidenced by recent self inflicted cuts to

wrist.

3: Disturbed thought processes related to history of physical abuse, sexual abuse, and

rape as evidenced by negative ruminations.

Potential Nursing Diagnoses

Potential nursing diagnoses for an individual diagnosed with chronic PTSD and

depression include but are not limited to:

•Self care deficit

•Ineffective coping

•Hopelessness

•Powerlessness

•Imbalanced nutrition: less than body requirement

RUNNING HEAD: Psychiatric Mental Health Case Study

•Disturbed thought process

•Social isolation

Conclusion

The circumstances prior to admission described by SM denote a common struggle among

women of low socioeconomic status who move from place to place and who have histories of

abuse in recent years and in childhood. The unhealthy lifestyle and frequent moving in with

different family members, boyfriends, and friends predisposes one to greater chances of

experiencing trauma. Involving children makes matters more complicated and caring for oneself

more difficult. This appears to be the case in SM’s circumstances. Although she openly admits to

her diagnoses, she seems highly motivated to work on herself for the betterment of her future,

and most importantly to her, that of her children’s. It is at best unfortunate the experiences SM

has been subjected to in the past by some of the men in her life, however, she appears resilient in

hopes for a better future. She expressed interest in attending STNA classes to enhance her job

opportunities and mentioned several other opportunities that will allow her a future with more

security and greater independence than she has had in the past.
RUNNING HEAD: Psychiatric Mental Health Case Study

References

Chivers-Wilson, K. A. (2006, July). Sexual assault and posttraumatic stress disorder: A review of

the biological, psychological and sociological factors and treatments. Retrieved March 21, 2019, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323517/

Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of

Major Depressive Disorder. Archives of General Psychiatry, 62(10), 1097. doi:10.1001/archpsyc.

62.10.1097

Mccormick, U., Murray, B., & Mcnew, B. (2015). Diagnosis and treatment of patients

with bipolar disorder: A review for advanced practice nurses. Journal of the American

Association of Nurse Practitioners,27(9), 530-542. doi:10.1002/2327-6924.12275