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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

Psychiatric Mental Health Comprehensive Case Study

Gina Ungaro

NURS 4842: Mental Health Nursing

Mrs. Teresa Peck

November 18th, 2021

Abstract

The information discussed throughout this case study pertains to a 24-year-old female,

M.S. The case study below is designed to take a deeper dive into her mental health history, and

the current mental illnesses that she is battling. The information discussed throughout this case

study was obtained from a personal interview with the patient herself, and her medical records on

file at the institution. The case study will be divided up into ten different sections in order to

thoroughly discuss and dissect her mental health history. It will also discuss M.S. behaviors,

family history, discharge plans and nursing and actual diagnoses. These sections include

objective data, the psychiatric diagnosis, the stressors and behaviors, family history, psychiatric

evidence-based nursing care, spiritual and cultural influences, evaluation of patient outcome,

plans for discharge, actual diagnoses and protentional nursing diagnoses. Numerous academic

journals were also reviewed to supplement the information about the patient’s case.
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

Objective Data

The patient, M.S. was admitted voluntarily on October 19th, 2021. The patient presented

to the emergency department that day, after realizing she needed admitted to get her meds

adjusted. Patient stated that ever since the death of her cat two weeks ago, and recently cheating

on her fiancé, she has been non-compliant with her medications and has had increasing suicidal

thoughts.

The medications she currently takes help with her anxiety, PTSD, major depressive

disorder and bipolar disorder. The patient’s laboratory results were all normal except her drug

screen was positive for THC. The patient made a comment during the interview that someone

told her she looked a lot different and she expressed that it was probably because she was not

high like she always is. Throughout the interview and the few days she had been there, M.S. had

been cooperative and compliant. The patient was very cooperative throughout the interview and

seemed to have a slight flat affect, but voiced positivity about the new medication doses helping

her. It appeared as though she was comfortable on the unit and she confirmed that by saying she

has been on a psychiatric unit on three previous occasions. She was observed hanging out with

two other girls on the unit and it appeared they had become friends while being there together.

M.S. appeared very responsible and on top of her treatment. She vocalized how it took her years

of dealing with mental illness to get to the point she’s at now. She said it was all worth it though

because now she understands when she needs professional help.

The medications M.S .takes include Venlafaxine ER 75mg PO once daily for depression,

Lamotrigine 150 mg PO daily to treat bipolar disorder, and Buspirone 5 mg PO bid for her

anxiety. Venlafaxine is an SNRI and works to treat depression by increasing the amount if both

serotonin and norepinephrine in the brain. This helps to increase mood because the depressed
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

patient has low levels of serotonin and norepinephrine which causes those negative feelings.

Lamotrigine is an antiepileptic drug that treats seizures and also is used as a mood stabilizer in

the bipolar patient. Buspirone is an anti-anxiety medication. This is usually used as first line

medication treatment for people with anxiety because it acts as a benzo, but is not addictive or

habit forming. She stated that after starting to take her medications again while being here she

already started to feel a little better. She expressed that she understands can leave whenever she

wants since she is a voluntary admit, but feels like she still needs to be on the unit for a couple

more days until she can trust herself.

Summary of the psychiatric diagnoses

M.S. has been diagnosed with more than one mental illness. These include PTSD,

anxiety, major depressive, and bipolar disorder. Although all of these contribute to her daily

struggles, the one that most contributed to this stay in the unit was her depression. According to

Bowyer et al. (2019) “depressive disorders are among the most prevalent psychological

problems, affecting more than 5% of all people annually and more than 16% throughout their

lifetime” (p.1). M.S. is a great example of how when not treated, depression can drive you to

have suicidal thoughts and feelings of hopelessness.

Videbeck (2020) said, “major depressive disorder typically involves 2 weeks or more of a

sad mood or lack of interest in life activities, with at least four other symptoms of depression

such as anhedonia and changes in weight, sleep, energy, concentration, decision-making, self-

esteem, and goals” (p.288). One of the main causes behind depression have to do with decreased

serotonin levels. When patients stop taking their medications, like M.S. ultimately did, they’re

serotonin levels will begin to decrease again with time and they will start feeling those negative

feelings again. Not only did M.S. stop her antidepressants, but she also stopped taking her
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bipolar and anti-anxiety medication as well that then in turn only increased her suicidal thoughts

even more.

According to Rockwood (2021) “"Clinical depression comprises a number of

symptoms that you experience most of the day, nearly every day, for at least two weeks," he

says, and you may not know why. Other signs: feelings of extreme guilt or worthlessness, loss of

interest in activities you once liked, and/or suicidal thoughts” (paras. 2). This helps disprove the

fact that “everyone gets depressed sometimes”. Depression is not just a bad day, or a bad week,

instead these feelings linger and persist for weeks to months at a time. There are a lot of myths

around mental illness and this was a good one to bring attention to. It is important to take mental

illness seriously and never to downgrade when a person says they are feeling depressed.

Identify the Stressors and Behaviors

There were multiple stressors and behaviors that led to her current hospitalization. These

events were M.S. cat dying and her recent episode of cheating on her fiancé. She has been

hospitalized three other times in the past and vocalized in the interview that because she has done

this so many times before, she now feels she’s at the point where she can identify when she

needs to check herself in and get her meds adjusted.

On arrival to the emergency department, M.S. explained ever since her cat’s death two

weeks prior she has become noncompliant with her medications and has had increasing suicidal

thoughts. Along with this, she expressed at the admissions interview that she recently cheated on

her fiancé and although he supposedly forgave her, she has still been feeling really guilty about

the situation. She expressed in the interview that she is currently living with her grandmother and

her fiancé even after the cheating happened. She expressed in the interview that her fiancé is the

love of her life and that they have a good relationship majority of the time. These two events
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were considered the stressors that ultimately caused M.S. to become noncompliant with her

medications. The medication noncompliance was the behavior that happened in result of the

death of her cat and her cheating on her fiancé. That behavior then helped lead her to voluntarily

admitting herself for hospitalization. M.S. explained that during a stressful event she tends to get

overwhelmed, and starts to feel depressed. When she begins to feel this way, she reverts to

becoming noncompliant about taking her medication.

She explained in the interview that when her suicidal thoughts become intense enough,

she knows she needs to bring herself to get help. M.S. explained that she reached out to her mom

and let her know she was feeling this way. Her mom asked her if she thought she needed to be

hospitalized again and she said that she didn’t trust herself right now and thought that it was best

that she admitted herself.

Discuss Patient and Family History of Mental Illness

Although M.S. never directly stated any history of mental illness in her family, she did

elaborate on a situation that causes her to now struggle with PTSD. She explained how she never

grew up with a father until her mother married someone else. This man then became the closest

thing to a father she had ever had. Eventually things went south and her mother divorced the only

father figure M.S. had ever known. She expressed how difficult this was for her to accept and

that it caused her to struggle with abandonment still to this day. The only father figure she had

ever known had never reached out to her after her mother divorced him. This was very tragic for

M.S. and was the start of her struggle with the mental illness. Gardner, 1976; Wallerstein, 1985

study as cited in (O’HARA, K. L. et al 2021) found that in children from divorced families a

common threat appraisal that is directly related to their sense of security is the fear of being

abandoned by or losing contact with one or both parents. Despite the fact that her mother
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divorced this father figure that caused her to have abandonment issues, M.S. states that her

mother is her best friend and they get along very well.

Milieu Therapy and Evidence Based Nursing Care

Throughout the patients stay in the unit, multiple evidence-based nursing interventions

and milieu therapy techniques were used. One of the biggest evidence-based intervention used is

the removal of all hazardous items from the patient upon arrival to the unit. These items range

anywhere from knives and razors to pencils and belts. The unit does not allow smoking, use of

any glass products, and have rooms specially designed so that patients are not able to harm

themselves.

Another interesting evidence-based intervention used is medication system. In order to

instill medication compliance and responsibility, the patients must come out of their room every

morning at a certain time to go and get their medications. This gives them a reason to get out of

bed every morning, and helps with getting them into a routine of taking their medications every

day when they are discharged. The environment is bright which help the patients feel better,

calm and quiet which help relax the environment, and games like cards and coloring books are

left out to use. These types of activities help the patients decompress, relax, and are therapeutic.

Group therapy is another evidence-based intervention that takes place everyday on the unit.

Group helps to teach positive things such as coping techniques, instill social skills, help with

social interaction, and provide a positive environment that helps promote healing.

Ethnic, Spiritual and Cultural influences

M.S. is a 24-year-old Caucasian female, and did not state a specific religion.

Socioeconomic status was not talked about but she stated she lives with her grandmother and

fiancé so one could assume they are not financially well off. There was no talk about her job or
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previous work. Travel was not mentioned, she explained that she hung out with her cats a lot.

M.S. did express that she smokes a lot of weed, and takes many naps to cope when things get

stressful or don’t go her way. She expressed that she loves being with her fiancé and that he is

the love of her life, leading one to believe that she spends most of her time with him.

Evaluation of Patient Outcomes

There are multiple patient outcomes that are desired for a patient containing the problems

that M.S. has. Some of the outcomes that were met included self-care, medication compliance,

self-harm, social interaction, and more. She appeared well kept and clean, and was viewed

pleasantly interacting with two other girls. She had mentioned that they had become friends and

she was glad to have met them. M.S. was compliant with her medications that morning and

expressed that although it was still early, she liked the way the medications were beginning to

make her feel better. She had remained free of self-harm thus far and she admitted that her

suicidal thoughts were beginning to subside. Some outcomes that were not yet met included self-

esteem, disturbed thought process, and positive coping techniques. M.S. will still need to work to

achieve those outcomes with the help of the staff on the unit, and continue with outpatient

therapy after she returns home.

Summarize the Plans for Discharge

M.S. situation is a little unique because she is a voluntary admit so she is ultimately able

to leave whenever she feels she is ready to go. When she does decide she is ready to leave, she

will be returning home with her grandmother and fiancé. She is expected to continue her

medication regime. It is important to teach before discharge the importance of medication

compliance since that is ultimately how she wound up here this time. It would also be helpful to

include education on positive coping techniques for next time she goes through a tough time. The
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

home environment she will be going back to sounds like a safe and positive environment and she

says she has a good support system. It may be beneficial to recommend relationship counseling

or family counseling with her mother in order to help her work through the guilt of cheating on

her fiancé, and the PTSD she experiences from her mothers divorce years ago.

Prioritized List of Actual Nursing Diagnoses

1. Risk for self-harm related to increasing suicidal thoughts.

2. Risk for self-care deficit related to depression.

3. Risk for suicide related to mental illness.

4. Noncompliance related to not taking medications correctly.

5. Post trauma syndrome related to parental divorce.

6. Impaired mood regulation related to bipolar disorder.

7. Ineffective coping related to marijuana use.

Potential Nursing Diagnoses

1. Hopelessness

2. Risk for suicide

3. Stress overload

4. Sleep deprivation

5. Impaired social interaction

6. Self-neglect

7. Ineffective coping

8. Ineffective health maintenance

9. Impulsive Behavior

Conclusion
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

In conclusion, M.S. was an interesting patient to conduct this case study on. She was very

complex with her diagnosis of all four PTSD, depression, anxiety, and bipolar disorder. The

patient seemed as though she has already been through a lot and will be able to remain compliant

with medications and treatment with the help of outpatient therapy. It is especially important to

start relationship counseling and get a therapist she can trust. These will help her to forgive

herself for cheating on her fiancé, and work through her PTSD from her mother’s divorce years

ago. M.S. grandmother, mother and fiancé will play a big role in supporting her throughout her

mental illness journey. The ultimate goal at discharge would be compliance with medication so

that she does not end up admitting herself again, or following through with committing suicide or

other self- harm.

References
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PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY

Bowyer, C. B., Joyner, K. J., Yancey, J. R., Venables, N. C., Hajcak, G., & Patrick, C. J. (2019).

Toward a neurobehavioral trait conceptualization of depression

proneness. Psychophysiology, 56(7), e13367. https://doi-org.eps.cc.ysu.edu/10.1111/psyp.13367

O’Hara, K. L., Rhodes, C. A., Wolchik, S. A., Sandler, I. N., & Yun, T. J. (2021). Longitudinal

Effects of PostDivorce Interparental Conflict on Children’s Mental Health Problems Through

Fear of Abandonment: Does Parenting Quality Play a Buffering Role? Child Development,

92(4), 1476–1493. https://doi-org.eps.cc.ysu.edu/10.1111/cdev.13539

Roxkwood, K. (2021). 5 Myths About Depression. (cover story). Prevention, 73(9), 60–63.

Videbeck, S. L. (2020). Psychiatric Mental Health Nursing (8th ed.). Lippincott Williams and

Wilkins.