Running Head: CASE STUDY ON DEPRESSIVE DISORDERS 1

Case Study on Depressive Disorder

William Erskine

Youngstown State University

Comprehensive Case Study

CASE STUDY ON DEPRESSIVE DISORDERS 2

Abstract

This paper examines and reviews three published nursing research articles that report on

depressive disorder and the expected behaviors associated with the disease. These articles work

in conjunction to provide a finite definition of depressive disorder as well as the common

behaviors and manifestations that precipitate as a result of this illness. This paper also observes a

specific patient whom is suffering from depressive disorder with suicidal ideation. The contents

of this paper are objective data, a summary of depressive disorder, identity of the patients

stressors, patient and family history of mental illness, nursing care for the patient, ethnic,

spiritual, and cultural influences on the patient, an evaluation of the patients outcomes, a

summary of the patients discharge plan, patients actual nursing diagnoses and a number of

potential nursing diagnoses for the patient. This paper provides scholarly facts and observations

by providing evidence from nursing journals such as Practice Nurse, Plos One, and the Health

Science Journal.
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Objective Data

Patient was admitted on February 24th, 2017 and was cared for on February 28th, 2016.

The patient is diagnosed with depressive disorder with suicidal ideation. The patient also has a

history of substance abuse. The patient was initially admitted after what they claimed to be an

unintentional overdose and spent multiple days on a medical unit prior to admission to the psych

unit. All medical conditions were absolved prior to admission to the Psychiatric unit. Patients

psychosocial and environmental contributing factors include long history of addiction, recent

breakup with fianc, and terminal illness of the patients father whom patient has a poor

relationship with. Patient is also potentially facing jail time as they are on a police hold after

breaking probation. Patients score on the global assessment functioning scale is 31-40. Once

patient was medically stable she was very open and willing to discuss problems with admitting

physician to psychiatry unit.

On the day of care the patient had a very animated facial expression. The patient leaned

forward while speaking but was well kempt and wearing clothes from home. Patients

appearance was relatively neat with small messes on clothes. The patient was friendly and very

eager to speak to me, being very open and feeling obligated to teach a student about mental

illness. Patient made eye contact intermittently while speaking but spoke at a very fast pace and

often experienced flight of ideas. Patient was very upfront and willing to share their story with

myself and other students, however, patient seemed ashamed to some degree to discuss their

addiction and children. When assessing the patients recent mood they expressed being much
CASE STUDY ON DEPRESSIVE DISORDERS 4

sadder and depressed than usual leading to eventual relapse with substance abuse, specifically

cocaine, which is the patients drug of choice. Patients thoughts were unorganized at times as

they struggled to speak as quickly as their mind was thinking. Patient would often lose train of

thought and often need redirected to the origin of conversation. Patient states they want to live

because of their kids, but feel overwhelmed by lack of motivation and sadness on many days.

Patient states the use of street drugs, specifically uppers, allow for them to feel the necessary

mood and drive to care for my child. At times, the patient feels even these drugs are not enough

to overcome their persistent sadness and lack of a will to live. Patient is aware they have a

mental illness and feels that hospitalization for psychiatry care, followed by rehabilitation (rather

than jail time) is the best thing for the patient to begin recovering. Patient was refusing all

antidepressants and psych medications as a whole which seemed counterproductive to their

statements acknowledging the mental illness theyre suffering from.

Summarize

The patient is diagnosed with depression accompanied by suicidal ideation. According to

Fry (2015), primary contributor to A Practice Nurse Guide to Common Mental Health

Problems: Depression, depression is one of the most common mental health problems in the US

and UK. However, as common of a mental illness as it is, it is complicated and not fully

understood. According to Haberstick et al. (2016), authors of Depression, Stressful Life Events,

and the Impact of Variation in the Serotonin Transporter: Findings from the National

Longitudinal Study of Adolescent to Adult Health depression is a complex and heterogeneous

disorder with a highly variable course. According to McQueen (2009), depression can refer to

a symptom, a syndrome or a diagnosis. In the patient addressed throughout this specific case
CASE STUDY ON DEPRESSIVE DISORDERS 5

study depression is the diagnosis. McQueen (2009) proceeded to make claim that since the

understanding of depression is so limited, there is an absence of consensus about how best to

classify depression it has been recommended that classifications should be based at least upon

unambiguous operational criteria which exists in the form of the DSM-IV and the ICD-10.

However, McQueen (2009) states that the ICD-10 warns us that: these descriptions and

guidelines carry no theoretical implications, and they do not pretend to be comprehensive

statements about the current state of knowledge of depression. They are simply a set of

symptoms and comments that have been agreed, by a large number of advisors and consultants in

many different countries, to be a reasonable basis for defining the limits of categories in the

classification of mental disorders.

McQueen (2009) then delves further into the ICD-10 criteria for a diagnosis of a

depressive episode. To be considered, the patient must qualify by meeting three general criteria:

The depressive episode should last for at least 2 weeks, there have been no hypomanic or manic

episodes at any time in the individuals life, and the episode is not attributable to psychoactive

substance use or to any organic mental disorder. If general criteria are met then one looks for

several of the hallmark symptoms to be present: depressed mood most of the day and almost

every day, Loss of interest or pleasure, and decreased energy or increased fatigability. There are

then other symptoms beyond the first three which aid in the determination of the degree of

depression: loss of self-esteem and self-confidence, excessive guilt or self-reproach, recurrent

thoughts of death or suicide, or any suicidal behavior, reduced concentration, indecisiveness,

agitation or retardation, disturbed sleep, and changes in appetite with weight change. The higher

numbers of the second set of symptoms which are present are indicative of the severity of the

patients depressive episode. (McQueen, 2009)

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Identify

The patient was brought to the hospital via ambulance after overdosing by snorting what

they thought was cocaine. The patient would come to find the substance was actually fentanyl,

which is what caused the overdose. The patient claims this was the first relapse they have

experienced two years and feel it was a result of depression with progressing severity. The

patient describes an extremely strained relationship with their father for most of their life.

Recently, the father was diagnosed with a terminal illness and expressed a desire to be involved

with the patients child. The patient also recently had a relationship with their fianc and father of

their child end. This caused both emotional and financial stressors that began to weigh on the

patient day by day. Eventually, when the child was not home, the patient reached out to a friend

seeking drugs as an escape from the worsening depression and a cry for help.

Discuss

The patient denies any family history of mental illness outside of a grandpa who may

have had depression. The patients history of depression stemmed to a young age as the strains

between the patient and their father progressed and the patient went to college. The patient then

went to college and became addicted to multiple substances and the party scene to attempt to

compensate for frequent depressed feelings. The patient stated that in the years following the exit

from the party scene and attempts to normalize their life, the depression began progressing and

taking hold of their thoughts and emotions much more significantly. The patient was diagnosed

with depression around age 28 and is currently 44 years old. The patient often quits taking their
CASE STUDY ON DEPRESSIVE DISORDERS 7

medications at home or refuses to pick them up at all. This is the second time the patient has

been hospitalized related to their mental illness.

Describe

The mental health unit at St. Elizabeths hospital provided evidenced based psychiatric

nursing care to the patient. The psychiatrists, nurses, student nurses, and case workers all

correspond to work diligently to provide effective care. The staff on the unit monitored the

patients behavior regularly and consistently to ensure that the patient remains safe from harm on

the unit. The patient committed to a verbal contract agreeing to disclose to the staff any desire to

harm themselves. The patients antidepressant medication is ordered, however, the staff cannot

force the patient to take the medicine. They consistently remind the patient of what positive

benefits it may have and of the reasons the patient should take the medication. The patient

attends group therapy where the collective group of patients is encouraged to share their stories

and backgrounds while promoting problem solving identification with positive outcomes.

Nursing students spoke with the patient and encouraged them to share what lead up to their

admittance to the unit, help the patient identify precipitating factors that may have caused the

event, and provide potential solutions or alternative actions that may be taken to prevent a repeat

of the same result if the circumstances occur again. The staff also removed all objects that could

be harmful or dangerous from the unit to ensure the safety of the patient on the unit. The staff

and students also balance a low level of stimuli to ensure the patients are kept at ease on the unit

and are able to feel comfortable in their environment.

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Analyze

The patient is of Slovakian and Polish descent and has a family history of alcohol

dependence. The patient attended both protestant and catholic churches at different times of

childhood but did not value these experiences and chose to discontinue practice when they were

able to leave home and provide for themselves. The patient has no ethnic, spiritual, or cultural

traditions that they partake in other than the traditional Americanized versions of Easter and

Christmas primarily revolving around chocolate and gifts for the patients child, respectively.

The patient separated from their former fianc and has a seven year old daughter with the ex-

fianc. The patient identifies minimal hobbies for filling their time outside of attempting to

provide for their child. The patient expresses a loss of interest in some of the things they enjoyed

partaking in at one point in their life. The patient graduated high school and finished multiple

years of college, although the patient downplays the importance of the college experience due to

the lack of focus on academia in their time at the institution. The patient is unemployed as they

have been unable to hold a job due to either the past substance abuse or the incapacitating

depression.

Evaluate

The patient interacted appropriately with staff, students, and other patients on the unit.

The patient did not present with any signs and symptoms of irritation or outward aggression. The

patient has not harmed themselves or others. The patient seems to struggle with truly taking

responsibility for their actions. They frequently state they accept responsibility but frequently

discuss stressors and addiction as justifiers. The patient verbalized that they have no intentions of
CASE STUDY ON DEPRESSIVE DISORDERS 9

carrying out their suicidal thoughts. The patient has openly discussed their negative thoughts and

feelings with staff on the unit. The patient seems to understand their situation and has some

desire to fix it, while still struggling to accept the need for medication intervention. The patient

has been compliant with the regulations placed on them while staying on the unit.

Summarize

The patient is currently on a police hold which is causing a lot of controversy regarding

the discharge. The patient is also having suicidal ideations which must be deemed to be

controlled enough that the patient is not a self-harm risk upon discharge. Due to the patient

breaking probation with the drug use the patient will either be mandated to rehabilitation or jail.

The patient would like to maintain custody of their daughter but it is unclear at that time if it is

feasible. If it is not, the patients primary reason for not wanting to carry out their suicidal

ideations will also be removed from their life, putting them at a greater risk for suicide.

Prioritize

1. Risk for self-directed violence related to disturbed thought processes as evidenced by the

verbalization of suicidal ideation.

2. Risk for self-mutilation related to impaired cognitive processing as evidenced by the use of

street drugs as a coping mechanism.

List

Ineffective coping

Hopelessness
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Impaired social interaction

Imbalanced nutrition, less than body requirements

Self-care deficit

Chronic low self-esteem

Ineffective health maintenance

Fatigue

Stress Overload

References
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Fry, M. (2015). A Practice Nurse guide to common mental health problems: Depression. Practice

Nurse, 45(8), 26-30.

Haberstick, B. C., Boardman, J. D., Wagner, B., Smolen, A., Hewitt, J. K., Killeya-Jones, L. A.,

& ... Mullan Harris, K. (2016). Depression, Stressful Life Events, and the Impact

of Variation in the Serotonin Transporter: Findings from the National Longitudinal

Study of Adolescent to Adult Health (Add Health). Plos One, 11(3), e0148373.

doi:10.1371/ journal.pone.0148373

McQueen, D. (2009). Depression in adults: some basic facts. Psychoanalytic Psychotherapy,

23(3), 225-235. doi:10.1080/02668730903226463