MENTAL HEALTH CASE STUDY 1

Mental Health Case Study

Anthony Devengencie III

Youngstown State University

MENTAL HEALTH CASE STUDY 2

Abstract

An 18-year-old female, K.R., arrived at St. Elizabeth’s Hospital Main Campus on 28 February

2018. K.R. was admitted to the hospital with a single episode of major depressive disorder

related to a suicide attempt. The patient had overdosed on Prozac, clonidine, and Tylenol PM and

was taken to the hospital by family members. In this case study, K.R.’s situation will be

evaluated and explained with personal statements and evidence-based research. The patient’s

DSM axes I to IV, and behaviors during the admission and day of care will be elaborated in this

paper. The patient’s spirituality, learned coping mechanisms, and personal plan for discharge

will be discussed further.

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Objective Data

On the date of admission, 28 February 2018, K.R., an 18-year-old female was transported

to the St. Elizabeth’s Hospital emergency room by way of a privately-owned vehicle. The patient

was brought to the facility by their family under the impression of attempted suicide. It was

confirmed that the patient overdosed on Prozac, clonidine, and Tylenol PM. The emergency

room staff took note that the patient stated they were worried that they caused permanent

damage. The patient also told the staff that they did not know if God will forgive them,

expressing sadness and anxiousness. On the date of care, 1 March 2018, the patient was observed

by the staff nurse on the mental health unit in bed. The nurse noted the patient was not interested

in eating breakfast and reported visual hallucination of “lights and colors that I see sometimes”.

Upon arrival to the unit, I observed K.R. sitting alone eating breakfast. She was dressed

in a hospital gown with sweatpants, which seemed appropriate for the time of day. I asked the

patient if they were willing to speak with me about why they came to the unit, in which K.R.

stated that she was willing to talk with me. After a proper introduction, the patient began to tell

me how she arrived on the unit from her own account. K.R. stated she arrived there the night

before for suicidal ideation. I reviewed K.R.’s chart prior to sitting with her and noted the initial

event leading to admission was a suicide attempt by way of overdose. I asked the patient if they

were taking any prescribed medication before admission to the hospital, and K.R stated that they

were prescribed antidepressants by a therapist a day before the initial event. K.R. was not ready

to speak to me about the initial event leading up to the admission. After further discussion, K.R

told me that she felt she was going to get the proper help in the facility and learn useful coping

mechanisms to help with the sadness. K.R. was diagnosed with Major Depression single episode.

DSM Axes I-IV:

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I: Major depressive single episode

II: No personality or other mental disorder

III: No medical or neurological disorders

IV: Problems related to social environment

The patient’s behavior was appropriate, and she had an awareness of her current

condition. K.R. participated in a unit wrap-up group and was on a medication regimen consisting

of Cogentin: to alleviate adverse effects of antidepressants as needed, Haldol: to decrease

excitement in brain as needed, Vistaril: for anxiety as needed, and Desyrel: for depression. The

safety and security measures on the unit were maintained for all patients. All patients arriving on

the unit are searched and any hazardous material is held until discharge. The unit is always

locked and access badges as well as keys are the only way of entry.

Summary

Depression was previously viewed as a disorder seen only in adults. Many thought that

children and adolescents were not developed enough to experience disorders related to

depression. Prior to evidence-based research, what is now considered depression was believed to

be a mood swing when seen in adolescents (Depression in Childhood and Adolescents 2013).

Research found that females have a higher prevalence of major depressive disorder after puberty,

as opposed to males. This disorder often is accompanied by other psychiatric diagnoses such as

anxiety, attention deficit disorder, and oppositional defiant disorder (Depression in Childhood

and Adolescents 2013). One of the biggest risks for patients with major depressive disorder

(MDD) is suicide. Common behaviors of patients diagnosed with MDD are an increased risk of

suicide and may include reports of depressed mood, anxiety, feelings of hopelessness, and

insomnia (Li 2017). Research is still inconclusive of the exact cause of MDD, though some
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research indicates a possible imbalance of serotonin and childhood adversities such as sexual

abuse and poverty (Maughan 2013).

Identify

K.R. was brought to St. Elizabeth’s Main Campus emergency room by her family. She

expressed worry that her suicide attempt may have caused permanent damage after taking

multiple pills at once. K.R. experienced side effects from the overdose of medications and

worried that they might not go away. She also made a statement in reference to her religious

beliefs that God may not forgive her. K.R.’s beliefs can have a great impact on her recovery

later, as good religious values relate to lower suicide rates and related behaviors (Bullock 2012).

After sitting with K.R. and asking her to elaborate what her stressors are, they seemed to relate to

problems in her social environment. Although she did not fully disclose her stressors to me, K.R.

described what makes her sad, such as people getting picked on at school. K.R. was vague when

I asked about her peers and only said that they are nice. She also explained her strong emotional

responses to tragedy seen while watching TV.

Discuss

During the session with K.R., she expressed that, to the best of her knowledge, she had

no family history of depression or mental illness. This was further elaborated on when she was

asked about grandparents and distant cousins. Throughout the session, there were no indications

of related illnesses in her family.

Describe

The care provided on the unit can be altered per the patient’s disorder. There are group

activities on the unit that are supported by evidence-based research, such as a group session.

K.R. had one group session called a wrap-up group. When asked about how the group session
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made her feel she stated, “It helped me understand that I am not alone, and other people have

problems too”. This group session was very therapeutic and a way for the patient to socialize

with others that have similar stressors in their lives. Group therapy and other therapeutic groups

have been proven to increase patient outcomes. The milieu activities were vast on the unit, in

which the environment is manipulated to provide the best patient outcomes. The patients on the

unit are expected to learn new coping mechanisms and learn how to socialize properly with

others, while implementing these strategies into their daily lives. The main room on the unit is

set up for socialization, with many approved tables and chairs set up around a television and

dining area. The rooms are painted with bright colors to promote positivity and energy to the

patients. There is also plenty of space for the patients to move about on the unit without feeling

trapped or enclosed. There is a library on the unit which offers books and other materials for the

patients to read, which can be therapeutic for some patients. There are opportunities for patients

to create artwork, with areas throughout the unit to display their work. The design of the unit’s

set up and activities offered to patients are built around the concept of milieu therapy.

Analyze

During the session with the patient, K.R. elaborated on what religion meant to her. She

stated that she was a practicing Catholic and enjoyed going to church. We discussed how often

she attended church and if there was any recent changes in her pattern of going to church. K.R.

stated “recently I haven’t gone as much as I have in the past”. She explained that instead of

going to church once a week as she once did, it was now closer to every other week. K.R.

discussed her family’s strong religious values that she grew up following. She expressed during

admission to the ER that she had strong religious views, especially after mentioning her fear of

God not forgiving her for attempting to take her life. It has been shown that clients that are
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connected to religious beliefs have a lower rate of suicide. Religious counseling can be a big part

of the client’s treatment if they choose to do so.

Evaluate

K.R. has made a lot of progress towards accepting the situation and looking to move

forward with therapy in order to live a positive life. During the session with the patient she

stated, “I understand why I am here and I feel that I will be able to get the help I need”. K.R. was

new to the unit when I was there, after only spending a day and a half there so far. She is still shy

and not ready to talk about details leading up to her admission, although she will have plenty of

opportunities to get to that point. K.R. can learn to form trusting relationships on the unit with

doctors and staff to express her feelings, and medication can help to stabilize her mood.

K.R. already sees that there are others in the unit with similar issues and is learning how to cope

with those issues. It is good that she understands the importance of being on the unit so that she

is able to recover and receive the help that she needs.

Summarize

The patient is not sure when she will be discharged. K.R.’s family has not visited the

facility yet because she wants to focus on getting to a better place before seeing her family.

When asked during the session of what her plans and goals were after discharge, she stated that

she would like to go back home and continue playing sports. Her favorite sport is softball and

mentioned that sports is one of her ways of coping with stress. K.R.’s family plans to come to the

facility when she is ready and will be ready to take her home upon discharge.

List of prioritized nursing diagnoses

- Risk for Suicide AEB prior suicide attempt, feelings of sadness

- Hopelessness r/t long-term stress AEB decreased appetite, decreased verbalization

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- Situational low self-esteem r/t behavior inconsistent with values AEB strong

religious values

- Risk for spiritual distress AEB cultural conflict, inability to forgive, low self-esteem

and stress

- Interrupted family processes r/t shift in health status of a family member and

situational crises AEB changes in communication patterns

List of potential nursing diagnoses

- Risk-prone Health Behavior

- Social isolation

- Spiritual distress

- Readiness for enhanced communication

- Self-neglect

- Risk for ineffective activity planning

- Risk for compromised resilience

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References

Ackley, B.J., & Ladwig, G.B. (2014). Nursing Diagnosis Handbook: An Evidence-Based Guide
to Planning Care (10th Ed.). Maryland Heights, MO: Elsevier.

Bullock, M., Nadeau, L., & Renaud, J. (2012). Spirituality and Religion in Youth Suicide
Attempters' Trajectories of Mental Health Service Utilization: The Year before a Suicide
Attempt. Journal Of The Canadian Academy Of Child & Adolescent
Psychiatry, 21(3), 186-193.

Li, H., Luo, X., Ke, X., Dai, Q., Zheng, W., Zhang, C., & ... Ning, Y. (2017). Major depressive
disorder and suicide risk among adult outpatients at several general hospitals in a
Chinese Han population. Plos ONE, 12(10), 1-15. doi:10.1371/journal.pone.0186143

Maughan, B., Collishaw, S., & Stringaris, A. (2013). Depression in Childhood and
Adolescence. Journal Of The Canadian Academy Of Child & Adolescent
Psychiatry, 22(1), 35-40.