Major

Depression Case Study: J.G. 1

Major Depressions Case Study: J.G.

Natalie Laurence

Youngstown State University

Major Depression Case Study: J.G. 2

Abstract

This paper explores a case study that looks into the effects that Major depression can have on an

individual. The individual discussed is J.G. who had her first admit to the hospital on the psych

floor. The paper discusses objective data retrieved from the patient and looks into the individual

behaviors and events that led to the patient’s hospitalization. Treatments and therapies are looked

at to help explain the situation and status of J.G. throughout her hospitalization. Causative factors

are addressed ranging from ethnic, cultural and spiritual influences. This paper also explains the

intended discharge plans for J.G. and dives into the holes in the health care system that exist in

today’s day in age. This case study will explain how major depression greatly affects and took

hold of the life of J.G.

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Major Depression Case Study: J.G.

Objective Data

J.G. was admitted to the psychiatric unit on 3/15/19. The date of care took place on

3/19/19. J.G. has a primary mental health diagnosis of Major Depression. She is also diagnosed

with bipolar disorder as well as anxiety. She had her first admit to this unit on 3/15/19. Previous

visits to the hospital were due to pregnancies and injuries. This admission was due to her being

picked up by the police and brought to the ED because of her state due to alcohol and marijuana.

She stated multiple times “my family would be better off without me” in the ED therefore she

was then pink slipped and admitted to the unit a few hours later. At the beginning of the patient’s

admission she displayed a very flat and emotionless affect. She negated attempts of conversation

and appeared to be very depressed in her mood and physical presentation. She presented feelings

and thoughts of hopelessness. Patients facial expressions started with sad, angry and even

depressed with slouched posture. However, two days after admission her expressions changed to

that of friendly, animated and one that contained more expression. Her gestures and posture

appeared to be relaxed, with calm and deliberate movements. J.G. presented at first disheveled

and very unkempt in appearance and seemed to not have much care for her personal hygiene.

However, a few days into her stay, her clothing was more straightened, appropriate and more

care seemed to be given into her personal hygiene. Her hair was combed and clothes very neat.

No abnormal movements, tics or tremors were observed. J.G. also has other medical conditions

including noncompliance to medications and history of drug/alcohol abuse. Treatments for these

conditions unit protocols and medications to help stabilize the depression and control the

withdrawals from alcohol/nicotine. Unit protocells help ensure patients safety of self and safety

of others on the unit. Upon admission, patient’s belongings were taken and locked up to ensure

Major Depression Case Study: J.G. 4

safety of herself and others on the unit. Medications prescribed are used to treat both of her

psychiatric and medical diagnoses. J.G. is prescribed Abilify, an antipsychotic to help her

depression. Haldol, an antipsychotic to help control agitation. Cogentin, to help treat her acute

dystonia. Vistaril, an anxiolytic to help control her anxiety. Lastly, Nicotine gum is prescribed to

reduce cravings and withdraw from nicotine.

Summarize

The following information under this heading is according to Psych Notes Clinical

Pocket Guide by Darlene D. Pedersen. Major depressive disorder requires at least 2 weeks of

depression/loss of interest and four additional depressive symptoms with one or more major

depressive episodes. Common signs and symptoms to expect in a client with major depression, is

that they will be in a depressed mood or have a loss of interest for 2 weeks or more, and a

presence of 4 or more of the following symptoms: significant weight loss/gain, insomnia or

hypersomnia, psychomotor agitation or retardation, fatigue, worthlessness feelings of

inappropriate guilt, problems with concentration, and recurrent thoughts of death.

Generalized anxiety can be defined as excessive anxiety that is difficult to control and

presence of persistent worry about future events. These need to be present for at least 6

consecutive months. Patients with generalized anxiety will often present behaviors such as:

hypervigilance, restlessness, constantly being on edge, easily frustrated, problems with

concentration, irritability, muscle tension, sleep disturbances, dizziness, tachycardia, chest

tightness, sweating and tremors.

Bipolar II disorder is defined as a disorder that includes one or two major depressive

episodes (as defined above) and at least one hypomanic episode. With hypomania a patient may

Major Depression Case Study: J.G. 5

exhibit signs and symptoms such as grandiosity, decreased need for sleep, excessive talking,

racing thoughts, buying sprees, increased activity, foolish business investments, and excessive

involvement in sex. Most of these are found to be presented in a very low intensity as opposed to

full-blown mania.

Identity

The stressors, events and behaviors that precipitated J.G.s hospitalization range back to

her excessive use of alcohol and marijuana along with occurring suicidal thoughts. She was

using alcohol and marijuana during the night while watching a series which contained the story

line of how to kill yourself. There was also a major storm that night. Between the storm and the

Netflix series she was watching, those events trigged her to begin to have anxiety. Her sister

called the police due to J.G.’s behavior. The police picked her up, took her to the St. E’s ED, she

was admitted due to excessive intoxication and marijuana use. During her admit to the ED she

began to state statements such as, “my family would be better off without me.” Due to those

statements, she was pink slipped for direct admittance to the psychiatric unit. This was her first

time being admitted to the psychiatric unit.

Discuss

J.G. exhibits a history of depression that originates from her relationships with her family

members. Multiple other events exacerbated her depressive states and led to her suicidal

ideations. She had never attempted suicide before, yet admitted to having suicidal thoughts

frequently. In conclusion from conversations I had with J.G. and charted data there was no

Major Depression Case Study: J.G. 6

indication of any mental illness within the family. No questions were specifically asked

pertaining to the family mental status however so it could be a possibility.

Describe

The care that J.G. received involves a combination of therapeutic care and environmental

considerations. Care provided includes forms of interpersonal psychotherapy which defined by

R.L. Osborn as, “addressing social issues that are causing the patients depression”. During this

visit however it was completed in the form of daily group therapies. Also in addition, problem

solving therapy is addressed in the group therapy setting. This type of therapy is used to help

define personal problems that have multiple solutions and which solutions will most benefit the

patient in her daily life. Both of these therapies can be performed by the nurse without the need

for a trained therapist. The care also includes administration of medications from antidepressants

and antianxiety medications mentioned prior. The administration of these medications helps to

maintain medication compliance and build of a therapeutic level of stabilization while J.G. is

admitted.

Along with traditional therapy use, J.G. attended multiple milieu therapy

opportunities/experiences. She was given many choices with open communication in her daily

care so she could be in control of her care and daily activities. This therapeutic interaction is very

important in this patient’s case due to helping her gain independence and regain confidence in

herself and improve depressive factors. One of the biggest factors of J.G.s milieu therapy

includes the containment aspect. This promotes a safe environment that discourages any harm to

the patient, especially to herself. Each patient on the floor is not permitted any potential

weapons, shoe laces, belts, or any substances that can cause harm. This helps to ensure that J.G.

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does not have any means to attempt to harm herself during her stay. Validation is also a critical

part in care for J.G. Validation ensures respect to the patient and promotion of her human rights.

This ensures that she retains a sense of self-worth and reduces depressive thoughts. Lastly,

structured interaction is implemented in the milieu for the client. It not only helps to enforce the

rules and regulations of the unit, but it greatly helps to improve the patient’s social interaction

with other patients. As J.G. even stated herself, she enjoys the fellowship she has and feels while

interacting with the other patients on the unit.

Analyze

There are multiple societal influences that have great impact on J.G. and her mental

health. The largest cultural influence is that of her family. The lack of support of her pregnancies

with her family put a lot of stress on her. After her pregnancies, her parents neglected to accept

J.G. in their lives which added to the unavailability of support in her life influencing a furthering

of his depression. Also within the community in which J.G. lives she has trouble to find

employment due to the lack of opportunities, without having employment J.G. lacks an income

and sense of independence which once again leads to a furthering of her depressive state.

Spirituality or lack thereof may also impact J.G. in her ability to cope with her depression and

feel a sense of belonging within a spiritual community. Lastly, the negative stigma associated to

mental health may pose a negative effect on J.G. and the bettering of her mental state. Mental

illness is culturally frowned upon in our society and not widely accepted which may deter her

from feeling a sense acceptance in the society in which she resides.

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Evaluate

Throughout the first days of care, there was not much improvement or positive outcomes

with care toward J.G. Medication compliance was maintained however finding placement and

acquiring a discharge date promoted ineffective outcomes for the patient. The lack of positive

outcomes led J.G. to continue to display depressive actions/emotions with lack of motivation,

monotone voice and statements indicating no presence of hope. However, after the first couple

days J.G. received news that progression was being made towards her discharge plans, her

medications approached a therapeutic level and her mood greatly was improved. J.G. presented

herself with a very well kept manner and showered. Her mood was that of cheerful and she

expressed much interest in conversation. She expressed thoughts of excitement and hope for her

placement and stated that she is excited to finally begin to make changes within her life. Based

upon these observations and thoughts expressed by J.G. outcomes were that of a positive and

effective result.

Summarize

On this current admission J.G. has a stay due to suicidal ideations and this was her first

admit to this unit. The plans for discharge are to get J.G. into therapy groups and return home to

her children with a stable mood. More discharge plans include attempts to maintain medication

therapy compliance. Her caseworker is also working on assisting her in receiving social security

benefits. J.G. has a case that demonstrates the holes and cracks within the mental health care

system that prevent some people from acquiring the care they need. She has a home under her

name so she does not apply for qualification with group home placement. Along with this, if she

sells her home she will no longer be eligible to receive any form of social security funding. J.G.

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also has had trouble in being eligible for unemployment/disability benefits. With her being a

single mom, having psychotic disorders, and no income is not enough to categorize her as being

disabled. Due to all of these complications the patient has a very complicated discharge plan.

Getting her placed in the programs she requires/needs requires an increased amount of work and

labor in helping her to fall into the categories she needs in order to receive such cares/benefits.

Prioritize

Major depression as evidence by loss of interest in previous activities.

History of drug and alcohol abuse as evidence by increased elevated BAC upon admission.

Noncompliance to medication regimen as evidence by non-therapeutic drug levels.

Generalized anxiety as evidence by apprehension toward discharge plan.

List

According to Linda Carpenito, potential nursing diagnoses for major depression include

the following. Risk for self-directed violence. Risk for Suicide. Ineffective coping. Hopelessness.

Social isolation. Impaired social interaction. Chronic low self-esteem. Disturbed thought process.

Self-care deficit.

Conclusion

In conclusion it is evident that a diagnosis such as major depression can have a major

impact on one’s life. With multiple admissions to a psychiatric unit there is still a presence of a

mental illness that is debilitating to the clients everyday functioning. With treatment such as

medications and therapies, improvement was made in the patient’s status. However, with this

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particular case half the battle is to get J.G. the care she needs in terms of financial assistance and

living placement to truly provide a therapeutic environment to help better her mental health.

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Sources Cited

Carpenito, L. J. (2017). Handbook of nursing diagnosis. Retrieved November 22, 2018.

Osborn, R. L., Demoncada, A. C., & Feuerstein, M. (2006). Psychosocial Interventions for

Depression, Anxiety, and Quality of Life in Cancer Survivors: Meta-Analyses. The

International Journal of Psychiatry in Medicine, 36(1), 13–

34. https://doi.org/10.2190/EUFN-RV1K-Y3TR-FK0L

Pedersen, D. D. (2018). Psych notes: Clinical pocket guide (5th ed.). Philadelphia: F.A. Davis

Company.