Mental Health Case Study

Gina Bellotta

Mental Health Nursing

Case Study

Phyllis Jean Defiore-Golden

St. Elizabeth’s Youngstown Campus

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Mental Health Case Study

Abstract

This mental health case study focuses on a 36-year-old male, R.F., who suffers from

Major Depression, Bipolar Disorder, and anxiety. R.F. was involuntarily admitted to St.

Elizabeth’s in Youngstown, Ohio on October 14th, 2019 after encountering an aggressive

altercation with his wife and father. R.F. has been previously hospitalized for a suicide attempt

two years ago. This case study will focus on aspects related to R.F.’s mental health such as him

and his family’s mental illness background, stressors and behaviors precipitating this

hospitalization and his actions, cultural influences, nursing care provided and coping activities

attended. Following this data, there will be a prioritized list of nursing diagnoses, a summarized

plan for discharge, and an evaluation of patient outcomes.

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Objective Data

R.F. is a 36-year-old Puerto Rican male. He was admitted to the Mercy Health St.

Elizabeth’s Main Campus in Youngstown, Ohio on October 14th, 2019 and the date of provided

care was on October 17th, 2019. R.F. was admitted involuntarily. The patient has no known drug

allergies.

This patient was admitted with the diagnoses of Major Depression, Bipolar Disorder, and

anxiety. This patient also has a medical history of Asthma. Patient R.F. has no history of

physical or sexual abuse in his childhood or adulthood. This patient has a history of a suicide

attempt by trying to hang himself two years ago. The patient was calm and cooperative upon

admission and was placed on patient self-hard precautions and specific protocols for his

diagnosis of Major Depression and previous suicidal ideations. The staff on this unit will

continue to observe and assess risk for suicide and self-harm on a clinically routine basis.

Per the DSM IV-TR of Axis I through Axis V, patient R.F.’s clinical diagnoses fit into

Axis I with his diagnoses of Major Depression, Bipolar Disorder, and generalized anxiety.

When reading into Axis IV, it states that conditions that influence the patient’s diagnoses are

psychosocial and environmental related. This patient would fall under Axis IV because in

regards to his condition, his living situation at home with his wife has a major influence on his

poor mental health. Along with his living situation, he and his wife do not get along well and

often experience altercations, which corresponds with Axis IV relating to family issues that

contribute to his mental diagnoses. Patient R.F. also has a history of substance abuse, which falls

under Axis III due to it affecting his mood even further and interfering with effective treatment.

In relation to Axis V, patient R.F. would fall under the scale of 30-41 with family relations,

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judgment, mood and thinking impairment. This patient may also fall under the scale of 41-50

due to a previous suicide attempt.

Patient reports being in a current unstable family situation with his wife. They do not get

along and says they plan to get a divorce. He shares two out of his three children with her and

does not have a relationship with the mother of his other child.

When R.F. was involuntarily admitted to the Psychiatric Unit on October 14th, 2019, he

was exhibiting potentially dangerous behavior, feelings of anger and anxiety, and frustration. On

the day of provided care, October 17th, 2019, this patient appeared to be calm and relaxed and

expressed that being on the unit away from home, his wife and his father, whom he had had the

altercation with, he felt better and at ease and felt he could collect his thoughts more efficiently.

Patient R.F.’s treatment included being placed on patient self-harm precautions and specific

protocols pertaining to his diagnoses. This patient also attended the provided group therapies

that focused on coping dexterity, learning how to express self-inflicted issues, and developing

communication skills. The patient was also prescribed medications relating to his diagnoses

which included: Zoloft (sertraline) 50 mg by mouth daily, which is an antidepressant that is used

to treat depression and anxiety; Zyprexa (olanzapine) 5 mg by mouth or 10 mg IM every four

hours PRN, which is an antimanic used to treat agitation for individuals diagnosed with Bipolar

Disorder; Vistaril (hydroxyzine) 50 mg by mouth three times daily PRN, which is an antianxiety

medication for patients suffering with depression and anxiety; Cogentin (benztropine mesylate) 2

mg IM twice daily PRN, which is an antiparkinson agent that is used to control the side effects of

medications associated with Bipolar Disorder.

Summarize

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“Major Depressive Disorder is characterized by depressed mood or loss of interest or

pleasure in usual activities” (Morgan & Townsend, 2017). Typically to be diagnosed with

depression, symptoms that exhibit impaired social and occupational functioning must persist for

at least two weeks (Morgan & Townsend, 2017). “The individual who is severely depressed

may also demonstrate a loss of contact with reality. This level is associated with complete lack

of pleasure in all activities, and rumination about suicide are common” (Morgan & Townsend,

2017). The effects of depression on some domains may often vary whether they have increasing

or decreasing effects. For example, one’s appetite and body weight may either be elevated or

diminished, and there may be an occurrence of either insomnia or hypersomnia (Gelenberg &

Hopkins, 2007). Although major depression may have a rather severe effect on one’s body and

emotions, it is a very manageable illness. “It is reasonable for a primary care internist to

prescribe an antidepressant to a patient with uncomplicated or nonpsychotic major depression of

mild to moderate severity. The most widely prescribed first-line antidepressants are the selective

serotonin reuptake inhibitors” (Gelenberg & Hopkins, 2007). It is also conventional and

beneficial for a patient with depression to be prescribed the combination of medication along

with attending psychotherapy (Gelenberg & Hopkins, 2007).

“Bipolar disorder is a chronic, relapsing illness characterized by recurrent episodes of

manic or depressive symptoms, with intervening periods of that are relatively (but not fully)

symptom-free” (Jann, 2014). “Bipolar disorder has a lifelong impact on patients’ overall health

status, quality of life, and functioning” (Jann, 2014). There are two major types of Bipolar

Disorder which are Type I and Type II. Type I is defined by episodes of depression with a

presence of mania. Type II consists of episodes of depression but with hypomania. The

distinguishing difference between Bipolar I and Bipolar II is the severity of manic symptoms

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(Jann, 2014). “Full mania causes severe functional impairment, can include symptoms of

psychosis, and often requires hospitalization; hypomania, by contrast, is not severe enough to

cause marked impairment in social or occupational functioning, or to necessitate hospitalization”

(Jann, 2014). Pharmacologic treatments for Bipolar Disorder include mood stabilizers,

antidepressants and antipsychotics (Jann, 2014). “Anxiety disorders and alcohol or drug

dependence are particularly common comorbidities, with major consequences for treatment

outcome and increased cost” (Jann, 2014).

Generalized Anxiety consists of persistent, unrealistic, and excessive anxiety and worry

that have occurred for more days than not and lasts for at least 6 months (Morgan & Townsend,

2017). Along with worrying, one who suffers from anxiety may experience muscle tension,

restlessness, or feeling keyed up or on edge (Morgan & Townsend, 2017). “Anxiety disorders

are the most prevalent mental health conditions. Although they are less visible than

schizophrenia, depression, and bipolar disorder, they can be just as disabling” (Bystritsky,

Cameron, Khalsa & Schiffman, 2013). Anxiety disorders are present among many individuals in

the United States and constitute the most prevalent subgroup of mental illnesses (Bystritsky,

Cameron, Khalsa & Schiffman, 2013). “Anxiety disorders can be said to account for decreased

productivity, increased morbidity and mortality rates, and the growth of alcohol and drug abuse

in a large segment of the population” (Bystritsky, Cameron, Khalsa & Schiffman, 2013).

“Anxiety disorders can be effectively treated with the use of psychopharmacological and

cognitive-behavioral interventions” (Bystritsky, Cameron, Khalsa & Schiffman, 2013).

Identify

On October 14th, 2019, patient R.F. was admitted to St. Elizabeth’s Youngstown hospital

after an altercation between him, his wife and his father. The patient says that him and his wife

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have been married for over ten years and have two children together but they do not get along.

R.F. says that upon his discharge from the psychiatric unit he plans to pursue a divorce with his

wife. This patient states that he has been employed with Home Depot for four years and moves

around between four different locations when he is needed at each. He says that he also runs his

own business where he rents houses to people. R.F. has three children and pays child support

and states that he is financially independent and does not receive any financial assistance.

R.F. says after his altercation with his wife and father he was brought to the psychiatric

unit because two years ago he was hospitalized for trying to hang himself and his family

members were anticipating another recurrence. The patient admits to having both depression and

anxiety and says he often uses alcohol and drugs to cope with his illness. R.F. also says that

fighting with his wife triggers his detrimental behavior.

Discuss

The patient had no family history present related to mental health. He did not speak of

any family members besides his father, his wife, and his three children. This patient admits to a

history of being admitted to the psych unit for previously attempting suicide by hanging himself.

R.F. says that his poor mental health derives off his living and marital situation with his wife.

They often do not get along and their altercations are stressful and unhealthy. This was R.F.’s

third day on the psychiatric unit and says that being away from home has allowed him to gather

his thoughts and feel more at peace. He said he feels his father can become controlling and that

also contributes to his behavior. This patient has come to terms with accepting that he and his

wife have an unhealthy relationship and feels that it would be best for his family if upon his

return home, they pursue separating.

Describe

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Mental Health Case Study

This patient’s treatment at St. Elizabeth’s in Youngstown’s psychiatric unit includes 24-

hour around the clock care by all of the staff on the unit, attending the offered group therapies

such as learning new coping mechanisms, practicing healthy ways to express his emotions, and

sessions that focus on substance abuse education and how to overcome the addiction. The

patient is also receiving pharmacologic therapy including Zoloft, Zyprexa, Vistaril, and

Cogentin.

Analyze

The patient had not mentioned much about his cultural or religious background but

declared that he is Puerto Rican. Although this patient agrees that his living situation at home is

unhealthy, he says that his three children are most important to him and he will do everything to

provide the best care for them. This patient says that staying busy at work clears his mind and

keeps him on track. His children are his motivation to keep going. This patient admits to using

drinking alcohol and using marijuana as a coping mechanism for his depression and anxiety.

Although this patient admits to having a poor relationship with his wife, he agrees that separation

between him and his wife will make for greater civilization and create a better home life for his

children so they do not have to witness the mayhem.

Evaluate

My experience providing care to patient R.F. was pleasant and calm. This patient

admitted to his depression and anxiety disorders but didn’t display any symptoms of restlessness

or worry. The patient became a bit agitated when speaking about his wife but behaved in a

socially acceptable manner by keeping himself composed. R.F. was very open when speaking

about issues related to his mental health. This patient has created goals to pursue upon his

discharge to separate from his wife and focus on working and build a good life for his children.

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Mental Health Case Study

This patient denies having any current suicidal thoughts and proclaims that he feels he is in a

much better mental state since his admittance to the unit.

Summarize

Patient R.F. was admitted to St. Elizabeth’s psychiatric unit on October 14th, 2019

involuntarily by his wife and father because of a previous suicide attempt that occurred two years

ago. A dispute between him and his wife initiated his admission to the unit. The patient denied

he was having any suicidal thoughts upon admission and remained consistent with his statement

on my day of providing care, three days later. Patient R.F. was cooperative with his treatment

regimen at the hospital. The patient admits to having an unstable marriage and upon discharge

plans to move out of the house he lives in with his wife to create a better living environment for

his children. He plans to continue working hard for his job because being able to efficiently

support his three children is most important to him.

Prioritized List of Nursing Diagnoses

1. Risk for self-harm, related to feelings of helplessness and poor relationships with family

members at home.

2. Risk for violence: self-directed or other-directed, related to biochemical and neurological

imbalances, as evidenced by agitated behaviors and poor impulse control.

3. Ineffective individual coping, related to ineffective problem-solving strategies and skills,

as evidenced by destructive behavior towards self or others and use of drugs and alcohol.

List of Potential Nursing Diagnoses

1. Disturbed thought processes, related to overwhelming life circumstances as evidenced by

impaired judgment, perception and decision making.

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2. Impaired social interaction, related to lack of support system, as evidenced by

dysfunctional interaction with family, peers, and/or others.

3. Altered family processes, related to unstable relationships with family members, as

evidenced by family dysfunction.

Conclusion

Providing care for patient R.F. was an educational experience by applying existing

knowledge about mental illnesses and learning new ways to understand and treat it. This patient

was diagnosed with Major Depression, Bipolar Disorder, and anxiety and it was evident that his

mental illnesses have interrupted his daily functioning and have been detrimental to his family

and home life. I was grateful that this patient was very open to talking about his emotions and

his life outside of the unit so I could grasp a better understanding of him. By caring for this

patient, I was able to recognize that people with this disorders manifest their symptoms in

different ways because I was able to use previous patient assignments for comparison. During

my experiences in my mental health clinical and with this patient, I have found that it is essential

to be aware of any mental alterations you may be experiencing and to not hesitate to seek help

and treatment for yourself for the sake of your wellbeing and those around you that may also be

affected.

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References

Bystritsky, A., Cameron, M.E., Khalsa, S.S., & Schiffman, J. (2013). Current diagnosis and

treatment of anxiety disorders. Pharmacy and therapeutics, 30-38, 41-44, 57.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628173/

Gelenberg, A.J., & Hopkins, H.S. (2007). Assisting and treating depression in primary care

medicine. The American journal of medicine, 120, 105-108.

https://www.amjmed.com/article/S0002-9343(06)00699-1/fulltext

Jann, T. (2014). Diagnosis and treatment of bipolar disorders in adults: a review of the evidence

on pharmacologic treatments. American health & drug benefits, 489-499.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296286/

Morgan, K. I., & Townsend, M. C. (2017). Essentials of psychiatric mental health nursing:

Concepts of care in evidenced-based practice. Philadelphia, PA: F.A. Davis Company.

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