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MENTAL HEALTH CASE STUDY

Comprehensive Mental Health Case Study

Meredith Cavour

April 4th 2019

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MENTAL HEALTH CASE STUDY

Abstract

This mental health case study focuses on a 22-year-old male who suffers from major

depression disorder with suicidal ideation, anxiety and dependent personality disorder. He came

to St. Elizabeth’s voluntarily after falling into a deep depression and considered taking his life.

This case study will delve into different aspects such as his mental health background, family

history, medications/treatments and therapy. Different nursing diagnosis will be discussed as well

as an analysis and evaluation of his treatment and plans for discharge.

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Objective Data:

R.S. is a 22-year-old Caucasian male. He was admitted to Mercy St. Elizabeth’s Main

Campus - Youngstown on February 19, 2019 and the date of care was February 21, 2019. He

was admitted voluntarily and has no known allergies.

The patient was admitted with the diagnoses of major depression with suicidal ideation,

anxiety and dependent personality disorder. He has no history of sexual or physical abuse in

childhood or adulthood. The patient was under hospital observation for three days with standard

observation and precautions for someone admitted with his diagnosis of depression with suicidal

ideation. Staff will continue to assess suicide risk on a regular basis as part of ongoing clinical

procedures.

According to the DSM IV-TR, Axis I through V, patient R.S. psychiatric diagnosis’s fit

into the axis I with his diagnosis of major depression with suicidal ideation, as well axis II with

his diagnosis of dependent personality disorder. The patient suffers from frequent exacerbations

of irritable bowel syndrome. Therefore, according to axis III, the onset of these IBS symptoms

could aggravate the patient’s psychiatric illnesses. In reference to axis IV, the patient has a

somewhat unstable home environment. He moved around from one place to another frequently

and has been unemployed for a few months since a serious car accident while on the job as a

pizza delivery driver. Patient R.S. also has a history of unstable relationships with family

member and significant others. In relation to axis V, I would say the patient is either at level 41-

50 which is serious symptoms OR serious impairment in one of the following: social,

occupational, or school functioning or at level 31-40 which is some impairment in reality

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testing OR impairment in speech and communication OR serious impairment in several of the

following: occupational or school functioning, interpersonal relationships, judgment, thinking, or

mood.

On day of admittance to the psych ward at St. Elizabeth’s, the patient was exhibiting

signs of wanting to hurt himself, major anxiety and crying. The day of care patient R.S.

exhibited behaviors such as anxiety, restlessness and inability to focus for long periods of time.

The patient’s treatment included being under 24-hour observation at a medical facility

specializing in psychiatric illness, group therapy, lab work and medications. The medications the

patient wad prescribed were Zoloft/sertraline (25 mg daily) which is an SSRI (selective serotonin

reuptake inhibitor) which is an atypical antidepressant used as a first line treatment for

depression. The patient was also prescribed Abilify/aripiprazole (5 mg evening) which is an

antipsychotic typically prescribe for schizophrenia, depression and bipolar disorder. In addition

to that patient R.S. was prescribed Cogentin/benztropine (2 mg daily) which is an anti-tremor

medication and used to treat extrapyramidal side effects (EPS). The patient’s prn medications

include Haldol/haloperidol (10 mg) which is used to help certain mental disorders and anxiety,

Vistaril/hydroxyzine (50 mg) which is an antihistamine that can be used for anxiety and tension

and Trazodone (50 mg) which is a sedative and antidepressant that can be ordered to help

depression and also help one sleep.

Summarize

Major depression encompassed a wide range of symptoms and manifestations. “Depression

interferes with concentration, motivation, and many other aspects of everyday functioning. It is a

complex disorder, involving many systems of the body, including the immune system, either as a

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cause or effect.” (Depression, Paragraph 1) Depression is typically accompanied with anxiety

and such things as genetics and diet play a part in one’s susceptibility to it. In most cases,

depression is typically very treatable with things such as medication and therapy. It is often

cyclical with periods of no symptoms and episodes where there are varying degrees of indicators.

Some symptoms of depression include a feeling of sadness, anxiety, feeling of guilt or

worthlessness, loss of interest in things that were once pleasurable, insomnia and fatigue,

changes in appetite with it going either way: eating too much or too little and thoughts of suicide.

(Depression, 2019)

Dependent personality disorder is described as the need to be taken care of by others in

an extreme and at time inappropriate manner. (Dependent personality disorder, 2018) “This

condition results in submissive and clingy behavior, a fear of separation, and difficulty making

decisions without reassurance from others. Dependent personality disorder may be caused by a

combination of biological and developmental factors. People exposed to authoritarian or

overprotective parenting styles, chronic physical illness, or separation anxiety during childhood

may be more likely to develop dependent personality traits.” (Dependent personality disorder,

paragraph 1-2) A major goal of treatment for dependent personality disorder is to help the patient

increase their self-esteem and self-confidence in their own decision-making process and help

them develop a sense of independence. Behavioral health is the primary treatment for dependent

personality disorder. (Dependent personality disorder, 2018)

“Generalized anxiety disorder is when anxiety (worry, fear, apprehension, or unease)

happens over otherwise common things or events, it is difficult for the individual to control, is

excessive, and lasts at least 6 months.” (Torpy, paragraph 1) Signs and symptoms of generalized

anxiety disorder include tachycardia or fast or irregular heartbeat, sweating excessively for no

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physical reason, headaches and muscle tension, insomnia and fatigue, lack or loss of appetite and

increase of appetite, gastrointestinal symptoms such as nausea, diarrhea and vomiting. (Torpy,

2011)

Identify

The patient recently broke up with his girlfriend of 5-years. He was very dependent on

that relationship to make him happy and to fulfill him in different ways such as giving him a

sense of self and an emotional connection. He said he also recently lost his job as a pizza

delivery driver because he totaled his car while on the job. He said he felt loss without his

relationship with his girlfriend and didn’t know how he could be happy without her in his life. In

addition to that, his job loss caused him to also feel a loss of self and loss of sense of purpose and

responsibility. He said he felt like a loser with no reason to go on in this world. This led him to

become very anxious and depressed and he said he felt there was no reason to live without her

and being unemployed on top of everything else that was happening to him.

The patient said this caused him to go to his ex-girlfriend’s home to say “good bye” one

last time. The patient then then planned to go out to the woods to shoot himself in the head with

a gun. He didn’t share this information with his ex-girlfriend but the patient’s ex realized

something was terribly wrong with his behavior and contacted the patient’s father and let him

know she thought his son was planning to hurt himself. The father was able to reach his son

before he did anything drastic and talked him into going to St. Elizabeth’s psychiatric unit for

help with his depression and plans for suicide.

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Discuss

The patient has a family history of depression and bipolar disorder. He said his mother walked

out on the family when he was young and he no longer has a relationship with her. He said he

thinks his anxiety stems from when his parents would have huge fights with each other. He said

he doesn’t remember a time when they weren’t yelling at each other and fighting all the time. He

said the fights were very rough and got very scary at times because he thought his parents were

going to physically hurt each other at times. Ever since then he had issues with anxiety and then

the depression came when he was a teenager. He believes he developed a dependent personality

because his father was very overbearing at times and was extremely controlling and negative

towards him. He says his father did eventually receive therapy and their relationship is better but

still not great and could use a lot of work yet.

Describe

The patient’s treatment at St. Elizabeth’s psychiatric ward includes activities such as 24-hour

care by a professional staff of nurses and doctors trained in the care and treatment of people with

mental health disorders, medications such as Zoloft, Abilify, Haldol, Vistaril, Cogentin and

Trazodone and group therapy to discuss his emotions, feeling and to learn different coping

techniques.

Analyze

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The patient didn’t really mention or focus on any cultural aspects of his background. He claims

he is not religious but is spiritual and believes in god. He says that his friends are everything to

him and that they are a great support system to him since he doesn’t always have the most

supportive and loving relationship with his family at times. Though the patient claims his

relationship with his father has improved over the past few years since he got therapy as well and

is starting to work on dealing with his negative feelings and emotions towards his son. He also

says he is good friends with his ex-girlfriend though he is still finding it difficult to accept that

they are no longer together in that way.

Evaluate

When I spoke with patient R.S. he was still experience feelings of anxiety though he

couldn’t really explain why he was feeling anxious. He however said that his feelings of

depression had subsided somewhat and that he no longer had any desire to hurt or kill himself.

He was feeling positive and looking forward to the future. He felt that the medications he was on

were working for him and that he was learning a lot from group therapy and ways to cope with

his anxiety, feelings of depression and self-loathing.

Summarize

Patient R.S. said the he thought he was planning to be at St. Elizabeth’s psychiatric unit a

total of 3-5 days but that he thought he has ready to go home that day. However, he was going to

respect what the doctors thought he should do and figured they knew better. He claimed he

planned to stay on his medications after getting discharged because he knows they were working

for him in a positive manner. He also said he was going to be very dedicated to going to therapy

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as often as is recommended. The patient said he plans on moving back home with his father and

stepmother since their relationship has gotten better in recent years. He then wants to figure out

his next steps in life. He wasn’t sure whether that would be going back to college or getting

another job or possibly both eventually. He said his main priority is getting to a better place

mentally and emotionally and then he will move forward from there.

Prioritized List of Nursing Diagnoses

1.) Risk for suicide: At risk for self-inflected, life-threatening injury related to feelings of

hopelessness/helplessness.

2.) Ineffective individual coping: Inability to form a valid appraisal of the stressors,

inadequate choices of practiced responses, and/or inability to use available resources

related to inadequate social support created by characteristics of relationship.

3.) Anxiety related to changes in the environment and routines, threat to socio economic

status.

4.) Anxiety related to change in health status and situational crisis.

List of Potential Nursing Diagnoses

• Anxiety related to familial association/heredity.

• Risk of self-mutilation related to family history of self-destructive behaviors.

• Risk of ineffective coping related to lack of goal-directed behavior/resolution of problem,

including inability to attend to and difficulty organizing information.

Conclusion

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Speaking to patient R.S. was a very educational experience regarding mental health

disorders such major depression with suicidal ideation, anxiety and dependent personality

disorder. He was very open about his situation and did not hold back any emotion. It was very

eye-opening to hear extensively about his mental illness and his background information

regarding it. It’s just one of the many experiences I’ve had in my Mental Health clinical that

really affirmed to me that mental illness disorders have such a broad spectrum of symptoms,

causes, etc. and everyone’s experience as well as their treatment is different.

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References

Dependent personality disorder. (2018, May 25). Retrieved from

https://my.clevelandclinic.org/health/diseases/9783-dependent-personality-

disorder/management-and-treatment?view=print on 4/3/2019.

Depression. (2019, April). Retrieved from

https://www.psychologytoday.com/us/basics/depression on 4/3/2019.

Torpy, J.M. (2011, February 2). Generalized Anxiety Disorder. Retrieved from

http://jamanetwork.com/ on 4/3/2019.

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