Psych Case Study

Running Head: DEPRESSION AND MENTAL ILLNESS

Depression and Mental Illness Kimberly Muccio Youngstown State University

DEPRESSION AND MENTAL ILLNESS

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Depression is a widely growing epidemic in the United States resulting in hospitalization of people of all ages in psychiatric hospitals all across the country. The purpose of this case study was to collect subjective and objective data regarding a patient’s diagnosis and reason for hospitalization. The case study focuses on one patient at the psychiatric unit at St. Elizabeth Mercy Hospital in Youngstown, Ohio. Topics related to this patient such as signs and symptoms of the illness, stressors and behaviors that precipitated this hospitalization, patient and family history of mental illness, care provided, outcomes related to care, and plans for discharge are discussed in this case study. Nursing diagnoses related to this patient and a list of potential diagnoses will also be discussed.

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Objective Data S.M. is a 25 year old female who was admitted to the psychiatric unit at St. Elizabeth’s Hospital in Youngstown on February 19, 2019. I cared for her two days later on February 21, 2019. She has allergies to latex, penicillin, and fish oil. Her psychiatric diagnosis is depression. Her other medical conditions include suicidal ideation and chronic post-traumatic stress disorder. Her chief complaints were mood problems, anxiety problems, and suicidal and homicidal ideations. The patient presented to the emergency room by ambulance with superficial lacerations on her left wrist. She stated that she moved to Youngstown a couple of weeks ago to be with her boyfriend. They got into a fight and he told her to go home so she took out a razor and cut her wrist, but the blade was not sharp enough to cut very deep. She described to me that she was not trying to kill herself but she was simply trying to relieve the pain that she was experiencing mentally by cutting and experiencing that pain physically. She was understanding that she needed help, so she voluntary agreed to go to the psychiatric unit. She attends group activities while she is at the hospital and sees a social worker who has set her up with a therapist for treatment outside of the hospital setting. She sees a nurse practitioner on the psychiatric floor who has prescribed her a medication regimen that she will follow when discharged from the hospital. She does not have any extra self-harm precautions and is compliant with the rules of the hospital. She maintains safety to herself and others and is not at a high risk for harm, but is monitored closely for any changes of behavior. During our discussion, S.M. had an animated facial expression and seemed relaxed throughout the conversation. She maintained good eye contact while talking to me. She was dressed neatly and her hair was pulled back into a neat pony tail. She acted appropriate for the situation and spoke very friendly. She did not have any irregular muscle or motor movement

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such as akathisia, akinesia, or tardive dyskinesia. She had a pleasurable affect and did not seem to have any disturbances in cognition or thought. She told me that she has three kids at home and she was looking forward to getting out and seeing them. It seemed as though her kids motivated her in life and they are the reason she wanted to get better. She seemed excited that she was going to be discharged on the day that I cared for her. The patient’s psychiatric medications include Abilify 5mg twice a day for suicidal ideation, Haldol 10mg every six hours as needed for agitation, Vistaril 50mg as needed for anxiety, Remeron 15mg at bed time for depression, and Desyrel 50mg at bed time for depression. Summary Depression is one of the most common psychiatric mental health disorders. Depression is defined as “an alteration in mood that is expressed by feelings of sadness, despair, and pessimism” (Townsend, 2017). Individuals diagnosed with this psychiatric condition often experience symptoms such as change in appetite, sleep patterns, and cognition (Townsend, 2017). They also may lose interest in activities that they once enjoyed. Although these are the most common, “patients’ description of their symptoms are likely to be affected by their beliefs about their illness and to what they attribute symptoms” (Katona, 2005). This patient also had diagnosis of posttraumatic stress disorder. Posttraumatic stress disorder is defined as “a reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witness the violent death of others, being the victim of torture, terrorism, rape, or other crimes” (Townsend, 2017). S.M. described that at night she sees shadows because at a very young age she was molested by several family members. Child sexual abuse is not uncommon and girls are at “about 2.5 to 3 times higher risk than boys” (Putnam, 2003). She has flashbacks about these incidents. When she was 17 years old, she was raped by one of these family members and this rape resulted in her diagnosis of

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herpes and a miscarriage of the baby. In a study conducted by Putnam (2003), it was determined that “a variety of psychiatric disorders are clinically associated with childhood sexual abuse such as disorders of major depression, borderline personality disorder, somatization disorder, substance abuse disorders, posttraumatic stress disorder (PTSD), dissociative identity disorder, and bulimia nervosa”. Since she experienced such traumatic events in her life, she now suffers from posttraumatic stress disorder and depression over these events on top of the stress of her current day to day life. Identification of Stressors S.M. was voluntarily admitted to the inpatient psychiatric unit after being taken by ambulance to the emergency room at St. Elizabeth Mercy Hospital in Youngstown. On admission, she presented with superficial lacerations to her left wrist. She states that the stress of moving and the stress about fighting with her boyfriend just became too much for her to handle. She described that she knew she needed help and knew that she should go to the hospital once she determined that her three children had somewhere safe to go for the time being. Although she denied a suicidal attempt, in the doctors and nurses notes it was declared that the reason she was admitted was an attempted suicide. Self-cutting injuries have “the potential of leading to devastating disability and repeated suicide attempts” (Carroll, 2016). Though it has a low mortality rate, cutting is a type of injury that is commonly seen in patients who attempt suicide. Self-cutting has the function to “terminate the dissociation precipitated by a strong emotion, such as anger” (Carroll, 2016). This is why she told me that she was trying to stop the emotional pain by causing physical pain. Even though it is hard for people who do not experience mental illness to understand, there are a lot of instances where individuals believe that this action will take the pain away.

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Family History S.M. talked to me for a short period of time about her history and her family history of mental illness, but I found most of it in her chart on the computer. She told me that she had only been to a psychiatric institution one other time. When she was seventeen years old she went to Belmont Pines. We talked about Belmont Pines for a little because I just had an offsite rotation there. She said that Belmont Pines helped her a lot when she was there eight years ago. When I read a bit more in depth into her chart I realized that she was acting suicidal and homicidal toward her mother, so her mother took her to Belmont Pines. In her chart I also found that her father experiences bipolar disorder. It is not uncommon for mental illness to run in families, so I was not surprised to find out this information. Nursing Care The purpose of milieu therapy is to provide a healing and therapeutic environment for patients to be open about their illness and to discuss alternative and healthier coping mechanisms to deal with the feelings that they are facing. Milieu therapy is an important part of psychiatric treatment program on the unit. Patients are encouraged to attend these group sessions and be an open participant in them. S.M. attended all of the group therapy sessions that were offered at the hospital. She described to me that she thought they were very helpful to her because she realized that she was not alone in her illness. Peer pressure is a powerful tool that is used in the psychiatric setting to encourage discussion. To her, talking with the others who go through the same situations was eye opening and beneficial. When she is in the outside world, especially with social media, it’s hard to understand that some people are also going through difficult times just like you. She appreciated that I was empathetic and that we could just talk about her diagnosis without judgement.

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Analyze The patient did not discuss any ethical, spiritual, or cultural influences that impacted her decision making. She denies any spirituality and states that prayer is not a coping mechanism of choice for her. Patient Outcomes On the psychiatric unit, there are numerous patient outcomes and goals set in place for each individual. Every outcome and goal is specific to each patient since everyone presents with different symptoms for every diagnosis. Safety, as always, is of utmost importance on the psychiatric unit, so the outcome that the patient will remain safe and free of harm throughout hospitalization is a desired outcome for every patient on the floor. Some other desired outcomes specific to S.M. include: patient will seek help when experiencing self-harm impulses, patient will identify community support groups that she will be in contact with in the next month, patient will demonstrate compliance with any medication or treatment plan within the next three weeks, and patient will express feeling accompanied by practicing alternative coping strategies. These desired outcomes will discussed with discharge planning and followed up on in later therapy sessions once discharged from the hospital. Discharge Plans S.M. was discharged on the day that I cared for her. She will receive instructions on how to take her new medications and the importance of compliance to her medication regimen. Education about alternative coping strategies will also be discussed at discharge. Social work and case management are involved in her case and have set her up with a psychiatrist so that she can discuss her feelings in a therapeutic setting to prevent rehospitalization or another episode of self-harm. She told me that she plans to go back to her hometown with her children to be close to

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her family until she can get everything together and feel better. She seems excited about discharge and anxious to see her children. Actual Nursing Diagnoses Nursing diagnoses are important because they serve the basis of the selection of interventions and procedures that will occur with the care of the patients. They are specific to each and every patient, even those with the same illness. This specific patient’s actual nursing diagnoses in order of importance are as follows: Risk for self-harm related to feelings of depression as evidenced by cutting of wrists and suicidal thoughts, ineffective coping related to lack of understanding of effective coping mechanisms as evidenced by self-harm of cutting of wrist, and chronic low self-esteem related to traumatic childhood experiences as evidenced by expression of lack of confidence. Potential Nursing Diagnoses Potential nursing diagnoses are important to keep in mind in case the patient exhibits new signs and symptoms that indicate a new problem. Potential nursing diagnoses for depression include: impaired social interaction, risk for self-care deficit, disturbed thought processes, and risk of violence toward others. Conclusion The diagnosis of depression is a very common but serious disorder of all age groups of individuals. The individual discussed in this case study was diagnosed with depression with suicidal ideation and posttraumatic stress disorder. Subjective and objective data was collected and presented in this case study regarding a specific patient’ medical diagnosis. The diagnosis of depression was defined and common behaviors associated with this psychiatric illness were discussed. The patient’s current stressors and family history were discussed to determine the root of the problem that led to this hospitalization. Patient outcomes and plans for discharge were also

DEPRESSION AND MENTAL ILLNESS discussed as well as a list of diagnoses and potential diagnoses were determined. Safety was maintained for this patient throughout her entire hospitalization. A therapeutic milieu environment was promoted and group therapy was encouraged. The multidisciplinary approach on this psychiatric unit yields a beneficial healing environment for individuals diagnosed with psychiatric mental illness.

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10 References

Carroll, R., Thomas, K. H., Bramley, K., Williams, S., Griffin, L., Potokar, J., & Gunnell, D. (2016). Self-cutting and risk of subsequent suicide. Journal of Affective Disorders, 192, 8-10. Katona, C., Peveler, R., Dowrick, C., Wessely, S., Feinmann, C., Gask, L., ... & Wager, E. (2005). Pain symptoms in depression: definition and clinical significance. Clinical Medicine, 5(4), 390-395. Putnam, F. W. (2003). Ten-year research update review: Child sexual abuse. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 269-278. Townsend, M. C., & Morgan, K. I. (2017). Essentials of Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice. Philadelphia, PA: F.A. Davis Company.