Running head: TROUTMAN CASE STUDY 1

Youngstown State University

Mental Health Comprehensive Case Study

Jennifer Troutman

Patricia Flamino
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Abstract

The patient suffers from several different mental health disorders, including Bipolar Disorder,

Major Depressive Disorder, Obsessive Compulsive Disorder, and her most recent diagnosis of

Borderline Personality Disorder. On the day of care, the patient was very reluctant to talk to me

at first, but then she opened up. Discharge planning was still in the worst, considering it was only

the second day of her stay there. However, the plan so far was for her to be discharged home to

her parents’ house, continue to go to cognitive therapy, and do to some trial and error with

medications. The patient can live a fairly normal life if she complies with the treatment plan.
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Mental Health Comprehensive Case Study

Objective Data

The patient is a twenty-year-old female, admitted to St. Elizabeth’s Psychiatric Unit on

September 18th, 2017. The patient’s admitting diagnosis is Borderline Personality Disorder,

which would be under the DSM diagnosis AXIS II. She has a history of Obsessive Compulsive

Disorder, Major Depressive Disorder and Bipolar Disorder, which would all be under the DSM

diagnosis AXIS I. The patient also presents with obesity (DSM AXIS III) and a history of

suicide.

The patient was involuntarily admitted to the locked psychiatric unit because she cut

herself in an attempted suicide. I cared for her on September 20th, 2017 and at first, she did not

want to talk to me. She was in her room crying because she was very emotional and she would

only speak to the LPN. She did not want to talk to me because she wants to go to nursing school

at YSU and she was embarrassed that she was there. She thought that we might tell the people

that run the nursing program that she was there and that it might hinder her getting accepted into

the program. After the LPN explained to her that it would breaking HIPPA if we spoke about her

stay there, she came out and talked to me. She apologized for not talking to me when I first got

there and I explained that it was not an issue and that I accepted her apology. When we talked,

she wanted to walk around of a while. At first she was pretty restless and irritated but then she

calmed down and we sat down to talk.

The patient is obese but her thyroid functioning was normal, so she was not being treated

for that. We also check the thyroid functioning to see if that may be causing her depression,

which it was not. The patient is prescribed Benztropine Mesylate for agitation and/or acute

dystonia, Buspirone for anxiety, Haloperidol Lactate for agitation, Lorazepam for agitation, and
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Trazodone for sleep. As stated above, the patient is in a locked psychiatric unit. The patients are

checked every 15 minutes to know their whereabouts and what they are doing. They do not have

access to showers, the library, the washer and dryer, or the sensitivity room unless requested.

The patients’ rooms are set up for suicide prevention, meaning there is nothing that the patient

can hang themselves on. The patients do not have access to the pencil sharpener or anything

sharp. During meals, they are watched to make sure they do not use the utensils to hurt

themselves or anyone else. It is a very secure unit.

Summarize

As stated before, the patient has several mental health disorders, including Major

Depression, Bipolar Disorder, Obsessive Compulsive Disorder, and Borderline Personality

Disorder. Major Depression is “characterized by persistent feeling of sadness or a lack of interest

in outside stimuli.” (Lieber, November 2017). There are several types of depression, including

seasonal affective disorder, psychotic depression, postpartum depression, melancholic

depression, and catatonic depression. (Lieber, November 2017). No matter the type of

depression, they all exhibit similar signs, symptoms, and behaviors. Those include negative

thinking with inability to see positive solutions, agitation, restlessness, inability to focus, lashing

out on loved ones, and several others. (Leiber, November 2017).

Bipolar Disorder can exhibit similar symptoms as Major Depressive Disorder, but

patients with Bipolar Disorder “experience alternating bouts of mania or hypomania, and

depression, which may involve psychosis.” (Legg, 2017). Patients with Bipolar disorder may

experience several months of their mood alternating between high and low. They may also

hallucinate, they may engage in risky behaviors, or they may have trouble sleeping or may sleep

too much. That all depends on if their mood is high or low.

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The patient also suffers from Obsessive Compulsive Disorder, also known as OCD.

“OCD is a mental health disorder that affects people of all ages and walks of life, and occurs

when a person gets caught in a cycle of obsessions and compulsions.” (OCD, n.d.). This patient

exhibits more obsessions than compulsions. “Obsessions are unwanted, intrusive thoughts,

images, or urges that trigger intensely distracting feelings.” (OCD, n.d.). The patient told me that

she obsessive over very disturbing thoughts of a child being injured badly, and she described that

disturbing, repetitive thought to me. Other patients may experience obsessive thoughts of

contamination, losing control and harm. “Compulsion are behaviors an individual engages in to

attempt to get rid of obsessions and/or decrease his or her distress.” (OCD, n.d.). Some examples

of compulsions include washing and cleaning, checking, and repeating.

The most recent mental health disorder that the patient was diagnosed with is Borderline

Personality Disorder. “A personality disorder is a pattern of feelings and behaviors that seem

appropriate and justified to the person experiencing them, even though these feelings and

behaviors cause a great deal of problems in that person’s life.” (Lieber, July 2017). Patients with

Borderline Personality Disorder have difficulty maintaining long-lasting, healthy relationships

and they experience “inappropriate or extreme emotional reactions, have highly impulsive

behaviors, and have a history of unstable relationships.” (Lieber, July 2017).

With all of these different mental health disorders, it can be very difficult to maintain

mental stability. Which is probably why the patient is in a psychiatric unit for the second time

this year. It can be difficult because even though the depression may be under control with

medication and cognitive therapy, their personality disorder can cause problems in their personal

life. Which in turn, can cause the depression to become unstable. This can go for all four
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different disorders that she has. Compliance with medication and cognitive therapy can help

prevent admissions to the unit. However, it is going to be very difficult.

Identify Stressors

The patient was with a Middle Eastern man for two years who was supposedly verbally

and emotionally abusive and was very controlling. The two of them had plans to move to

Morocco in the near future. She has a mental break down and he told her that she was crazy and

he was tired of dealing with her unstable emotions. He blamed her for his anxiety disorder and

said that if he wasn’t with her, he wouldn’t have it. She felt like everything was her fault and

because of that, she cut herself in an attempted suicide.

Discuss Patient/Family History

The patient has a history of Major Depressive Disorder, Obsessive Compulsive Disorder,

and Bipolar Disorder. She explained to me that her OCD is more of obsessive thoughts. She

thinks about very disturbing things and she cannot stop thinking about them. She does not really

have the combustions. The OCD started when she was 8 years old after a traumatizing event that

she would not disclose to me. Later, she was diagnosed with Major Depression, as well as

Bipolar Disorder. Her most recent diagnosis was the Borderline Personality Disorder, which was

diagnosed during her last hospital stay here in May of 2017. The patient lives with her brother,

mother and father. When her ex-boyfriend would come in town, she would stay with him. The

only one in her immediate family with a psychiatric history is her mother. She has Bipolar

Disorder and Major Depression. Her mother takes Prozac for her depression and is compliant

with that.

Describe Psychiatric Evidence

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Psychiatric care on this unit includes Psychiatrist, Registered Nurses, Licensed Practical

Nurses, health care associates, milieu therapist, and activity directors. Safety on the unit is

everyone’s number one priority. Milieu therapy on the unit includes fifteen minute checks to see

whereabouts of the patients and what they are doing, a count of all silverware and plates after

meals, and mirrors that are not glass so that the patients cannot break them and harm themselves

and others. The beds are all low to the ground and the chairs and tables are very heavy so that the

patients cannot pick them up and throw them. The bathroom doors are not full doors, so the

patients cannot lock themselves in and try to harm themselves. Safety for the nurses includes not

going in a patient’s room without telling someone and always having a way to escape if things

start to escalate in the patient’s room.

There are also group therapies that are held every day that patients are encouraged to

participate in. Participation in group may determine if the patient can go home sooner or not.

Group therapy may include topics such as coping skills, assertiveness training and/or talks about

drug and alcohol addiction. On the day of care, the patient did not participate in the wrap up

group, but she sat quietly and observed.

Analyze Influences

The patient comes from an ethnic background of Irish, German, and English. She is a

Baptized Christian and recently started to study Christianity heavily. Her relationship prior to the

one she was just in, was also very controlling and unhealthy. She had to go through a church to

help her get out of the unhealthy relationship and they helped her get a restraining order against

him. She was still wearing the bracelet that had the organizations name on it. So, after that she

started going to church weekly and that has influenced her positively. Growing up she and her
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family did not really go to church, only on like Christmas or Easter. It wasn’t until her first

unhealthy relationship that she started going frequently.

Evaluate Outcomes

Because the patient has several diagnoses of mental disorders, it can be very difficult to

keep all four disorders in line. But with continuing cognitive and medication therapy, she can

live a fairly normal life. Compliance with going to therapy and with medications is vital for her

to stay out of the psychiatric unit, and she is very aware of that.

Summarize Discharge Plans

Although this was only day two of her stay at the psychiatric unit, there were already

plans in the making for discharge. She would be discharged home to her parents’ house. She has

been living with her parents, but when her ex-boyfriend was in town she would stay with him.

She is to go to cognitive therapy as she was before. She stopped going because she thought it

wasn’t helping her anymore. She admitted that after she stopped going that she felt worse and

that it was, in fact, helping. She is to continue with her medications, which they plan to do some

trial and error with that. So, she is not sure what medications she will be taking after discharged.

Prioritized List of Actual Diagnoses

Self-mutilation related to current and previous history of self-injury on wrist as evidence by fresh

superficial slashes on the wrist.

Disturbed thought processes related to overwhelming life circumstances as evidence by negative

ruminations.

Ineffective coping related to intense emotional state as evidence by manipulation of others.

Chronic low self-esteem related to dysfunction family of origin as evidence by currently going

through a bad break up.

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List of Potential Nursing Diagnoses

Risk for impaired social interaction related to self-concept disturbance.

Risk for self-directed violence related to borderline personality disorder.

Risk for self-care deficit related to anergia.

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References

Legg, T. (July 7, 2017). Bipolar disorder: Causes, symptoms, and treatment. Medical New

Today. Retrieved from https://www.medicalnewstoday.com/articles/37010.php

Lieber, A. (November 28, 2017). Major depression (Unipolar depression). Psycom. Retrieved

from https://www.psycom.net/depression.central.major.html

Lieber, A. (July 10, 2017). Borderline personality disorder. Psycom. Retrieved from

https://www.psycom.net/depression.central.borderline.html

What is OCD? (n.d.). About OCD. Retrieved from https://iocdf.org/about-ocd/