Psychiatric Case Study 1

Psychiatric Case Study

Vincenzo Sferra

Youngstown State University

Abstract

The patient involved in this case study will be referred to A.B. for the privacy of the patient.

The client has multiple diagnoses including bipolar disorder, major depressive disorder, and alcohol

abuse. This case study incorporate the clients personal and family history regarding her disorders. It

will also focus on how these disorders affect her daily life and relationships. The goal for her, and every

patient entering the unit, is to recover to normal functioning in society and to have a better quality of

life upon release. It is very important for each client to participate in daily activities and learn coping

and behaviors from others. A key factor with this patient is her addiction to alcohol. The clients abuse

amplifies the negative manifestations in her mental disorders, causing more stress to the patient. The

case study will use the clients information, responses, and situation in way that will not expose her

identity and not be presented in a negative way.

Objective Data:

A. B. was admitted to the Psychiatric E. R. voluntarily on the 23rd of October, and then was

admitted to the 7th floor on the 24th. The date I cared for this patient was on the 25th of October and

was admitted for SVT with a heart rate above 180 in the ER. She was transferred to treat her DSM-V

diagnoses of alcohol abuse, bipolar 2 disorder, and major depressive disorder. Upon meeting the

patient, we introduced ourselves and sat, talked, and I provided emotional support. The client was

open and easy to talk to. She was very willing to answer any question I asked. She began talking about

her reason for admission first, which was caused by an identified stressor. A.B. had lost one of her

close friends to suicide a few years ago and she was at the location where he passed away, which was

by some railroad tracks in a field. She said she was drinking whiskey on top of her car and called her

boyfriend, while drunk, saying she needed to die. The boyfriend ended up calling cops to her location

and went to the ER for the SVT. This gave me great insight for her current admission. She then jumped

around multiple different topics and stories about her history. The patient could barely sit after five

minutes and wanted to give a tour of the floor. A.B. was acting very manic and could not really stay on

one topic, she also has a poor appetite and trouble falling asleep. As far as safety precautions go, A.B.

had seizure and suicide precautions. The medications prescribed all related to her disorders of alcohol

abuse, major depressive disorder, and bipolar 2 disorder. She was ordered Ativan, Folvite, and a

multivitamin for her alcohol abuse. The Ativan is ordered 4mg oral tablet for every hour PRN, for the

alcohol withdrawals, since she has not been sober for 15 years, and the multivitamin and folvite once

everyday, for the liver and withdrawals of alcohol abuse. For her bipolar 2 disorder, she was prescribed

Depakote, which is an anticonvulsant, 500 mg extended release tablet once everyday. Depakote is

used to treat the manic symptoms of bipolar. She is also ordered haldol 10 mg IM injection for
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agitation and has an order for Cogentin 2mg for any EPS reactions.

Psychiatric Diagnoses:

My patient, A.B, was diagnosed with multiple disorders. These include, bipolar 2

disorder, major depressive disorder(MDD), and alcohol abuse. According to Jenna Fletcher, PhD, CRNP,

“ Bipolar II disorder is a form of the psychiatric disorder known as bipolar disorder. All forms of bipolar

disorder cause unusual mood swings and shifts in energy and activity levels. Bipolar II disorder is a

form of this disorder characterized by cycles of depressive episodes followed by hypomanic periods”1.

People who are diagnosed are not suffering from periods of manic that affect how they interact

socially on a severe level. This disorder is very overwhelming to a client, they can have mood swings

ranging from intense energy levels and increased dangerous behavior to depressed, suicidal thoughts,

and low energy levels. On top of this disorder, she suffers from MDD, Major Depressive Disorder. With

the depressive moods from the bipolar 2 disorder, experiences emptiness and sleep disturbances.

There are also symptoms that are the same as her previous disorder, such as, decreased energy,

agitated states, increased thoughts of suicide, and feelings of worthlessness. This disorder also leads

to substance and alcohol abuse, the latter of the two is a current diagnoses for the client as well. The

patient stated they have not been sober from alcohol for over fifteen years. This is a problem that the

patient understands and is seeking help for. Alcohol is a very widely abused substance and can lead to

major health problems. These disorders are very serious are effecting the clients daily life, social

interactions and relationships, and her career focus. She feels very upset about these diagnoses, but

the one that shes feel most concerned about his her alcohol abuse. She wants to make herself better

and has confidence in herself to do so.

Precipitating Factors:

The client gave a very detailed story about the events leading up to her admission at St.

E's. The client had lost a friend to suicide several years ago. The feelings and emotions associated with

this loss have never truly left client. She stated that she always thinks about her friend. The day prior

to admission, the client visited the location of the suicide and began to reminisce her moments with

him. She ended up drinking during this event. She drank almost a full liter a jack prior to admission

and the alcohol influenced her thought process. The patient called her boyfriend, after drinking all

day, and then said threat to her life in nondescriptive way. The boyfriend panicked, called the police,

and they arrived at her current location. The client then went on to say she never had any thought of

taking her own life, but thought it would be better I she was not here anyways. This situation is very

upsetting and one could understand the amount of stress this individual is having. This chronic build of

stress could be the reason the client has been admitted to the hospital, on top of her previous

diagnoses of mental disorders. According to Katleen T. Brady, “the relationship between stress and

AOD use is complex. Most likely, however, stress and the body’s response to it do play a role in the

vulnerability to initial AOD use, initiation of AOD abuse treatment, and relapse in recovering AOD

users”3. This is just an example of many studies that find stress and alcohol abuse are related. Not

only is this client exposed to to stress, she has mental disorders influencing her thought process as

well. These factors can also work in the opposite way and the client's disorders can be amplified

through alcohol abuse or even the stressors themselves can interact with her thought process and

emotions.

Psychiatric evidenced based nursing:

One of main care facilities for patients with mental illnesses, is located in Youngstown at
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St. Elizabeth's Hospital. They have a great psych unit with tremendous staff. Its easy to notice the

amount of time and quality of care each nurse gives to to the patients. The patients are on a schedule

that each client can follow but still maintains a choice to attend. There are multiple group sessions and

activities, time and assistance devoted by the nurses, social workers, and doctors for each patient, and

a safe and relaxing environment for the patients. The floor has little stimuli and is very basic unit. It

has many safety precautions for the patient, such as no wires, strings, or places to attempt to hang

oneself, clients are required to remove all hazardous belongings prior to entry, and constant

observation by the medical staff. This floor maintains a quality setting and care for the patient

population.

Patient and Family History of Mental Illness:

A.B. has been suffering from alcohol abuse for the last 15 years of her life. This disorder

has serious health complications if not treated. The patient completely the nature of how alcohol can

harm her body. Though the 15 years of alcohol abuse she sought out help because she never believed

it could help or that even that alcohol was the problem. The patient suffers from the loss of a close

friend and possible other stressors she has experienced throughout her life, but she could use alcohol

to to help numb herself and distract her from the pain. For the patient suffering from bipolar 2

disorder and MDD, it would be very tough to go through every day feeling down and low and being

influenced by the the build up of stress during her life. The patient has never stated or thought about

killing herself other than the night prior to admission. The patient also acknowledged the fact of how

alcohol can affect your thinking and emotions and believes that substance influenced how she felt and

how her emotions came out in speech. The client also stated that both her mother and father suffered

from alcohol abuse. Leaving her exposed environmentally as well as genetically. According to The
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National Institute On Alcohol Abuse and Alcoholism, “Research shows that genes are responsible for

about half of the risk for AUD. Therefore, genes alone do not determine whether someone will

develop AUD. Environmental factors, as well as gene and environment interactions account for the

remainder of the risk”2. The client has both factors effecting her causing more stress and worsening

her situation. Other than alcohol abuse there was no stated nor charted evidence of any other type of

mental illness within her family history.

Ethnic, Spiritual, and Cultural Influences:

Religion can play a big part on how people view suicide and mental illness. Most cultures

and religions view suicide in a negative way. If people are not religious or agree/believe in these view

on suicide, it would make it easier for a person to commit to it. The patient's chart stated she was

catholic. The patient never talked about her views on religion or culture, and said she was not heavily

involved with her religion throughout her life. Religion does not play a huge role in her life.

Patient Outcomes:

The patient was recently admitted one day prior to my clinical. She attended group

meetings during her first day. She also meet with a social worker and doctor to discuss her

medications and how to manage them. The social worker also provided her with multiple outpatient

care facilities and information regarding AA meetings and group therapy when the patient is out of the

hospital. The patient states that the group sessions were very beneficial and provided her a sense of

reassurance that she is not the only one that is struggling with mental illness. Also through these

meetings, she said she has opened up a little more and has been talking to a few other clients on the

floor. Making friends and sharing similar traits with each other gives someone a better understanding

on how to view the disorder and how to better understand it. These clients can also share valuable
Psychiatric Case Study 8

coping strategies and therapies to aid them against their disorders.

Plans for discharge:

This is her second day on the unit during my clinical and she is not sure on her discharge

date. She is expected to leave soon, once she is adjusted to her new medications and is on a routine of

taking them. She will be on the unit for two to three more days. Her plans for discharge include

improved and written instructions for the client, continue medication regimen at home, outpatient

treatment centers and AA meetings, and a recommendation to multiple therapists upon discharge.

The patient is anxious to leave the unit and get back to her daily life. She wants to stay away from

alcohol and take advantage of her medication to get her life back on track.

Nursing Diagnoses:

 At risk for ineffective individual coping related to ineffective problem solving skills as evidenced

by alcohol abuse.

 At risk for violence, self inflected, related to manic excitement as evidenced by delusions and

verbal threats.

 Ineffective individual coping related to ineffective problem solving skills as evidenced by

destructive behaviors, alcohol abuse.

 Risk for impaired social interaction related to disturbed thought processes as evidenced by

poor attention span.

 At risk for self care deficit related to inability to concentrate as evidenced by observation of

client.

Conclusion:

The client was very open to talking to me and had a lot to say about herself and her history. The
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patient has been diagnosed with three disorders, bipolar, MDD, and alcohol abuse, these disorders

affect A.B.'s daily. These disorders cause many problems and stress that are very hard to cope with

and overcome. She wants to make herself better mentally and physically by receiving help to have a

better quality of life. Through this hospitalization, she wants to learn how to cope, reduce the urge to

drink, and find a medication regimen that works for her.

References:

1. Fletcher, J. (2017, September 07). What is bipolar II disorder? Symptoms and treatment.

Retrieved November 15, 2018, from https://www.medicalnewstoday.com/articles/319280.php

2. Genetics of Alcohol Use Disorder. (2008, November 04). Retrieved November 16, 2018, from

https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-

disorders/genetics-alcohol-use-disorders

3. Brady, K. (1999). The Role of Stress in Alcohol Use, Alcoholism Treatment, and Relapse. [online]

Pubs.niaaa.nih.gov. Available at: https://pubs.niaaa.nih.gov/publications/arh23-4/263-271.pdf

[Accessed 16 Nov. 2018].