Running Head: PREDISPOING FACTORS TO MENTAL ILLNESS

Mental Health Case Study: Predisposing Factors to Mental Illness

Marissa Wiesen

November 3, 2020

NURS 4842: Mental Health Nursing

Mrs. Teresa Peck

Youngstown State University

PREDISPOING FACTORS TO MENTAL ILLNESS 1

Abstract

The purpose of this study is to analyze the effect that family history of mental illness,

specifically bipolar disorder and schizophrenia has on someone. The effects of childhood abuse

is discussed, along with sexual minorities and suicide risk. Five research articles were obtained

and assessed to determine the effect that predisposing factors has on mental illness. For example,

schizophrenia, bipolar disorder, and anxiety are more likely to cause delusional-like experiences.

Children who were abused as a child are more likely to attempt suicide and have anxiety. Also,

sexual minority individuals such as lesbian, gay, and bisexual are significantly more likely to be

at risk for suicide. Although medications do not cure mental disorders, they are priority

intervention for keeping signs and symptoms of mental disorders under control. Other nursing

interventions include milieu therapy, which is controlling the patient’s environment and stressors

in an inpatient psychiatric unit. This also involves having a therapeutic environment for all

patients.
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Predisposing Factors to Mental Illness

Objective Data and Subjective Data:

The patient of this case study on is a 22-year-old male with the psychiatric diagnoses of

bipolar disorder, anxiety, and schizoaffective disorder depressive type. To abide by HIPPA

regulations, the individual will be referred to as “MM.” He is a white Caucasian male who is

currently unemployed. He has a family history of bipolar disorder, schizophrenia and his mother

has borderline personality disorder. He has a very supportive boyfriend of 2 years, who he came

into the emergency department with voluntarily. He does not have a good relationship with his

parents. He does not speak with his mother often, but he has a better relationship with his father,

and they talk more often. During his admission assessment in the emergency room, he did not

give much information to the staff. He stated that he does not know why he is paranoid. He had

no current signs and symptoms with no relieving or exacerbating factors. He also denied having

any hallucinations or delusions. On the other hand, his boyfriend was able to give more

information. He stated that they were watching politics when he became paranoid that the FBI

was going to come and get him due to a comment made on youtube.com. He thought that they

were plotting against him. His boyfriend also stated that the patient was seeing people outside the

window and thought they were talking to him. He was admitted to the psychiatric unit on

October 14, 2020. I cared for this patient on October 20, 2020 which is also the day the patient

was being discharged.

MM exhibited other delusions during the time that he was in the psychiatric unit. This

included thinking everyone was out to get him which included a gang called MSB. He also

thought the other patients on the unit knew about his life and previous job in Massillon, Ohio. He

thought everyone on the floor was following him via Snapchat, and all the patients were
PREDISPOING FACTORS TO MENTAL ILLNESS 3

affiliated with one another outside of the hospital. Finally, he questioned the nursing staff about

giving the patients estrogen because they were doing this in hospitals in California.

During the conversation and assessment of this patient, he was friendly, had animated

facial expression that were appropriate to his mood and affect. He was dressed clean, neat and

well kept. He had good communication and eye contact during the conversation. He also used

hand gestures such as “quoting” with his fingers to explain the hallucinations and delusions he

was experiencing. He said that he was being doxed and people were out to get him. This means

that someone was trying to find out his real identity and use it against him. This belief was

causing him such anxiety that he starting to cut off friends and then family, 2 weeks prior to

admission. He stated that he knew they were not real while the hallucinations and delusions were

occurring.

Other medical conditions the MM has are hypokalemia, obesity, leukocytosis, low HDL,

syncope and collapse, hypertension and tobacco use.

The normal laboratory values the patient has are thyroid stimulating hormone (TSH) was

1.82, vitamin B12 was 391, aspartate aminotransferase (AST) was 11, alanine transaminase

(ALT) was 24, Hemoglobin A1C was 4.9, blood urea nitrogen (BUN) was 16.5, and creatinine

was .97. These were taken to rule out other causes of a psychiatric illness. For example, if TSH

or B12 are low, this can cause symptoms that are associated with depression. When the liver is

not functioning, it can cause ammonia to accumulate in the blood which is toxic to the brain.

Thus, causing hepatic encephalopathy that alters you level of conscious. This is seen in

alcoholics with severe liver disease. Finally, changes in blood sugar can cause changes in mood

such as fatigue, trouble thinking clearly, and anxiety. The abnormal laboratory values for MM

are white blood cells (WBC) at 11.8, red blood cells (RBC) at 5.78, potassium at 3.4, total
PREDISPOING FACTORS TO MENTAL ILLNESS 4

bilirubin at 1.2, total protein at 8.6, and high-density lipoprotein (HDL) at 32. His urine was also

positive for marijuana but negative for all other drugs.

On all psychiatric floors there are safety measures. The floor is a locked unit, so they

cannot leave until their 72-hour hold is up and no one can get in the unit without a badge or key.

The patients are allowed to make phones calls and have visitors, but this may be restricted if it is

causing stress or harm to the patient’s mental health. Upon admission, anything that any patient

can use to hurt themselves with is taken away. This would be things like shoelaces, draw strings

in pants or hoodie strings, pens or pencils, razor blades, and belts. A checklist is done upon

admission of the patient’s belongings which are given back when they are discharged. Other

things done to keep the patient safe is checking on him/her every 15 minutes and when giving

medications, their mouths are checked to make sure they swallow them and not pocket the

medications to take all at once.

Prior to admission, MM was not on any medications. During this hospitalization, he was

put on three different medications. He had been put on risperidone (Risperdal) which is an

antipsychotic medication. This helps to stabilize his mood related to bipolar disorder. He is also

on lisinopril (Zestril) which is an angiotensin-converting enzyme (ACE) inhibitor. This is an

antihypertensive medication which can be used for the treatment of depression. The patient was

diagnosed with schizoaffective disorder the depressive type, and he has hypertension, so this

medication helps to treat both of those problems. The last medication he is on is sertraline

(Zoloft). This is a selective serotonin reuptake inhibitor (SSRI), which is antidepressant

medication but, in this case, it is used for anxiety.

PREDISPOING FACTORS TO MENTAL ILLNESS 5

Summarize the psychiatric diagnoses and expected/common behaviors, with citations

Anxiety is a vague feeling of dread or apprehension. It is an emotional response to the

anticipation of danger, but it is different than fear. Anxiety has either an internal or external

stimulus that effects behavior, cognition, emotions and physical symptoms. These symptoms

include restlessness, fidgeting, difficulty sleeping, muscle tension, pounding pulse, headache and

many others (Videbeck, 2020).

Schizoaffective disorder is diagnosed when a patient has psychotic and mood symptoms.

This includes symptoms of schizophrenia and a mood disorder such as depression or bipolar

disorder (Videbeck, 2020). This patient has the depressive type of schizoaffective disorder. In

schizoaffective disorder, the behaviors associated with schizophrenia include positive symptoms

such as delusions, hallucinations, disorganized thinking, speech, behavior. The negative

symptoms include flat affect, lack of violation, and social withdrawal or discomfort. The

depressive symptoms of schizoaffective disorder include symptoms of depression such as low

energy and activity, hopelessness, and the inability to perform everyday tasks (Videbeck, 2020).

Furthermore, the symptoms the patient exhibited are delusions, hallucinations, and social

withdrawal from friends and family, and everyday tasks.

Bipolar type II is a mood disorder that is associated mood swings that involve episodes of

mania and depression. With bipolar type II, this patient has at least one hypomanic episode along

with recurrent depressive episodes (Videbeck, 2020). Hypomania is less severe symptoms than

acute mania, that do not affect a person’s activities of daily living. According to a study by

Karanti, A., Kardell, M., Joas, E., Runeson, B., Pålsson, E., & Landén, M. (2020), bipolar type II

is also seen as less disabling because hypomania does not usually cause marked impairment or

hospitalization like bipolar type I. This study also found that bipolar type II patients are more
PREDISPOING FACTORS TO MENTAL ILLNESS 6

likely to have children, live in ordinary housing, working, and be self-sustaining (Karanti et al,

2020).

In addition, this patient has anxiety and bipolar disorder along with a first degree relative

with a personality disorder and a family history of schizophrenia. It is a significant finding that

this study correlates that it is more likely for a patient with bipolar type II to have other

psychiatric conditions such as anxiety, ADHD, and personality disorders (Karanti et al, 2020).

Identify the stressors and behaviors that precipitated current hospitalization

The patient was watching politics with his boyfriend when he started to become

delusional and hallucinate. He stated that he thought he was being “doxed” and when asked what

this means, he said that people were tracking and coming for him. He was seeing things in the

television and outside the windows. He thought that the FBI was trying to find him and plot

against him. He stated that social media such as Snapchat and Facebook and the pandemic are

triggers to his anxiety and current illness. The duration of this event occurred over 2 weeks

where he began to isolate himself from his friends and shortly after his family. He stated that he

was deleting them on social media as a way to cope with his delusions and hallucinations.

During his time on the psychiatric mental health unit, he had a conversation with his

father over the phone. This included his father telling him that this would be the last time he

would be talking to him. In turn, this caused him a lot of anxiety because he does not know why

he said that or what he did wrong. On the other hand, a nurse on the unit also had a conversation

with his father. Where she found that the patient went to visit his mother about 1.5 weeks prior to

this hospital admission. After this visit is when the patient’s paranoia and other behaviors started.

This was another precipitating factor that lead to this decline of his mental health.
PREDISPOING FACTORS TO MENTAL ILLNESS 7

One other thing that causes him a lot of anxiety is the fact that he has a family history of

schizophrenia along with other mental illnesses. Many mental disorders tend to have a genetic

component and run in families. A study by Varghese, D., Saha, S., Scott, J. D., Chan, R. C., &

McGrath, J. J. (2011), found that a family history of major depression, anxiety, schizophrenia,

bipolar disorder, alcohol and/or illicit drug dependence are all significantly associated with

delusional-like experiences. Moreover, upon a more restrictive analysis, only a family history of

depression and schizophrenia were significantly associated with delusional-like experiences.

This is a very real trigger for this patient given his symptoms upon admission to the hospital and

his family history. The good thing is that he stated he knew and understood that the

hallucinations and delusions he was having were not real, but still they were causing his anxiety

to worsen.

Discuss patient and family history of mental illness

Other than this current hospitalization, the patient was recently in a mental health faculty

in Willoughby, Ohio four weeks ago. Also, in high school, there was an incident where the

patient drove to a bridge, got out of the car, and stood on the edge of the bridge wanting to jump

off. But he ended up getting back in his car and went home.

He has a history of being abused as a child. According to a study by Shah, S.,

Mackinnon, A., Galletly, C., Carr, V., McGrath, J., Stain, H., Castle, D., Harvey, C., Sweeny, S.,

& Morgan, V. (2014), male children who were abused are significantly more likely to have a

subjective thought disorder, suicide attempt, and anxiety (Shah, 2014). This is true for this

patient. He has had profound anxiety and has suicide ideation in the past. This study also found

that it is 71% more likely to have auditory hallucination with an abused child than the non-
PREDISPOING FACTORS TO MENTAL ILLNESS 8

abused child (Shah, 2014). Again, this is true for this patient, he was hallucinating where he

thought people outside the window were talking to him.

Likewise, one study noted that there is an increased risk of schizophrenia when there is a

first-degree relative with the following mental disorders; depression, bipolar affective disorder,

substance abuse, and personality disorders (Varghese, 2011). This is significant to this patient

because his mother has a personality disorder and as stated before he has a history of

schizophrenia in his family.

Describe the psychiatric evidence-based nursing care provided and milieu activities attended

Milieu therapy is essential to a patient on a psychiatric unit. This involves keeping the

patients in a safe, therapeutic environment which includes having interaction with other patients

on the unit, where they practice interpersonal skills, giving each other feedback, and working

cooperatively with one another to solve problems (Videbeck, 2020). In general, this means that

we are controlling their environment to prevent harm from themselves or other people. Their

safety is maintained by taking away any of their belongings that they can harm themselves with.

The amount of stress is controlled. For example, if a patient is becoming anxious and feels

unsafe when he talks to a family member on the phone, the staff is to restrict those phone calls.

This patient was anxious after talking with his father, so if necessary, the staff can restrict those

phone calls to benefit the patient. The patients are all encouraged to go to group therapy. This

allows them to have social interaction and get feedback on their behaviors from their peers in the

group. On the day of care, the patient did attend group therapy and he was an active participant.

It is also very important for the nurse to develop a therapeutic relationship with the client

which focuses on the client and their goals and feelings. In addition, it is important to develop
PREDISPOING FACTORS TO MENTAL ILLNESS 9

rapport, trust and respect with the patient. This allows for the patient to feel comfortable and

share more information with the nurse. This is done by doing what you say you are going to do,

meeting the patient’s basic needs, having a nonjudgmental attitude, and being accepting.

Medications are a key component to preventing psychotic behaviors, delusions and

hallucinations. The medication MM is on to help with psychotic behaviors is risperidone

(Risperdal), a mood stabilizer for bipolar disorder and to prevent delusions and hallucinations.

Medications are also very helpful for anxiety. This patient stated that he was on anxiolytic

medications when he was in high school which he found helpful then. At some point, he stopped

taking them, but during this hospital admission he was been put back on medications. When

asked if they are helpful, he strongly agrees that they help decrease his anxiety level. The

medication he is on is sertraline (Zoloft).

Analyze ethnic, spiritual and cultural influences that impact the patient

This patient is a Caucasian, white male, who stated that he is a conservative and gay. He

did not elaborate on being conservative, which is interesting because in general conservatives do

not support LGBTQ+ rights. A study by Mereish, E. H., Peters, J. R., &Yen, S. (2018), found

that the participants who had lower incomes and lower levels of education, which is identified as

high school or less, are at greater risk for suicide. This is significant because this patient has a

history of suicide ideation and is currently unemployed. Furthermore, this study also found that

people who are considered sexual minorities such as lesbian, gay, and bisexual individuals are at

higher risk of suicide at 27.7%. These individuals reported victimization, shame, and rejection

which are founded to be significant risk factors for suicide among sexual minorities (Mereish et

al. 2018).
PREDISPOING FACTORS TO MENTAL ILLNESS 10

On a positive note, according to a study by Plöderl, M., Kunrath, S., Cramer, R.J., Wang,

J., Hauer, L., & Fartacek, C. (2017), sexual minorities and heterosexual individuals who were at

risk for suicide in a psychiatric hospital showed no significant differences in treatment outcomes,

treatment expectations and working alliances. They also found that sexual minority patients had

longer hospital stays. Thus, having better improvements and a higher likelihood of responding to

treatment (Plöderl et al, 2017).

When dealing with stress and anxiety, this patient stated that he uses marijuana to cope.

This is evident by his urinalysis being positive for marijuana. He also believes in God or some

form of a higher power, because he will use prayer a lot when he wants to feel safe.

Evaluate the patient outcomes related to care and plans for discharge

Outcomes for this patient include, having no hallucinations or delusions and to have his

anxiety under control. This can be managed with the medications he has been put on. So,

compliance with the medications is very important. Teaching about medication side effects such

as sexual effects needs to be addressed because it is one of the main reason people stop taking

their medications. Another thing that needs to be addressed is teaching to continue taking his

medications even when he is feeling better. This means that the medications are doing their job

at stopping any symptoms the patient is having regarding hallucinations and delusions. The nurse

also needs to be aware of the patients access to the pharmacy and if the patient can afford his

medications because this will also decrease compliance.

MM has stated interest in stopping the use of marijuana because it will interfere with his

medications. Patient education on the medication interactions regarding marijuana and other

illicit drugs is a priority intervention. The nurse should always provide information on the mental
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disorders of the patient along with community resources available. This includes information on

the disease process, signs and symptoms, what exacerbates the disease, and when it is necessary

to reach out for help such as going to the hospital if mania or suicidal ideation or attempt occurs.

It should also be priority to assess the patient’s needs and affects related to being abused as a

child and referring the patient for counseling if necessary.

Prioritized list of all actual diagnoses using individualized NANDA format.

 Social isolation related to altered mental status, inability to engage in satisfying

relationships as evidenced by hallucinations, delusions, preoccupied thoughts, patient stating

withdrawing from friends and family.

o Nursing interventions: 1. Discuss and assess causes of perceived or actual isolation and

to promotes social interactions. 2. Help the patient identify social activities the patient

enjoys. 3. Identify the patients support system and involve those individuals in the

patient’s care.

 Risk for suicide related to history of suicidal ideation and attempt, age as evidenced by

sexual orientation and history of abuse.

o Nursing intervention: 1. Assessing for suicidal ideation. 2. Being aware for warning

signs of suicidal thoughts. 3. Refer the patient for mental health counseling.

 Anxiety related to stress and family history of schizophrenia as evidenced by racing

thoughts, hypertension, and difficulty concentrating.

o Nursing intervention: 1. Help the patient identify coping mechanisms that work in

controlling anxiety. 2. Assess the patient’s level of anxiety and physical symptoms

related to anxiety. 3. Assess the patient’s support system and teach signs and symptoms

of anxiety to the patient and their family/support system.

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List of potential nursing diagnoses

 Disturbed personal identity  Impaired verbal communication

 Noncompliance  Self-care deficit

 Ineffective health maintenance  Ineffective coping

 Disturbed personal identity  Interrupted family process

 Interrupted role performance  Fear

Conclusion paragraph

In summary, this case study has discussed the affect anxiety, schizoaffective, bipolar

disorder has on MM. It has discussed the role of family history on the development of mental

illness, along with delusional-like experiences. It has also analyzed the effect of being a sexual

minority has on the risk of suicide. The effect of childhood abuse on mental illness was briefly

discussed. For MM, a variety of factors played a role in his hospitalization, such as, current

stressors, family history of mental illness, and other influences. All of these things were taken

into considerations when developing a plan of care for MM.

PREDISPOING FACTORS TO MENTAL ILLNESS 13

References

Karanti, A., Kardell, M., Joas, E., Runeson, B., Pålsson, E., & Landén, M. (2020).

Characteristics of bipolar I and II disorder: A study of 8766 individuals. Bipolar

disorders, 22(4), 392–400. Doi: 10.1111/bdi.12867

Mereish, E. H., Peters, J. R., &Yen, S. (2018). Minority stress and relational mechanisms of

suicide among sexual minorities: subgroup differences in the associations

between heterosexist victimization, shame, rejection sensitivity, and suicide risk.

The association of suicidology, (49)2, 547-560. Doi: 10.1111/sltb.12458

Plöderl, M., Kunrath, S., Cramer, R.J., Wang, J., Hauer, L., & Fartacek, C. (2017). Sexual

orientation differences in treatment expectation, alliance, and outcome among patients at

risk for suicide in public psychiatric hospital. BMC Psychiatry, 17, 184. Dio:

10.1186/s12888-017-1337-8

Shah, S., Mackinnon, A., Galletly, C., Carr, V., McGrath, J., Stain, H., Castle, D., Harvey, C.,

Sweeny, S., & Morgan, V. (2014). Prevalence and impact of childhood abuse in

people with a psychotic illness. Data from the second austalian national survey of

psychosis. Schizophrenia Research, 159(1):20-26. Dio:

10.1016/j.schres.2014.07.011

Varghese, D., Saha, S., Scott, J. D., Chan, R. C., & McGrath, J. J. (2011). The association

between family history of mental disorder and delusional-like experiences: a

general population study. American journal of medical genetics. Part B,

Neuropsychiatric genetics: the official publication of the International Society of

Psychiatric Genetics, 156B (4), 478–483. Doi: 10.1002/ajmg.b.31185

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Videbeck, S. L. (2020). Psychiatric-mental health nursing. Wolters Kluwer.