Mental Health Case Study: Bipolar Disorder

Alleya Wagner

Youngstown State University

NURS 4842: Mental Health Nursing

Professor Teresa Peck

October 11, 2021

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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
Abstract

Mental illness affects many people throughout the world, it makes their lives hard to

manage. Illnesses such as Bipolar and Depression are very common and very real to many

people. This will discuss an individual who has both along with Post Traumatic Stress Disorder

and Asperger’s Syndrome. Aside from his career in the military, he has been through numerous

traumatic events. People with Bipolar 2 Disorder have manic and depressive periods that last at

least two weeks. Depression leads to demotivation, isolation, and thoughts of suicide. PTSD is

caused by traumatic events and caused intense flashbacks and night terrors. And Asperger’s can

make it hard to interact with other people because they can not pick up on sarcasm and social

situations. This will dive into the specific characteristics of the patient, discuss Bipolar,

Depression, PTSD, and Asperger’s more in detail, and how to evaluate and plan treatment for the

illnesses. It will discuss the importance of adhering to treatment plans and how to help get the

patient back to a normal and functioning lifestyle.

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Objective Data:

This patient will be referred to as JV is a 21-year-old male. He was involuntarily admitted

on 10/4/2021 to the Trumbull Hospital after attempting to commit suicide by hanging. The

patient had two known medication allergies which were carbinoxamine and pseudoephedrine

which caused hives and itchy skin. He was diagnosed with bipolar type 2, depression, PTSD, and

Asperger’s disease. The patient had just been admitted the night before so there were no

medications prescribed daily. The patient stated he had been previously prescribed Depakote and

Abilify in the past and stopped taking them 5-6 months ago. JV’s as-needed medications

included Buspar (anxiety), Haldol (sedation), Trazodone (insomnia), and Ativan (sedation). JV

had a team meeting on 10/5 where the doctor suggested a prescription for Lithium and Abilify

and the patient agreed to try them. The patient had two previous hospitalizations during active

duty in South Carolina during 2020. All of the patient’s lab work including QTC intervals was

normal and within a safe range. His urine drug toxicology and alcohol levels were both negative.

During the day of care, the patient was very open and honest about a lot of his history and

how he got to this point in his life. But during certain topics, he was very careful and skirted

around the question. If he was nervous about the topic he would give a nervous laugh such as

when the doctor asked why he wanted to end his life. But then said it was a cry for help because

he felt helpless and guilty. After all, affect he had to be discharged before his four years were up

due to his mental health. He made good eye contact but kept readjusting in his seat. The report

said when he was first brought in he would not make eye contact and gave very blunt and short

answers.

During the interview, he also stated he had a child with his girlfriend from high school,

who is now three years old. The patient does not have a set visitation schedule but will
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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
sometimes meet the mother at a park to see the child. The patient has a good relationship with

the mother and states that he still loves her but they are both not in the stage of life to try to be

together again. When asked if he wanted to see the child more, the patient stated that he needed

to work on himself before he brought the child into his life. In the future, he wanted more

visitation.

JV has had two incidents of violence in his history. He was charged with domestic

violence with his brother when they got into a fistfight at home. The second was with the mother

of his child’s boyfriend. The patient stated that the boyfriend slapped his child unprovoked. He

then grabbed the near item next to him which was a crowbar and repeatedly struck the boyfriend.

The boyfriend was then in the hospital for three weeks and the patient said he felt that it was

justified and would do it again.

For a patient to be diagnosed with Bipolar type 2 disorder, they must meet certain criteria

listed in the DSM-5. The DSM-5 states that they must meet criteria for a current or past

hypomanic episode and a past or current major depressive episode. Criteria for mania include

periods of mood disturbances that last at least 4 consecutive days and are present most of the

day. They must experience at least 3 of the following symptoms: inflated self-esteem, decreased

need for sleep (feels rested after only 3 hours of sleep), more talkative than usual, flight of ideas

that are racing, easily distracted, and excessive engagement in high-risk activities such as buying

sprees, sexual indiscretions or foolish business investment. The major depressive episode must

have 5 or more of the following symptoms during 2 weeks: depressed mood most of the day,

markedly diminished interest or pleasure at all, significant weight loss (change of more than 5%

of body weight), psychomotor agitation, fatigue nearly every day, feeling of worthlessness,

diminished ability to think and concentrate and recurrent thoughts of death or thoughts of
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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
suicide. Either episode must cause clinically significant distress or impairment in social,

occupational, or other areas of functioning. The criteria describe this patient because he was

admitted for attempting suicide and he has a history of self-harm including cutting his wrist. JV

has also had weight loss in the last three months, guilt from what he saw while he was in the

military, and diminished energy levels. The patient stated during manic episodes he would go on

shopping sprees and not sleep for three to four days at a time and would then crash.

Diagnosis criteria according to DSM-5 for depressive disorder is similar to the depressive

episodes for Bipolar Disorder. They must have five or more of the stated symptoms present in a

2 week period.

Diagnosis criteria for Post Traumatic Stress Disorder include exposure to actual or

threatened death, serious injury, or sexual violence including experiencing or witnessing.

Presences of one or more of the following symptoms: recurrent and intrusive distressing

memories, distressing dreams, dissociative reactions (flashbacks), and intense, prolonged

psychological distress at exposure to triggers related to trauma. The patient must also display

persistent avoidance of stimuli associated with trauma, negative alteration in cognition and mood

associated with a traumatic event, and duration of stated symptoms must last more than 1 month.

JV fits all of the criteria because he witnessed many people being shot and killed in a gruesome

way while he was overseas in the military and now experiences flashbacks and night terrors

unprovoked and during loud noises such as fireworks and gunshots.

During his stay at Trumbull Memorial Hospital many safety and security measures were

placed to ensure his safety. All of the doors were locked and only staff had keys and doorknobs

were all rounded and did not have a lip to prevent the patient from being able to hang

themselves. To get on and off the unit, there is a two-door system to prevent patients from
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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
escaping. When patients first arrive they are searched for anything that could harm themselves or

others. They take any strings or laces off their person and they are not allowed cell phones or

other electronics on the unit. Phone cords were short and there were no exposed television wires

for patients to try and harm themselves. The nurses’ station has thick windows up to the ceiling

to keep the nurses and patients safe and all supplies are inside the nurses’ station. There are

cameras positioned to see patients at all times and on top of the cameras and staff do 15 minutes

checks around the clock. During lunch, all the patients are given safety trays that have plastic

silverware, no straw, and nothing that could be used to harm themselves or others.

Summarize the Psychiatric Diagnosis

Bipolar 2 Disorder can be described as having at least one depressive episode and at least

one episode of hypomania that does not involve psychosis. Depression is often the dominant

mood, more than 50% of the time. The duration and severity of each episode range widely for

each patient (Fletcher). Hypomania includes symptoms such as more energy, self-confidence,

creativity, sociability, increased libido, being easily distracted, talking fast, drinking more coffee

and alcohol, smoking or taking more drugs, and engaging in risky behavior such as overspending

or arguments (Fletcher). This is then followed by a depressive episode including feeling sad,

empty, low motivation, loss of interest in activities, sleeping too much, gaining or losing weight,

and having suicidal thoughts or tendencies, and then the cycle starts over again (Fletcher).

Depression is very similar to the depressive episodes of Bipolar Disorder. They often feel

persistently sad for weeks to months at a time. Depression can effect people in a wide variety of

ways from losing interest normally in normally enjoyable activities to sleeping for 10-12 hours a

day and still feeling tired to not being able to sleep but not being able to get out of bed for days at
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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
a time. They often do not perform good hygiene by not showering, brushing their teeth and hair

for days or weeks at a time.

Someone with Post Traumatic Stress Disorder often relives their traumas through

flashbacks and night terrors. These cause them to become isolated and irritable. It also causes

problems with sleep and concentrating because they are afraid they will have flashbacks or night

terrors. PTSD can be caused by a variety of experiences including serious car accidents, rapes,

assaults, witnessing someone die, or natural disasters. Having a poor support system cause

enhance this because they have no one to talk to about their trauma. This is common in people

like JV, who are in the military because they are supposed to be tough men and mental health is

not a priority during deployment.

Asperger’s Syndrome is a form of Autism. It is a developmental disorder that affects their

ability to relate to people. Their behavior and thinking can often be rigid and repetitive. They do

well in school but have trouble understanding social cues, norms, and situations. They tend to

focus on one topic and be very good or knowledgeable about it. Many of these symptoms were

exhibited by JV because he received a full ride to his college for Quantum Psychics while he was

in the military. He also does not have a lot of friends because he always felt like an outsider in

high school.

Identify Stressor and Behaviors

JV has had many stressors that have occurred in his life that's brought him to where he is

now. It started when he was 5 years old when his parents' landlord sexually molested him. The

patient would not elaborate on this incident but it was in his chart and he had previously talked

about it with another nurse. He then started cutting himself at age 14 as a release. He was not

diagnosed with depression until he was 17 years old which he then went on antidepressants to
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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
help. Also at 17 years old, his house caught on fire which caused him and his family to move

into their garage temporarily until they could rebuild or find another home. While living in the

garage, his father was alone while everyone else was at school or work and their garage also

caught fire, killing his father. To make matters worse, the local news station got to the fire before

the fire department and filmed the incident where JV watched on LIVE television as his father

was burned alive. The family then sued the news channel as stated by the patient. The following

year his adopted brother was in the military and was on a plane home from deployment and the

airplane crashed and he was also killed. JV’s family comes from a long line of military

background with a majority being in the marines, so he joined the military at age 17 and went to

basic following graduating from high school.

While on active duty in the military he rose through the ranks very fast. He was taking

college courses while he was deployed and was able to get his bachelor’s degree in Quantum

Psychics. During his 4 years, he was deployed four times in 6 months increments to Afghanistan

and Iraq where he developed PTSD. He said he was often afraid even at the base because there

were IEDs everywhere in the sand and JV stated he no longer can go to beaches or anywhere

with sand. While in his second deployment the patient was in a humvee with his best friend who

was shot in the head while sitting right next to him by a sniper. Soon after started having

flashbacks and night terrors about said incident and others including seeing people blown up

from IEDs and other attacks on his unit. The patient describes his flashbacks as reliving the

traumas and will often stare off into space and will go to a secluded place to be alone because he

often becomes agitated after.

Since returning home he stated flashbacks have become worse because he feels guilty

that he has come home physically unharmed while he lost so many friends. JV was discharged
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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
medically due to his depression and suicidal ideations. One month after being home, another

friend that was still overseas was one of the 13 soldiers killed in Afghanistan. This caused the

patient even more guilt because he felt he should still be there and that it should have been him

killed instead of his friend.

The killing of his friend is what put him over the edge that led to his most recent suicide

attempt. JV tried to hang himself from the ceiling fan and by cutting his right wrist. His mother,

who came over to check on him, walked in during the attempt. After arriving at the emergency

room, the patient stated he was glad to be alive and that it was a cry for help.

Family History of Mental Illness

The patient was diagnosed with Aspergers in his adolescence. The patient’s brother also

has an Asperger’s diagnosis. The patient has a very mild case and shows very few symptoms. He

was diagnosed with depression at 17 after a history of self-harm and cutting. Soon after he was

diagnosed with Type 2 Bipolar Disorder. During his time in the military, he developed and was

diagnosed with PTSD. His family has a history of mental illness. Both his parents have

depression and bipolar diagnoses and bipolar have a genetic trait and is likely been passed down

to JV. According to MedlinePlus, the risk of developing bipolar disorder is greater for first-

degree relatives of affected individuals such as siblings and children (Medline Plus). His father

also has a history of alcohol abuse and addiction to smoking cigarettes. The patient also smokes

cigarettes which are not caused specifically by genetics but many studies show addictive

personalities can be passed down. “Researchers have found that having family members that

smoke not only increases the chance that young people will start smoking but also influences

how many cigarettes they smoke per day,” according to MedMD (WebMD). A combination of
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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
shared genetics and environmental factors plays a major role in determining a person’s cigarette

smoking habits.

Psychiatric Evidence-Based Nursing Practice

After an initial evaluation of the patient’s mental state and goals, the physician ordered

Lithium for his Bipolar disorder. He was also prescribed Abilify for his depression and Bipolar

Disorder. For the duration of his stay, he has also been prescribed medications as PRN. These

included Buspar for anxiety and depression, Haldol for acute psychotic behavior, Trazodone for

sedation and sleep aid, and Ativan for anxiety and insomnia. All of these medications were

prescribed based on the information conducted during admission, team meeting, and as a safety

protocol.

Along with medication, other treatments are being implemented to help JV. Cognitive-

behavioral therapy, group psychotherapy, and Psychoeducation are being used to help the patient

identify triggers and coping mechanisms to help them return to normal life and deal with the

negative thoughts in his head. Cognitive-behavioral therapy is used to identify unhealthy

thoughts, feelings, and behaviors and how to replace them with healthy ones. The use of group

psychotherapy allows the patient to socialize. Psychoeducation therapy enables the patient to

learn about their diagnosis including his bipolar disorder, depression, and PTSD. By

understanding the illness and behaviors that go with it, he can learn about his triggers and look

for signs for when he is going into a manic or depressive episode. At Trumbull, patients are on a

strict and specific schedule for meals, therapy times, and bedtimes.

Other activities that JV can participate in while at the hospital are often for socialization.

There is a television in the common room, listening to music, there are books to read and

material to draw with. There is an outside area where on nice days they have corn hole boards set
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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
up, chairs to sit in the sunshine or exercise if they choose. All of the care provided is to ensure all

patients’ safety and help them get better as fast and efficiently as possible.

Analysis Ethnic, Spiritual and Cultural Influences

JV did not have any specific ethnic or cultural aspects in his life. The patient stated that

he was Catholic when asked about his religious affiliation. But did not say he went to church

recently. When asked about what he liked to do for fun or how he dealt when he was stressed, JV

stated he likes to meditate and listen to music. JV grew up in Hubbard, Ohio with his parents,

adopted brother, and biological brother. His father was an alcoholic. He did not like to talk about

him other than he followed in the family’s footsteps of going into the Marines.

Evaluate Patient Outcomes

Expected outcomes for JV include medication compliance, developing more and positive

coping mechanisms, and planning for the next stage of his life. Medication compliance is one

number priority. The patient has a history of not taking medication as prescribed once he starts to

feel better. If he stays on medication it will help with the depressive and manic episodes of his

Bipolar Disorder and suicidal thoughts from depression.

Another important outcome is developing more healthy coping mechanisms. JV feels

very secluded because he has been away from home for the past four years. He feels he has no

one to talk to about his PTSD. His mom is his main support person but does not want to scare her

by talking about his experiences from overseas. JV’s brother is leaving for the military and he

has talked to him but says they often but heads because they are so much alike. The only coping

mechanisms were meditating, listening to music, and talking to his mom. The patient stated that

while he was on active duty he had his home soundproofed so he could not hear loud noises at

night, which often triggered night terrors and flashbacks.

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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
Other outcomes will include being able to identify triggers for his PTSD and identifying

symptoms of when he is going into a manic or depressive episode. By identifying triggers he will

be able to demonstrate control of her emotions and utilize his learned relaxation techniques.

The patient wants to continue his education in Quantum Psychics by getting his

doctorate. He still is a student at his college online but is currently on medical leave.

Summarize Plans for Discharge

JV will remain in the acute setting until he is stabilized mentally and get the right dosage

for his new medication. After the patient is educated on why medication compliance is so

important and agrees to stay on them, he can move on to the next step which is discharge. During

the discharge process, he will be made aware of community researches and resources through the

Veterans Association. Appointments for a group therapy session would be beneficial for his

PTSD and depression especially if it is through the VA because he will be surrounded by peers

who have been through the same thing as him. Outpatient therapy will also be set up for one-on-

one Cognitive Behavioral Therapy. This will continue to grow his coping mechanisms, help

identify triggers and help him to handle stress on his own. Having these appointments and

resources will also help him keep a schedule and will increase the chances of success on his

journey to better mental health.

Prioritize List of NANDA Diagnosis:

● Risk for self-harm related to the client trying to kill himself and history of cutting

● Ineffective coping related to PTSD caused by the many killings he saw while in the army

● Interrupted family process related to his father, brother, and two friends dying and him

witnessing two of them

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● Grieving related to losing his two friends while in combat and having to be discharged

early and losing his career

List of Potential Nursing Diagnosis

● Ineffective Coping

● Labile emotional control

● Dysfunctional Family Process

● Risk for complicated griefing

● Hopelessness

● Risk for self-injury

● Noncompliance

● Risk for impaired parenting

Conclusion Paragraph

The mental illness that JV has been diagnosed with the need to be taken very seriously.

For them to be treated properly, they need to be properly diagnosed, fortunately for him, he has

been. With correct interventions, he can be on the road to recovery. It is important to stay

compliant with all treatments. Medication compliance is most important but his therapy sessions

are very important too. If JV continues to educate himself it will be very beneficial too because

he will be able to self-identify symptoms of approaching depressive or manic episodes and he

will be able to identify and avoid or cope with triggers for flashbacks and night terror. To obtain

and maintain a healthy mental status, all treatments and interventions are necessary and must be

taken seriously.

Works Cited
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MENTAL HEALTH CASE STUDY: BIPOLAR DISORDER
American Psychiatric Association. DSM-5 TM. 2013.

Fletcher, Jenna. “What Is Bipolar II Disorder? Symptoms and Treatments.”

Www.medicalnewstoday.com, 17 June 2020,

www.medicalnewstoday.com/articles/319280#symptoms.

Medline Plus. “Bipolar Disorder: MedlinePlus Genetics.” Medlineplus.gov, 9 Feb. 2021,

medlineplus.gov/genetics/condition/bipolar-disorder/#inheritance.

WebMD. “Smoking Habits May Be Genetic.” WebMD, www.webmd.com/smoking-

cessation/news/20041118/smoking-habits-may-be-genetic. Accessed 13 Oct. 2021.