Mental Health Clinical Case Study

Joseph W. Kusior

Department of Nursing, Youngstown State University

NURS 4842 Mental Health Nursing

Dr. Theresa Peck & Mr. William Church

March 30, 2023

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Abstract

Embedded in this case study will be the components of a particular patient’s mental

health diagnosis, the events leading up to the mentioned disease as well as contributing factors,

stressors and distinctive behaviors, patient and family history of illness, analysis of the

influences that impact the patient, evaluating patient outcomes, a list of actual diagnosis in the

patients chart along with a list of potential nursing diagnosis. Following the data, there will be a

conclusion on the patient’s mental health, the overall look into the diagnosis of the patient with

final explanations using a scholarly article that will be attached with this case study. This case

study is a project that will describe the patient, the care provided, lab results and their meaning

and the inclusion of a list of medications that this patient is on to control his/her diagnosis or

medical diagnosis associated with the primary diagnosis.

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Objective Data

The patient that will be discussed in this case study will go by the identification “B.C.”

This patient was admitted to the unit by order of the court, his legal status being pink slipped for

inability to care for himself and his son who was living with him at the time. Upon admission,

B.C was irritated, stating that he felt he was not good enough for his family, his son, or the

people that he needed to provide to. B.C also had felt that he was wrongfully admitted to the unit

because he “had done nothing wrong other than go to sleep after visiting my ex-girlfriend, the

mother of my child where she had called the cops thinking I was under the influence. Next thing

I know the cops had taken me away from my condo.”

B.C had felt that he was wrongfully admitted to the unit being pink slipped and having a

court order but had known that he made irrational decisions by being under the influence of

marijuana when being in the presence of his child at the time of visitation with his ex, whom he

has no contact with since. Upon conducting an interview with this patient, he was able to list and

identify the medical diagnosis to me that were listed in his chart accurately. The patient’s

psychiatric diagnosis was Bipolar II disorder with suicidal ideations. The medical diagnosis that

are listed in the chart secondary to Bipolar II are PTSD and substance abuse, that substance

being marijuana. Treatments for this patient included maintaining positive attitude while in the

unit, medication compliance, engaging in group activities when prompted and establishing goals

that will have a reasonable outcome in a proper span of time. Security measures that are in place

for this patient are suicidal precautions, removing all sharp objects and potentially harmful

objects from the patient’s way during his stay on TRMC 3 South.

B.C was prescribed medications that would help with his primary diagnosis and keep his

medical diagnosis under control. Previously before he was admitted, there was history of
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admission with medication non-compliance, causing severe mood swings that were exacerbated

by the confrontation with his ex-girlfriend, the girlfriend’s mother whom B.C had the most

conflict with and the stress of raising the child on his own without support from the mother. The

medications that were prescribed to B.C are as follows: Depakote (Valproic Acid) 250 mg PO

daily, Haldol (Haloperidol) 10 mg PO daily and Risperdal (Risperidone) 3 mg PO daily.

According to Dailymed.gov (2023), “Depakote (divalproex sodium) is a valproate and is

indicated for the treatment of the manic episodes associated with bipolar disorder.” Depakote

was the physicians first line medication for this patient, although medication compliance became

an issue when the patient had come under severe stress, causing symptoms of mild mania to re-

occur. The lab results for Depakote in this patient’s admission report were sub-therapeutic,

indicating that medications were not taken as prescribed. According to Dailymed.gov (2023),

“Haloperidol Decanoate Injection is indicated for the treatment of patients with schizophrenia

who require prolonged parenteral antipsychotic therapy. Haldol in this case is used to control the

patient’s irritability, racing thoughts and restlessness. According to Dailymed.gov (2023),

Risperidone or Risperdal “is indicated for the treatment of schizophrenia.” For this patient

specifically, Risperdal is being used to control his racing thoughts which according to the patient

consume his life and had told him that he is never good enough, he cannot live up to anyone’s

standards and recently that he should commit suicide.

Summarize the psychiatric diagnosis

B.C was diagnosed with Bipolar II disorder which according to mayoclinic.org (2022)

“bipolar disorder, formerly called manic depression, is a mental health condition that causes

extreme mood swings that include emotional highs (mania or hypomania) and lows

(depression).” Different from bipolar I disorder which has high incidents of mania that last,
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Bipolar II disorder involves the swinging on moods from depression to mania, each lasting

different durations, the depression phase making the individual feel sad, hopeless and lose

interest or pleasure in activities. When in mania, an individual can feel euphoric, full of energy or

unusually irritable. These mood swings can affect one’s sleep schedule and patterns, energy,

activity, sense of judgement, behavior and the ability to think clearly making rational and

intelligent decisions.

Identify The Stressors & Behaviors

Behaviors observed and collected from the interview with B.C indicate that this patient

has issues with depression from past experiences, mostly being with his own personal family.

Collected from the interview, B.C had always felt that he was the “black sheep” of his family,

that he was never as good as his brother who he described as successful in life, free of any

depression or mental illness. Primary stressors in this patient’s life include obtaining custody of

his child, financial struggle, relationship issues that revolve around the absence of the mother to

their child while she is out with other men in casual relationships, non-payment of child support

from the mother when B.C had attained custody, later losing it when caught under the influence

of marijuana, dysfunctional family, an alcoholic mother that he says “constantly puts me down,

making me feel embarrassed to be a part of my own family and telling me that I can never do or

will do anything correctly in my life.” B.C also struggles with abuse from his mother both verbal

and physical, also this patient struggles knowing that his ex-girlfriend’s mother is just like his

own in that she is abusive to the mother of their child just like his own mother. The largest

stressor that was identified in this patient was the inability to see his child as he had lost custody

of the child to his brother in South Carolina.

Discuss Patient & Family History of Mental Illness

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B.C has a history of both PTSD from the abuse in his family, more specifically from his

mother who had abused him in school since she is a local teacher at the school, at home where it

was at its worst and in public. These encounters over many years have caused this patient to have

severe PTSD to those moments, damage to his self-esteem and his ability to think of himself as

anything more than a burden to those around him, even his own child.

Familial history includes only the mother of B.C who was diagnosed with bipolar

disorder, which type was unspecified, but her symptoms include mostly agitation, mania and

abusive behaviors which are indicative of Bipolar I disorder.

Describe the Psychiatric Evidence Based Nursing Care Provided

The nursing care provided to B.C at TRMC 3 South included daily group therapy which

the patient had concluded he does not like to involve himself due to the feeling of emptiness and

not having the energy. Also provided are one to one activity with a specialist that had B.C write

down how he feels daily on a piece of paper with questions, when finished this paper is filed

away in his chart which can be used to look for any indications of a change in behavior or

thoughts. Upon the day of care for this patient our group had been able to identify with this

patient and offer positive coping skills, one that was specifically able to make the patient feel as

if he could take control of himself The coping skill that we had implemented for this patient was

to write down things that he sees as positives in his life as well as goals to make himself meet in

short times, whether it be one or two goals, but never going over three at a time. B.C was able to

talk, identify and physically write things that he sees as positives and potential goals for himself,

one being the stability of medication while he is on the unit until discharge. The patient’s primary

positive attribute of himself was “I am a good person, and a good father to my son.” When a

group therapy session had started, the patient had left to his room, he later told us that anxiety
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had spiked but he was able to go to his room where he was able to identify more positive things

about himself to lift his mood and have a positive coping skill rather than a negative.

Analyze Ethnic, Spiritual & Cultural Influences

B.C had disclosed that he believed in a higher being, but had not gone into further details

about church, what he does to wash of his sins, what he does to serve his savior. All that was

disclosed was that the patient does believe in God, but he feels at times that things do not go his

way, that God does not help when he prays. No cultural or ethnic influences for this patient.

Evaluate The Patient Outcomes

From admission notes to the current time of the interview with B.C, the outcomes of his

behavior and mood have had a drastic change, a common reason is medication compliance which

is more likely the cause with this patient. Upon admission B.C had made suicidal ideations,

causing suicide precautions to be placed. Also mentioned were failure to take care of his child,

acknowledgement of medication non-compliance, a relapse in drug use related to family trauma

and history which had caused severe emotional trauma. On the day of the interview, there were

no suicide ideations, no feelings of hopelessness although there was a serious lack of eye contact

due to a damaged self-esteem with discussing traumatic events to the patients past. B.C has been

clean from drugs since admission and plans to join another drug addiction facility to seek help,

remove stressful situations from his life and be able to try for custody of his son when he is ready

to do so.

Summarize Plans for Discharge

Discharge for this patient on the day of care includes that the patient will be discharged

from the facility with the idea that the patient will follow-up with his appointments to ensure

medication compliance, regular labs to check and ensure Depakote levels are within therapeutic
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range and behavior is under control with little to no mood swings. According to Dahmen and

Stoner (2007) “The therapeutic range for divalproex sodium in acute mania according to primary

literature suggests improvement is greatest at concentrations above 50 μg/mL and that adverse

effects increase significantly at concentrations above 125 μg/mL “(p. 840). Also included in

discharge planning is the admission to a drug rehabilitation center to begin a sober life of

recovery so that B.C will have a clean life to live without stressors and have a chance to obtain

custody of his child that currently resides with his brother in South Carolina.
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Conclusion

B.C is a very troubled individual that through therapy and identifying stressors, would be

able to live a normal life as much as one could that is diagnosed with bipolar II disorder along

with PTSD and substance abuse. With the abstinence of marijuana, the proper medication

compliance as prescribed by the overseeing health care provider and regular scheduled check-ups

B.C will be able to steady his diagnosis and further control his symptoms. Reviewed in this case

study were the patient, diagnosis, lab result for Depakote, which was sub therapeutic, a summary

of the primary psychiatric diagnosis, identified stressors and behaviors, familial and personal

history of mental illness, the care provided and patient outcomes.

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Reference Page

Mayo Foundation for Medical Education and Research. (2022, December 13). Bipolar disorder.

Mayo Clinic. Retrieved April 11, 2023, from https://www.mayoclinic.org/diseases-

conditions/bipolar-disorder/symptoms-causes/syc-20355955 

National Institutes of Health. (n.d.). DailyMed - DEPAKOTE- divalproex sodium tablet, delayed

release. U.S. National Library of Medicine. Retrieved April 11, 2023, from

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=08a65cf4-7749-4ceb-6895-

8f4805e2b01f 

National Institutes of Health. (n.d.). DailyMed - haloperidol decanoate injection. U.S. National

Library of Medicine. Retrieved April 11, 2023, from

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=262456c4-47e5-4713-8379-

844f8f587495 

National Institutes of Health. (n.d.). DailyMed - Risperdal consta- risperidone kit. U.S. National

Library of Medicine. Retrieved April 11, 2023, from

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bb34ee82-d2c2-43b8-ba21-

2825c0954691 

Stoner SC, Dahmen MM. Extended-release divalproex in bipolar and other psychiatric disorders:

A comprehensive review. Neuropsychiatr Dis Treat. 2007 Dec;3(6):839-46. doi:

10.2147/ndt.s1264. PMID: 19300619; PMCID: PMC2656326.