RUNNING HEAD: Mental Health Case Study 1

Ariel Gilchrist

Mental Health Case Study

Youngstown State University

Abstract

This paper will give insight into a patient admitted to St. Elizabeth’s Hospital in Youngstown. It

will also discuss the patient’s background. I will tell the details surrounding the patient’s

admission, precipitating events, and some of her stay. Nursing diagnoses will be provided based

on the patient’s medical and psychiatric diagnoses. I will also share the patient’s history, means

of living, support system, family history, current issues, and personal statements.
RUNNING HEAD: Mental Health Case Study 3

Objective Data

A.G. is a 20 year old Caucasian female admitted to St. Elizabeth’s Hospital in

Youngstown on March 9, 2018 with a psychiatric diagnosis of bipolar with suicide ideation. I

provided care for her on March 12, 2018. Ackely and Ladwig define bipolar disorder as, “a

mental illness that brings severe high and low moods and changes in sleep, energy, thinking and

behavior. High and low moods don’t follow a pattern.” A.G. was in a manic state during our time

together. She quickly moved from one idea to another sometimes linking the two and other times

not. When she talked nothing was in chronological order and she did not have an acceptable

concept of time. The patient was very restless; constantly fidgeting in her chair and moving her

hands around. During the interview she communicated that she had been engaging in risky

behaviors such as having unprotected sex with multiple partners which is how she contracted

trichomoniasis. A.G. was prescribed Cogentin and Haldol for agitation, vistaril for anxiety,

Seroquel for, and desyrel for insominia.

Axis I: Bipolar I Disorder with Recent Manic Episode

Axis II: No personality traits/disorders; No Mental Retardation

Axis III: Obesity, Trichomoniasis, Brochitis

Axis IV: Death of relatives, stress r/t significant other and friends

Axis V: GAF 31-40

Summarize

The National Institute of Mental Health (2017) defines bipolar disorder as a disorder that

causes usuaual shifts in mood, energy, activity levels and the ability to carry out day-to-day

tasks. NIMH (2017) states people with bipolar disorder experience manic and depressive signs

and symptoms. With mania patients may experience feeling very “high”/elated, having a lot of
RUNNING HEAD: Mental Health Case Study 4

energy, increased activity levels, insomnia, flight of ideas (talking really fast about a lot of

different things), being agitated, racing thoughts, and wreckless behaviors. During episodes of

depression feeling sad/down, anergia, sleeping too much or too little, anhedonia (unable to

experience pleasure), feelings of worry, having trouble concentrating, being forgetful, eating too

much or too little and thinking about death or suicide.

The three major risk factorsassociated with bipolar disorder are brain structure and

functioning, genetics, and family history (NIMH, 2017). Brain structure and functioning: studies

have shown that people brains with bipolar may differ from brains of healthy people (NIMH,

2017). Family history: Having a family member/relative that has bipolar is thought to increase

the incidence of the illness showing up somewhere else in the family tree even though there are

cases where one identical twin is affected by bipolar and the other twin is not (NIMH, 2017).

Genetics: Scientists say people with certain genes are more prone developing bipolar disorder

than others (NIMH, 2017).

The National Institute of Mental Health recommends a combination of medication and

psychotherapy (“talk therapy”). Bipolar is lifelong, but with appropriate treatment better control

of mood swings can be achieved.

Identify

Prior to A.G. being admitted to the hospital this time her aunt and uncle passed away

within a month of each other. Her aunt and uncle two of her biggest supporters and played a big

role in aiding her through her illness. She stated she did not cope properly with their deaths and

this was a key component in her hospitalization. The night she was admitted her and her

boyfriend had been arguing and he broke up with her. She was very emotional and could feel

herself spiraling out of control. On top of all of that, A.G. found out her best friend whom she
RUNNING HEAD: Mental Health Case Study 5

had been living with was lying on her to her bpyfriend and caused their break up. With all of

these stressors and no one to talk to she felt overwhelmed. She called 911 and told them she

wanted to kill herself. She explained that before all the stressful events occurred she had been

free of suicidal thoughts for over a year. When she got here they kept her in the emergency room

overnight until there was a bed available on the behavioral unit.

Discuss

Both the patient and her chart deny any existence of mental health issues among her

family. Her parents didn’t raise her so she never discussed her diagnosis with them. Her mother

was unable to meet her basic needs so she gave custody to AG’s father. AG’s father physically

and sexually abused her until she went to live with her grandmother. At 14, AG’s grandmother

gave her over to the state after stating that she was crazy and too much to handle according to

A.G. She went to live in a foster home where she was physically abused until she ran away. She

fled the city and moved in with friends until she returned to Youngstown at 18. At that point, the

child services stated she was an adult and no longer needed their supervision. Although she

doesn’t have a family history of bipolar, she unquestionably had enough environemental stimuli

to play into her diagnosis of bipolar disorder.

Describe

The National Institute of Mental Health lists psychotherapy as an evidene based nursing

care that can be utilized. Psychotherapy includes cognitive (change the way you think),

behavioral (change the reactions to stimuli), family-focused, interpersonal, social, and

psychoeducation therapies (NIMH, 2017). These therapies provide support, education and

guidance to people struggling with bipolar disorder and their families (NIMH, 2017).
RUNNING HEAD: Mental Health Case Study 6

According to Dr Abroms, most therapies including milieu have two common objectives

being controlling or setting limits on symptomatic behavior and learning basic psychosocial

skills (Abroms, 1969). With milieu therapy these goals are obtained by controlling the client’s

environment to prevent self-destructive behaviors. Essentially, everything during the patient’s

hospitalization is supposed to be therapeutic ([Link], 2013). Part of milieu therapy

is structured interaction and open communication and A.G. informed me that she had been going

to group since her arrival on the unit. Unit group sessions run by the nurse offer both structured

interactions with the other patients on the unit and open communication. Milieu also emphasizes

family involvement ([Link], 2013). When I initially arrived on the unit A.G. and her

mother were talking with the nurse. They were also scheduled to have a family session the

following day. This demonstrates the type of family involvement described in milieu therapy.

Analyze

A.G. did not specify any religious, ethnic or cultural affiliations. She did mention that she

likes to draw and it helps her to cope with situations. She also pointed that she cuts which we

discussed. By the end of our encounter she stated that cutting was bad (maladaptive) and she was

going to try and find other means of coping. A.G. has a friend John Doe that lives in

Pennsylvania. She calls him and he is able to help her work through any situations that are

stressful to her.

Evaluate

There are many significant patient outcomes related to AG’s care. They are listed as

followed: the patient will be free from self-harm. This outcome is regarding the patient’s safety.

The reason she was admitted was because she threatened to commit suicide. The patient will

state three new coping mechanisms. AG likes to draw, but she doesn’t have any other skills
RUNNING HEAD: Mental Health Case Study 7

besides cutting to use when she gets overwhelmed. New coping skills will help her not get to the

point where she wants to commit suicide. The patient will express her feelings and participate in

the planning of her care. By AG participating in her care it is more likely that she will do all the

treatments since she had a part in putting the treatment plan together. Patient will identify

negative thoughts and reframe them. By changing her thought process, A.G. can ensure she

doesn’t get to the point where she is having suicidal thoughts.

Summarize

Discharge instructions for A.G. include getting in touch with a therapist, seeking out new

coping mechanisms, and a safety contract that outlines things that she must do before she self-

harms. A.G. getting in touch with a therapist will provide her with continual monitoring so she

doesn’t spiral out of control. The therapist can also help manage her medications. Seeking out

new coping mechanisms is something A.G. can do both in therapy and on her own. AG’s safety

contract will help her to not self-harm. A.G. helped create the safety contract so all the terms

listed in it she has agreed to. This should help her to follow the guidelines that were mapped out.

The safety contract is also a reminder that she has more options than just to self-harm. Upon

discharge, A.G. plans to move to Pittsburgh with her best friend John Doe and get enrolled in

school. I think that will be good for her because it will give her something to do with her time,

give her a sense of self-worth, and someone that is stable to be her support system.

Prioritized

1. Risk for injury related to suicidal thoughts as evidenced by an attempt at self-harm

2. Ineffective coping mechanisms related to situational crisis and inadequate support system

as evidenced by suicide attempt and cutting

3. Disturbed thought process related to grieving and bipolar disorder as evidenced by

disorientation, impulsivity, and inappropriate social behavior

List

 Ineffective Relationships

 Risk prone health behavior

 Risk for suicide

 Disturbed sleep pattern

 Ineffective impulse control

 Hopelessness

 Stress overload

 Ineffective coping

 Risk for complicated grieving

Conclusion

A.G. seemed to be right on point with what she needed to do once she was discharged,

but she blamed everyone else for her problems. Without taking responsibility for her actions and

seeing the role she plays in her own life, it is probable that she will be back to the unit again.

Doing this case study on her helped me fine tune my assessment and care planning skills. I was

able to take a much deeper look into nursing diagnoses, treatments, nursing care, and discharge

teaching/instructions for this patient. This will help me to look further into all my patients and

provide better care.

Citations

Abroms, Gene. (November 1969).Defining Milieu Therapy.

Retrieved from [Link]

National Institute of Mental Health.(April 2016).Bipolar Disorder.

Retrieved from [Link]

Psychiatric Nursing.(September 19, 2013). Nurses’ Role in Milieu Therapy.

Retrieved from [Link]