Running head: PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY 1

Psychiatric Mental Health Comprehensive Case Study

Giovanni Paolo Bruno

Youngstown State University

Abstract

The purpose of this case study is to provide and document a pediatric patient’s experience of

mental health recovery within an acute inpatient setting at Belmont Pines Hospital. Specifically,

quantitative and qualitative data was collected through therapeutic communication between the

patient and myself and the patient’s medical record. Using both sets of data collection allowed

for a greater understanding of the patient’s journey from living a life marked with psychological

and emotional impairment to an inpatient hospital admission, where she received treatment to

manage her diagnosis. The case study offers important implications regarding this patient’s

experiences with her illness and how the care she received allowed her to manage her life with

the illness after discharge.

I. Objective Data
K.B. is a 16 year-old female, who was involuntary admitted to Belmont Pines Hospital on

October 1, 2020 for having suicidal ideations related to her Major Depressive Disorder. She has

been diagnosed with steady depression for three years and has had one depressive episode in the

past while taking Abilify. She currently has no other medical diagnosis. She has a history of

suicidal behavior and was placed into self-harm precautions at the time of admission. She is

allergic to two medications, Lexapro and Seroquel, where she experiences minor reactions such

as bruising and insomnia. Her laboratory results showed elevated cholesterol levels, and her

urinalysis was positive for THC. The psychiatric medications she is currently being administered

include Wellbutrin and Trazadone. She is receiving Wellbutrin orally, once a day in the morning,

at 150mg. This medication was prescribed for her depression and to assist her in quiting

smoking. She is receiving Trazadone orally, once a day at bedtime, at a dose of 75mg. This

medication was also prescribed to help K.B. mange her depression.

On the day of admission, K.B. presented with suicidal ideation. During the initial assessment

she stated “I don’t wanna be here anymore.” She had no plan to kill herself, but was having

intrusive thoughts. She told the nurse on admission that she would rather be dead than go on like

this, and stated that she feels like a “disappointment” to her family and others around her. K.B.

explained that she has lost interest in things that she once enjoyed like drawing and painting. She

reported problems with keeping up with her school work because she felt completely

overwhelmed. She said that she “begins and ends the day by crying.” When trying to explain

these feelings to her parents, she stated that they told her to “suck it up” and that her “illness isn’t

real.”

During the initial assessment on October 1, 2020, K.B. had a flat affect and displayed

poor eye contact. She was antisocial and showed intrusive or inconsistent interpersonal skills.
PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY 4

She appeared to be wary and attentive. She communicated minimally and appeared to be

unhappy and tense. Her speech was a normal rate, volume, and her articulation was coherent. In

regards to her facial expression and general demeanor, she had a depressed mood. She had a

short attention span, but showed fair judgement.

During my day of care, October 6, 2020, K.B. showed a sad or depressed facial

expression. Her affect was flat, and she lacked eye contact. She was tense during our

conversation. Throughout the interview, she showed signs of restlessness by shaking her legs and

fidgeting with rubber bands. Her speech was a normal rate but shaky at times. She replied to all

of my questions with short and clear statements without elaboration. I asked several follow-up

questions to gain more information. When asked about her overall mood, she stated “I’m feeling

good.” She claimed that being admitted into this facility has helped her find new ways of coping

with her feelings.

II. Psychiatric Diagnosis

According to Videbeck (2020), Major Depressive Disorder is a common but serious mood

disorder. It causes severe symptoms that affect how an individual might feel, think, and complete

their activities of daily living. The signs and symptoms of Major Depressive Disorder include

persistent feelings of being sad, anxious, and hopeless (Akiskal, 2017). The individual may be

irritable, and have lost interest in hobbies or activities that they once enjoyed. The individual

may have decreased energy levels but feel restless throughout the day. They would have

difficulty with the ability to concentrate and make decisions. The individual would also have

altered sleep and eating patterns, such as over or under eating or sleeping. An individual with

Major Depressive Disorder may also have thoughts of suicide or suicidal behaviors when the

symptoms become unmanageable for the patient.

III. Identify Stressors

K.B. was admitted with severe symptoms of depression and suicidal ideations. The main

stressor identified was that her boyfriend was sent to JJC for stealing a vehicle. She explained

that her boyfriend was her only support system because she would only discuss her feelings with

him. Because of her boyfriend being incarcerated, she cannot speak to him without receiving

permission from the boyfriend’s mother. She claims that his mother does not allow her to call

him while he’s in JJC. A second stressor identified was school. K.B. reports that she gets so

overwhelmed with school work because she is a “perfectionist.” She says she “worries

constantly” about getting every answer correct and that leads to her having several panic attacks

throughout the year. Because of the consistent panic attacks, she completely dropped all of her

class work because it was too much to handle.

IV. Family History of Mental Illness

The patient’s family has a history of mental illness. K.B.’s mother is diagnosed with Bipolar

Disorder and Depression. The maternal grandmother is also diagnosed with Bipolar Disorder and

Depression. K.B’s younger brother is diagnosed with ADHD.

V. Nursing Care

The nursing care provided for K.B. ranges from therapy sessions, administering medications,

and implementing precautions. The nurses have a set schedule on the wall that lists the times and

activities that will take place. Group therapy takes place at 5:00 in the afternoon and is

approximately one hour long. Everyone has to attend the group therapy session. Group therapy is

beneficial for individuals with depression because they learn new information regarding coping

strategies. For instance, K.B. says using the rubber band by flicking it against her wrist prevents

her from cutting herself. Group therapy also instills hope and allows for interaction between
PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY 6

members. K.B. stated “I feel like I belong because there is so many other kids that have the same

problems as me.” This is the idea of universality, where the individual becomes aware that they

share the same problems with other members of the group and provides a sense of belonging

(Yalom & Leszcz, 2005).

Medication administration with the use of talk-therapy has been proven to be extremely

beneficial when treating individuals with depression (Mullen, 2018). The nurses administers

Trazadone and Wellbutrin as it is prescribed by the psychiatrist to help with her symptoms of

depression. After the drug administration, her mouth is inspected to make sure she has actually

taken the medications. The medications prescribed to K.B. alter the neurotransmitter imbalances

of Dopamine, Norepinephrine, and Serotonin by increasing their levels. The low levels of the

monoamines correspond to the signs and symptoms seen in a patient with depression. Thus by

increasing these neurotransmitters, the patient with depression will experience better sleep,

appetite and overall mood.

Lastly the use of precautions with K.B. keeps the staff aware that there is a risk of her

becoming suicidal and or having suicidal thoughts. Self- harm and suicidal precautions include

taking away the patient’s belongings at the time of admission and completing a cavity search.

Afterwards, a nurse or behavioral technician will be documenting every 15 minutes what the

patient is doing and saying, and there is one on one observation due to the acuity of the patient.

Therefore, the patient is never left alone. All of these measures are taken to prevent K.B. from

harming herself.

VI. Social Influences

K.B. is white and Caucasian. She does not affiliate with any religious or spiritual practice.

She denies any cultural traditions or affiliations. Even though there is no ethnic, spiritual or
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cultural influences, there is several social aspects that impact the patient. K.B. uses alcohol,

marijuana and tobacco. The use of these substances has been learned by watching her parents

and friends use them throughout daily life. She states, “My dad gave me my first sip of alcohol.”

K.B. claims that whenever her parents were stressed, they would use smoking and alcohol to

relax them. She went on to explain that her boyfriend would supply the marijuana she would

smoke, and that they would get high together. These social influences on K.B. have led her to

use these various substances as a means to cope with ongoing symptoms of depression and

anxiety.

VII. Patient Outcomes

K.B. tolerated the treatment plan well. The two main goals set forth by the staff were to

decrease her anxiety and increase her coping. She participated in all of the group sessions and

took her medications as they were prescribed. She did not harm herself while remaining within

the facility, and she remained free of suicidal ideations. K.B. learned two knew coping

mechanisms that she says make her symptoms more manageable. She uses the rubber band

around her wrist to help her with restlessness and fidgeting. She also says “It prevents me from

cutting myself.” K.B. also learned new breathing techniques, which she uses when she feels

overwhelmed. She claims the breathing techniques calm her down. Overall, K.B. met the goals

that were set for her and was able to be discharged.

VIII. Discharge Planning

I did not provide care to K.B. on the day of discharge. However, the plan was for her to be

discharged on October 7, 2020. She was to be discharged home to her parents in West Virginia.

Her mother was the individual who was coming to pick her up from the facility. After discharge,

continuity of care would be needed for K.B.’s psychiatric diagnosis. K.B. was to see a therapist
PSYCHIATRIC MENTAL HEALTH COMPREHENSIVE CASE STUDY 8

weekly at Well Springs located in West Virginia. This would allow her to be open with her

feelings in a mileu setting. The overall goal was to have K.B. continue using the coping

mechanisms she learned from her stay at Belmont Pines and to continue taking the medications

prescribed to her.

IX. Current Nursing Diagnoses

a. Anxiety r/t situational crisis of current boyfriend being sent to JJC aeb: feeling

hopeless, having shortened attention span, leg shaking and fidgeting with her

rubber band.

b. Hopelessness r/t loss of boyfriend going to JJC aeb: Pt. stating “I’d rather be dead

than keep going like this,” believing she is a “disappointment,” and not caring

about her school work anymore.

c. Disturbed Sleep Patterns r/t to and anxiety aeb: Pt. stating “I have been having

trouble sleeping at night. I can’t shut off my brain. It’s like I have these racing

thoughts, and I can’t stop them,” irritability, lack of energy, and general tiredness.

d. Ineffective Individual Coping r/t situational crisis aeb: Pt. boyfriend being

incarcerated, loss of support system, and history of cutting or self-injury.

e. Social Isolation r/t altered state of being aeb: lack of support system, feelings of

sadness and withdraw, and lack of eye contact during interview.

f. Readiness for Enhanced Resilience r/t effective meaningful communication aeb:

setting goals to decrease anxiety and enhance coping, learning new coping skills

(rubber bands, breathing techniques), and making progress towards goals.

X. Potential Nursing Diagnoses

a. Risk for Self- Directed Violence r/t feelings of depression and hopelessness aeb:

history of suicidal thoughts, history of cutting thighs and waist with razor blades,

and Pt. stating “I’d rather be dead than keep going like this.”

b. Risk for Suicide r/t psychiatric illness of MDD, substance abuse, and poor support

system aeb: suicidal cues, history of suicidal ideations, and feelings of

hopelessness.

XI. Conclusion

K.B. is a pediatric patient battling with Major Depressive Disorder, who was involuntarily

admitted to Belmont Pines Hospital after having suicidal thought related to her boyfriend’s

recent incarceration. Throughout her length of stay, K.B. participated in group therapy sessions,

developed new coping mechanisms, and took psychiatric medications to manage her symptoms

of depression. She showed improvement with her symptoms and was able to be discharged home

to her family. Following her discharge, K.B. would visit a therapist weekly at another facility

and continue taking her newly prescribed psychiatric medications. The outpatient setting would

be beneficial for K.B. to live her life and mange her symptoms of depression.
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References

Akiskal, H. S. (2017). Mood disorders: Clinical features. In B. J. Sadock, V. A. Sadock, & P.

Ruiz (Eds.), Comprehensive textbook of psychiatry (Vol. 1, 10th ed., pp. 1630–

1660). Philadelphia, PA: Lippincott Williams & Wilkins.

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health

Clinician, 8(6), 275–283.

Videbeck, Sheila L. (2020). Psychiatric-mental health nursing (8th ed). Philadelphia, PA:

Wolters Kluwer.

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed).

New York, NY: Basic Books.