Psychiatric Mental Health Comprehensive Case Study
Psychiatric Mental Health Comprehensive Case Study
Mike Audi
Thursday 7:00-1:00
Objective Data
The patient I cared for on October 4, 2018 was a thirty-one-year-old female who was
involuntarily admitted to the unit on October 3, 2018. She was diagnosed with Major
Depressive Disorder and Alcohol Abuse Disorder without psychosis. The patient was brought to
the emergency department in custody of the police around nine o’clock at night. Upon
admission, the patient was extremely intoxicated and aggressive toward police and medical
staff. A “spit guard” had to be worn by the patient while she was in the custody of police and
she made multiple verbal threats towards police officers and healthcare providers. When the
police arrived at her house, she also displayed suicidal intentions. The patient slept in the
emergency department that night and was brought to the floor in the morning. The patient
states that she does not remember any of the night, and that she consumed an entire bottle of
vodka before authorities arrived at her home. The morning after the patient’s erratic and
aggressive behavior, she was very calm and cooperative and displayed an absence of alcohol
withdrawal symptoms. The patient states that she understands she has an alcohol problem and
is ready to take the necessary steps towards beating her addiction. The patient is prescribed
Summarize
One diagnosis the patient received was Major Depressive Disorder. “Major depressive
disorder (MDD), also known as clinical depression, is a profound depressed mood that persists
for longer than 2 weeks, severe enough to cause noticeable problems in the patient’s ability to
maintain personal relationships, meet work or school obligations, and participate in previously
enjoyable social activities” (Davis, 2017). Some common symptoms of Major Depressive
Disorder include feelings of sadness, feelings of worthlessness and guilt, and changes in
appetite. Next, her second diagnosis was Alcohol Abuse Disorder without psychosis. This
disorder is characterized by a dependency to alcohol which can affect the patient’s social life,
Identify
The patient had multiple stressors that precipitated her hospitalization. The patient was
a Physicians Assistant, but her license is currently suspended for one year because she was
caught drinking between patients. She is currently required to go to treatment and take
multiple urine tests for drugs and alcohol. The patient also lost her marriage due to her alcohol
addiction, and currently alternates between living in a house on her own and staying at her
current boyfriend’s apartment. The patient stated that she would drink alcohol immediately
upon waking up in the morning and continued to drink throughout the day. She stated that she
had lost many friendships due to her alcohol use, and it has also had a major effect on her
family relationships.
Discuss
The patient comes from a good family with a solid support system. Her father is a
physician, and she grew up around a family that always got along and maintained stable
relationships. The patient’s family history of mental illness consists of her mother and maternal
aunt who are both diagnosed with Generalized Anxiety Disorder and Depression. The patient
has a medical history of alcohol dependency, anxiety, and depression. This past year, on the day
her mother took the breathalyzer out of her car, she was charged with driving under the
influence and possession of an open container. The patient denied previous psychiatric
hospitalization, but has a history of treatment including rehab and participation in alcoholics
anonymous.
Describe
The patient attended multiple group meeting on the floor and stated that she thought it
was very helpful. She stated that she can speak more freely in a group setting and did not feel
any judgement within the group. Nurses and other healthcare professionals also did a good job
of facilitating the conversation. This type of therapy helped the patient feel like she is not alone
and helped her realize that people were willing to help her.
Analyze
The patient is Caucasian and does not describe herself as religious, but states that she is
spiritual. She had grown up as a Catholic but stated that she stopped identifying with the
religion when she moved out of her childhood home. Since then, she has remained spiritual and
reads books that guide her in a positive moral direction. The patient identified reading as a
Evaluate
One possible patient outcome related to alcohol abuse is verbalizing the awareness that
the patient does indeed have a substance abuse problem. This outcome was efficiently met, as
the patient stated multiple times she knew she had a problem and wanted to actively take
steps toward becoming sober. Another patient outcome is engaging in therapeutic programs.
This is currently required by the state, so she can get her license back, but she stated that she is
finally ready to take the program seriously. The patient has been to rehab on three separate
occasions this year and has never made it past step three of alcoholics anonymous. “Made a
decision to turn our will and our lives over to the care of God as we understood Him” (Strobbe,
Hagerty, Boyd, 2012). The previous quote is the third step of alcoholics anonymous. The patient
plans on reading more and getting in touch with her spiritualty to make it past this step. She
stated multiple times that this attempt will be different, and she is finally ready to take the
program seriously.
Summarize
The patient’s discharge plans include finding new coping mechanisms to deal with her
daily stress. The patient has identified activities such as reading and spending more time with
her family to achieve this outcome. Another discharge plan is to continue her treatment for
alcohol abuse. The patient plans to finally complete the twelve steps of alcoholics anonymous
Prioritized
1. Risk for suicide related to diagnosis of major depressive disorder as evidenced suicidal
ideation.
List
Conclusion
“The 2010 National Survey on Drug Use and Health: Mental Health Findings estimated
that 3.4 million (16.9%) of the 20.3 million adults who met criteria for past-year SUD reported
also experiencing a major depressive episode (MDE) during that same period” (Devido, Weiss,
2012). The previously stated statistic does not come as much of a surprise after meeting with
this patient. The patient believes that she drinks because she is is frequently depressed. Alcohol
abuse is a harmful coping mechanism for the patient, so the goal is to find healthier options to
deal with her stress. The patient has lost a lot in her life because of her alcohol abuse disorder,
and she seems to realize how severe her addiction is. The patient seems motivated to turn her
life around by actively participating in therapy and working toward getting her license back.
References
Davis, C., & Lockhart, L. (2017). Not just feeling blue. Nursing Made Incredibly Easy, 15 (5), 26-
32.
DeVido, J.J., & Weiss, R.D. (2012). Treatment of the Depressed Alcoholic Patient. Curr Psychiatry
Strobbe, S., Hagerty, B., & Boyd, C. (2012). Applying the Nursing Theory of Human Relatedness
to Alcoholism and Recovery in Alcoholics Anonymous. Journal of Addictions Nursing, 23(4), 241-
247