Mental Health Case Study

Stephanie Mayor
 Abstract

Major Depression, also known as MDD or Major Depressive Disorder, is a common

psychiatric condition that is demonstrated by a persistent feeling of sadness and lack of interest in

activities one used to find enjoyable. Major Depressive Disorder is well understood and is very

treatable if caught before it progresses to a condition of fatality. The incidence of this disease is

very common. According to the Journal of the American Medical Association, the lifetime

incidence of depression in the US is more than 20-26% in women and 8-12% in men. This disease

can have a wide range of severity, from something that may begin as inability to cope with

negative feelings, all the way to the occurrence of suicidal and/or homicidal ideations.

The purpose of this case study is to explore and explain MDD in patient SB, along with

indulging in her family and medical history to determine how they may have played a roll in

creating the mental illness she suffers from today. MDD is just one of numerous mental and

physical illnesses she possesses, such as Bipolar Disorder, PTSD, Borderline Personality

Disorder, bulimia nervosa, Dissociative Convulsions, Generalized Seizure Disorder, and a

history of both sexual abuse and self mutilation. 


 “It’s a good word, patient. It means ‘one who suffers.’ I guess we are all patients.”

- BJ Miller, (Ted Talk; what really matters at the end of life)

Objective

SB is a 32 year old female that presented to the Mental Health Unit on September 11,

2018 through involuntary admission after a repeated suicide attempt when she slit her wrists in an

attempt to end her life. Upon admission, when asked why she did this, her response was “My

depression got bad and I wanted to kill myself.” SB has a history of suicidal ideation with one

past suicide attempt documented. She took a surplus of prescription medication in the hopes of

ending her life and was brought to the Emergency Room and resuscitated.

SB has suffered from various mental illnesses throughout her life. Her diagnosis of MDD

was accompanied by Post Traumatic Stress Disorder, Borderline Personality Disorder, Bulimia

Nervosa, dissociative convulsions, generalized seizure disorder, Bipolar Disorder, and a history

of both sexual abuse and self mutilation. As a child, SB was raped by her father until the age of

four years old. Of whom, she admitted to having homicidal ideations toward. After this

unfortunate situation, she was brought into the foster care system and was raped repeatedly by

numerous sex offenders. She disclosed to me that her depression was worsening until she was 17

years old, when her father died and she was “relieved he couldn’t touch me anymore.” Shortly

after this, she was raped by her sisters husband and the depression worsen ed greatly and quite

rapidly.

Her medical history doesn’t stop there. She suffered a stroke one year ago and the left side

of her body is totally nonfunctioning. Being a mother of two, age five and six, this major life

alteration has caused complete disruption of her normal life. SB explained to me that she feels
like her children would have an easier life without her there to disrupt them. She has had to

revaluate and redevelop every aspect of her life and says she feels “drained” and “like a failure.”

With such a prominent history of sexual and emotional abuse, it is certainly understandable that a

level of emotional trauma is to ensue.

Some of her symptoms were very prominent. Throughout the course of our conversation,

she frequently repeated herself, was very easily upset, and became verbally aggressive. She

became fixated rather easily and had trouble letting things go. She would become obsessed with

small details and became incredibly paranoid that people were planning to harm her. She stated

that “nothing is fair, so what is the point.”

Throughout her numerous hospitalizations for both her mental illness and her seizure

disorders, it was identified that she had allergies to Geodon, Ability, Morphine, and Latex. With

these medications providing set backs in her treatment, she claimed that it seemed as though she

was not meant to get better. She continues to see a counselor, whom she feels does not care

about her at all, nor actually wants her to get better. SB reported that in her last therapy session

before her most recent suicide attempt, her counselor came to her house for a session. The

patient states that she had a seizure during the session and her counselor left her without calling

for help. Her fiance returned home four hours later and found her unconscious on the floor of

their living room before proceeding to call an ambulance.

After years of trial and error, SB is now prescribed a lengthy list of daily meds that include

Neurontin 600mg for generalized seizure disorder, Lamictal 50mg for dissociative seizures,

Keppra 500mg for seizures, Zyprexa 10mg for MDD and Bipolar Disorder, and Topamax

100mg for seizures. 


 Summarize

“When someone experiences persistent and intense feelings of sadness for extended

periods of time, then they may have major depressive disorder (MDD).” Major Depressive

Disorder is an illness that affects both mood and physical functions. According to the DSM-1V,

diagnostic criteria for this disorder include feeling sad or irritable most of the day, nearly every

day, being less interested in things you once enjoyed, change in weight or appetite, change in

activity level, alternation in sleep pattern, feeling worthless or guilty, difficulty concentrating or

making decisions, and/or feelings about harming yourself and others or committing suicide. In an

informative speech by Andrew Soloman, a patient and author on the topic of Depression, a

patient described this painful sickness of the mind as “a slower way of being dead.”

Identify

According to SB, these symptoms seem to be precipitated by stressors such as money,

family feuds, her physical handicaps, and fights with her fiance. SB stated that when she has

these feelings she listens to melancholy music or goes for a ride in her wheelchair to go get a drink

from the gas station. When the coping strategies fail to make her feel better, she feels “hopeless”

and “sad.”

Discuss

The patient revealed a history of mental illness regarding her mother, who also suffered

from Major Depressive Disorder. SB states that her mother was aware of her father raping her

and simple did not care. She claims that her mother never cared about her at all and that she

wanted even her to be punished by her father. This leads me to her father, who evidently
experienced Pedophilia. SB claimed that she is not aware of her father ever raping anyone aside

from her.

Describe

This case was especially interesting due to the nature of the physical diagnosis that

accompanied her mental diagnoses. While her mental health diagnoses was MDD, she suffered

from a significant illness regarding recurrent seizures. Her seizures began at a very young age and

she has been told they are what are responsible for the stroke that resulted in the loss of function

throughout the left side of her body. Due to the stroke having only been one year ago, this

handicap was significantly exacerbated by her history of poor coping skills and self mutilation.

While her physical handicap, admittedly, made self mutilation difficult for her, it in no way

stopped her from “trying to numb the pain.” SB explained that her difficulty attempting to relearn

her life carried over as a factor in her decision to attempt suicide.

Evaluate

After looking in the patients chart, it appears that SB has a lot of work to do with her

counselor. While she it was evident that she was eager to go home and see her children and

fiance, I worry that her sense of euphoria will digress and cause her feelings of insignificance to

resurface. Her sense of obsession over things she cannot control was evidenced by her eruption

when a friend she met during her hospitalization was not released at the same time as her. Her

aggravation climbed to the point of no longer being able to affectively hold concentration long

enough to communicate, resulting in a need to pause the interview.

 Summarize

When talking to this patient, with so many aspects of life working against her, I became

very worried that she would fail to thrive when she left the cushion and direction of the

psychiatric hospital setting. A large part of our discussion was working together to discover

coping skills that could possibly help her to better accommodate to her feelings of sadness and

hopelessness, when they occur. As our top strategy, we brainstormed to prioritize the most

important aspects of her life. Upon discharge, her fiance, two children, and herself plan to move

into a new apartment that can provide the two young children to roam more freely and have their

own space to develop physically and mentally.

Throughout the interview, SB repeatedly mentioned how much her children mean to her

and how she only wants what is best for them. She eagerly talked about them and bragged about

how much they help her on a day to day basis. We decided together that they should become the

focal point of her recovery. The goal being to not only work on bettering herself for her own sake,

but also the sake of the two young children that rely upon her for support and love. Other

planned coping strategies include buying an adult coloring book in the attempt to allow her focus

to be on something other than her problems. Additionally, she decided to begin planning small

outings with her children and fiance that will help her spend time with them and remember the

importance they provide in her life.

SB is a prime example of someone who has had continuous setbacks throughout the

course of her life. Accompanied by a set of very poor coping skills, she has suffered stressor after

stressor causing her resilience to slowly decline almost to the point of nonexistence. Thus leading

to the point of not only wanting, but attempting, execution by her own hand. 

 Nursing Diagnosis

1. Risk for Self Harm related to feelings of helplessness, loneliness, or hopelessness secondary

to psychiatric disorder major depressive disorder

2. Ineffective individual coping related to situational crisis as evidence by verbalization of

inability to cope, reported life stress, and alteration in social participation

3. At risk for behaviors in which an individual demonstrates that he or she can be physically,

emotionally, and/or sexually harmful to others related to low self esteem as evidenced by

agitation and homicidal ideations

 References

https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life

https://www.psycom.net/depression.central.major.html

http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/G001.htmlhttp://

www.robholland.com/Nursing/Drug_Guide/data/monographframes/L004.html http://

www.robholland.com/Nursing/Drug_Guide/data/monographframes/O003.htmlhttp://

www.robholland.com/Nursing/Drug_Guide/data/monographframes/T059.htmlhttps://

www.healthline.com/health/clinical-depression

https://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share

https://www.psnpaloalto.com/wp/wp-content/uploads/2010/12/Depression-Diagnostic-Criteria-

and-Severity-Rating.pdf