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MENTAL HEALTH CASE STUDY

Psychiatric Mental Health Case Study

Regan LaVigna

October 7, 2022

Mrs. Defiore-Golden

NURS 4842 Mental Health Nursing Laboratory

Youngstown State University

Abstract

The subject of the study is BC, a 21-year-old Caucasian male patient admitted to the inpatient psychiatric

unit with suicidal ideation. BC is also diagnosed with Bipolar II disorder with a most recent hypomanic

episode and also has cluster B personality traits. He also displays symptoms of anxiety and depression

following the breakup with his girlfriend. With medication treatments including Antipsychotics,

Anticonvulsants (used to treat manic and depressive episodes related to bipolar disorder), Antihistamine

(for anxiety which makes more serotonin available in the brain), BC is able to manage his symptoms and

communicate his feelings with others. Some nursing care provided on the unit is focused on controlling

emotions, providing types of coping mechanisms, using pharmacologic methods of controlling symptoms

of bipolar II, and therapeutic group therapy sessions.

Objective Data

Patient identifier: BC

Age: 21

Sex: Male

Date of admission: 9/21/22

Date of care: 9/23/22

Psychiatric diagnosis: Bipolar II disorder

Other diagnoses: anxiety, cluster B personality, suicidal ideation

Behaviors on admission: BC was admitted to the emergency department with suicidal ideation after

breaking up with his ex-girlfriend who recently took out a new contact order against him. This severely

depressed him into having suicidal thoughts and expressing them to staff and students on campus who

had reported his behaviors and was admitted onto the unit as a pink slip.

Behaviors on day of care: BC was a very calm and compliant patient who was more than happy to have

multiple conversations with me regarding his admission and thoughts. He participated in the group

therapy session in the common area as well as in the therapy room with the social worker. BC was very

positive during the sessions as well as speaking to me. BC stated that he “wants to get back to the happy

person he was when he was with his ex-girlfriend” and also that he “wanted to go to bars and coffee

shops to meet new people once he gets out of here”. He also mentioned that he works two jobs, one being

on campus at the Jambar as a journalist, and the other being at The Vindicator. He stated that his coping

mechanism through all of this is through writing and that’s where his joy comes from.

Safety and security measures: There were multiple safety and security measures that took place, one

being around the clock checks by the nurses. BC was not permitted off the unit and all items were taken

from him upon admission. All harmful items including, shoelaces, hoodies with strings, razors, pencils,

pens, cell phones, medications, and any other items that can harm themselves and others, were taken.
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Medications were given to the patient by the assigned nurse only and the nurse would verify each

medication upon giving it. The nurses provided excellent safety measures for all patients who were

having potential outbursts and patients who could potentially cause harm to others.

Laboratory results:

Lab Value Result

Potassium 3.9

Sodium 141

Glucose 106

TSH 0.682

T4 7.3

RBC 5.95

Hbg/Hct 17.5/49.1

AST/ALT 16,14

WBC 18

BUN/Creat. 18/1.0

QTc 415

Toxicology N/A
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Psychiatric medications:

Generic name Trade name Class/category Dose/Frequency Reasoning

aripiprazole Abilify Antipsychotic 10mg daily Bipolar disorder

Oxcarbazepine Trileptal Anticonvulsant 300mg daily Bipolar disorder

Haloperidol Haldol Antipsychotic 5mg daily Dipolar disorder/mood

swings

Acetaminophen Tylenol Analgesic 650mg Pain

Hydroxyzine Vistaril Antihistamine 50mg Anxiety

Summary of psychiatric diagnosis

BC’s diagnosis is Bipolar II disorder which is characterized by having at least one hypomanic

episode in their life. People with Bipolar II disorder suffer more often from episodes of depression where

the term ‘manic depression’ comes from. Bipolar II differs from Bipolar I in that Bipolar II disorder, the

up mood doesn’t reach full blown mania. Bipolar I disorder experiences full mania (a severe, abnormally

elevated mood with erratic behaviors).

Hypomanic episodes are described as less-intense elevated moods and that is what occurs in

Bipolar II disorder but, they are often longer-lasting than Bipolar I. This accurately correlates with BC’s

medical diagnosis because stated in his chart, he had a most recent hypomanic episode. Upon my

observation speaking to him, I could tell he was in between episodes of hypomania and depression

because he was acting normal and very pleasant. I did notice signs of depression with his tone of words

and how he was talking about his ex-girlfriend. According to a source, symptoms of hypomanic episodes

include, flying suddenly from one idea to the next, having exaggerated self confidence, rapid “pressured”
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(uninterruptible) and loud speech, increased energy, with hyperactivity and a decreased need for sleep

(Hoffman, 2022).

Hypomanic episodes aren’t exactly negative unpleasant behaviors. Hypomania can lead to people

being very pleasant and enjoyable to be around because they take intense interest in others and have

extremely positive moods (Sussman, 2022). Although, these moods can lead to impulsive and dangerous

behaviors that can lead to bad consequences. For example, they can do things they don’t normally do

including drugs, seeking out sex, and spending money that they don’t have. I can notice areas of

hypomania while talking to BC like his flight of ideas after leaving the unit and his thoughts of wanting to

meet people at bars, coffee shops, restaurants, and online websites.

Bipolar II disorder is complicated to diagnose because it is very much like clinical depression.

They have very low lows, but when they are over it, they act like normal people.

However, hypomania is by no means benign, as it is accompanied by a high risk for suicidal

behavior and social impairment and is followed by manic episodes in 10–15% of cases in the

course of illness (Hoffman, 2022)

From my clinical observation, I believe following his hypomanic episode, that is when his thoughts and

ideas of suicide were verbalized to his peers.

Identification of stressors and behaviors precipitating current hospitalization

BC was admitted to the unit after suicidal ideation as stated above. Prior coming, he lived at home with

his parents and did not make any negative comments associated with his parents and with his feelings of

depression. His major subject of depression and suicidal thoughts was the breakup with his girlfriend of 8

months. BC was placed on a hold for being a danger to himself. He had poor insight and judgement and

little interest to do anything upon coming here. The doctors had said they will not be discussing discharge

until he is compliant with his medications and participating in his therapy and care. When we entered the
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room to discuss his progress with the doctors, the doctor questioned why he continued to hold his head

down at the floor as it looked like he was depressed.

Patient and family history of mental illness

BC stated that he is depressed but did not make any mention to me about his diagnosis of Bipolar

II disorder. He said the medications he had been taking are helping with his anxiety and depression and he

will continue taking them. There was no known family history of mental illness although, he does have

history of past suicide attempts. Back in April, he took 24 sleeping pills attempting suicide.

BC lives with both of his parents and a significant piece of information I came across was that his

mother bathed and slept with him until the age of 14. Once he got to high school and became a freshman,

this stopped. I personally think this plays a very big part in BC’s mental health to this day because of the

many comments about how he is afraid to be alone and not have someone romantically. As a child, he

was comforted and everything was done for him. As he continued getting older, his anxiety grew when he

didn’t have someone to do these things for him which led to feelings of anxiety and fear of loneliness. He

wasn’t taught how to cope with normal stress and anxieties in life related to break ups and relationships

which later on developed to him acting out and having no control over his emotions.

Psychiatric evidence-based nursing care provided

During BC’s stay, a lot of nursing care was provided along with evidence-based care. Medication

was given to him which includes aripiprazole. It is an antipsychotic regularly used for the treatment of

schizophrenia but has found to be very effective in bipolar disorder. It is an FDA approved drug which

treats the manic episodes associated with bipolar disorder. Another drug that was used in his treatment is

oxcarbazepine (Trileptal) which is an anticonvulsant that is sometimes prescribed off-label to treat manic

and depressive episodes associated with bipolar disorder (Smith, 2022). The drug in this case is used to

act as a mood stabilizer to reduce symptoms of mania, reducing hyperactivity, agitation, and restlessness.

Hydroxyzine (Vistaril) is an antihistamine which surprised me a lot because I wasn’t expecting a patient
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admitted onto the unit to be prescribed a medication like this. In this case, it is used to treat BC’s anxiety.

“As an antihistamine, hydroxyzine blocks the effects of histamine in your body, which makes you sleepy.

(Think about how you feel after taking Benadryl or Nyquil) Serotonin is a chemical that affects your

mood. Hydroxyzine’s unique effect on serotonin is likely why it’s the only antihistamine used for

anxiety” (Chang, 2021).

Cognitive Behavioral Therapy (CBT) was used throughout BC’s stay on the unit which aims to

focus on his way of thinking to help adapt healthier to common stressors. Cognitive therapy focuses on

the persons thought and belief and behavioral therapy focuses on a person’s actions. CBT is used as a

combination with medications and other treatments. Things that the patient learns in CBT is problem

solving techniques and ways to identify triggers. This technique is used to ultimately minimalize

hospitalizations through teaching how to cope with stress (Mind, 2022).

Another treatment that has been used with BC is the participation in group therapy. Although it is

not mandatory, it is highly suggested and encouraged by the nurses and staff on the unit that they attend.

They strongly advise the patients to also participate to get something out of the therapy group and learn

different communication techniques with their peers. I noticed at a lot of group therapy sessions, they

always ask for goals that they want to achieve while being here and BC’s goal was to be happy. BC

regularly attends group therapy and when I was there, he participated quite a lot and took interest in the

session. He expressed to me that he enjoys attending them because he likes to hear other people’s stories

and learn different ways of coping. The doctor specifically told him that he needed to participate and be

engaging in activities in order to be able to leave here and be healthy. The unit and staff did a great job at

providing structure to the patient’s day by writing the daily schedule large for everyone to see and follow

throughout the day. BC was also able to make personal phone calls throughout the day with the public

phone on the wall.

One of the conversations I made sure to have with BC was asking about healthy ways that he

could get his mind off of negative thoughts and behaviors. BC was very positive while answering and
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said his one love is writing and journaling and that is his escape from negativity. He also told me about

the Rock and RnB music that he enjoys listening to and that it helps to clear his head.

Ethnic, spiritual, and cultural influences

BC is a 21-year-old Caucasian male that does not state a specific religion or background,

however, he made mention in conversation about God. He also made mention about his Eastern European

family and how that is where his ‘large nose’ comes from. He does not speak any other language besides

English and did not make any mention of any friends. Other than that, it did not seem like there was much

of a cultural background for BC.

Evaluation of patient outcomes

Outcomes that were specific to BC during his time here would be developing positive/healthy ways of

coping with his stress and emotions, knowing what triggers his bipolar, and remaining free from harming

himself. While on the unit, BC has been very compliant and easy to talk to as well as having an interest in

his care. However, when he first came onto the unit, he was very confused as to why he was here and did

not see an issue with his behaviors. He had little interest in doing most things but after speaking to his

medical team and after being told that there is not going to be a discussion about discharge until he starts

participating and engaging with others, his motives changed and he has been a lot more outgoing.

Summarized plan for discharge

When BC leaves the hospital, he will go back home to his mother and father’s house in the Youngstown

area. He attends college and is a junior who is studying journalism and will continue to pursue that. There

is no talk about discharge with the medical team for him because of his lack of progress. BC stated

multiple times this day about the want to go back home and prioritize himself and search for his own

happiness. He wants to be happy and make himself his top priority as before, he prioritized others.
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Prioritized nursing diagnoses

Risk for injury related to manic episodes with bipolar II disorder and consumption of marijuana.

Disturbed thought process related to imbalanced alterations in the brain.

Risk for self-related to suicide precautions and previous suicide attempt as well as suicidal ideations.

Interrupted family process related to patient’s upbringing growing up.

Potential Nursing diagnoses

Risk for loneliness

Risk for Suicide

Self-care deficit

Ineffective impulse control

Risk for violence

Ineffective individual coping

Conclusion

In conclusion, BC was a very interesting and pleasant patient to work with. He answered all the

questions I had for him and also would ask stuff about me. BC struggled with loneliness and said talking

to me was the highlight of his day. I believe if he continues to have a positive outlook and participate in

group therapy as well as take his daily medications, he will see great results and his goal of happiness will

soon be reached.
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References:

Evidence-based treatments for bipolar disorder. Mind Matters Institute. (2020, April 13). Retrieved
October 7, 2022, from https://mindmattersinstitute.org/bipolar-disorder/treatments-bipolar-
disorder/ 

Hoffman , M. (2022, August 14). Bipolar II disorder: Symptoms, treatments, causes, and more. WebMD.
Retrieved October 7, 2022, from https://www.webmd.com/bipolar-disorder/guide/bipolar-2-
disorder 

Smith , K. (2022, September 12). Trileptal (oxcarbazepine) for bipolar disorder - PSYCOM. Trileptal
(oxcarbazepine) for Bipolar Disorder. Retrieved October 7, 2022, from
https://www.psycom.net/bipolar-medications-trileptal 

Susman, J. L. (n.d.). Improving outcomes in patients with bipolar disorder through establishing an