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Running head: COMPREHENSIVE CASE STUDY

Psychiatric Mental Health Comprehensive Case Study

Juliana M. Rotz

Youngstown State University

Abstract

The purpose of this case study is to select a psychiatric patient currently admitted to a

mental health facility. This case study contains the collected subjective and objective data of said

patient while on the road to mental health recovery in an inpatient setting such as Belmont Pines

Hospital. In this study, topics that are discussed include objective data about the chosen patient,

the psychiatric diagnosis and its symptoms, behaviors and stressors that contributed to the

hospitalization, the mental health history of the patient and family, types of nursing care

provided, outcomes that are to be expected, and plans for discharge. The qualitative and

quantitative data was collected through therapeutic communications between me and the medical

record and the patient. This collection of data enabled me to have a better understanding of the

journey taken by the patient through her life which was impaired due to emotional and

psychological struggles.
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Running head: COMPREHENSIVE CASE STUDY

I. Objective Data

L.S. is a 14-year-old female. L.S. was admitted to Belmont Pines Hospital on October 19th,

2020. The date of care for this patient took place on October 20th, 2020. The admitting

psychiatric diagnosis is Major depressive disorder, or MDD. The patient also has a medical

diagnosis of Asthma. Major depressive disorder is a type of mental illness classified by

persistently depressed moods or loss of interest in activities. This illness causes significant

impairment in one’s daily life. L.S. has been a patient in previous months in the acute care wing

of Belmont Pines. L.S. has also been seen in the emergency department at Akron Children’s

Hospital Mahoning Valley on occasion due to self-harm behaviors such as cutting and burning.

L.S. has a history of one suicidal attempt that took place over a year and a half ago. During this

attempt there was suicidal ideation present and the patient had a plan to overdose but stopped

herself right before it happened. The patient stated, “I stopped myself because I did not want to

let my family down. I have a dog and a cat that I would miss too much if I were gone. I want to

find love one day and I can’t do that if I’m dead.”

The patient had been seeing a counselor at Meridian Health care. Unfortunately, due to

Covid-19, the therapy sessions were canceled. The sessions just recently began again but only

via Zoom video conference. L. S. stated that although it was a relief to begin the sessions again,

it was not as helpful as before. The patient said it was not the same, she was not getting the same

type of help, and it was hard to make a connection with counselor like before.

While caring for L.S. on the 20th of October 2020, a number of observations were made.

During the group therapy session that was held with all of the other teen members, L.S.

interacted only a brief bit. I did notice she was more reserved than the other children. When her

and I eventually had the opportunity to sit down for our conversation, we were in the gym during
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Running head: COMPREHENSIVE CASE STUDY

the kid’s gym time. L.S. was very pleasant, nice, and spoke in a soft tone of voice. L.S. appeared

relaxed but she struggled to make and keep eye contact with me while we were talking. She

seemed to be distracted by the others playing around us. L.S. was willing to open up and talk

about her mental health with me. While I was asking about the precipitating events leading to her

admission, L.S. would repeat the same answer without really adding any new details. I had asked

L.S. how she feels like her moods have been lately and she replied, “My moods have just been

okay lately.” I then asked if her moods have been more or less emotional than usual. She replied,

“I guess my moods have been a little more emotional these last few days. I feel like I am always

worrying about what others are thinking or feeling more than myself.”

According to the medical record, L.S. did not have any abnormal labs. She is currently

prescribed Albuterol via an inhaler at 90mcg taken in two puffs. This bronchodilator is a home

medication that is used to help with her asthma. L.S. is also prescribed Clonidine (Catapres) PO

0.1-0.2mg every night at bedtime. Although this drug is classified as an antihypertensive, it is

typically prescribed for depression to help treat the somatic symptoms.

II. Psychiatric diagnoses

In the mental health setting, children are most diagnosed with some type of depression.

This diagnosis is typically seen more often in children ages 14 to 15 and the onset is earlier in

girls than boys. The depressive symptoms can range from moderate to severe with roughly

7.6% of children ages 12 and older exhibiting symptoms. It is affiliated with suicidal

attempts, increased risk for suicide, teen pregnancy, and poor academic performance

(Haefner, 2020).

As mentioned previously, Major depressive disorder is the persistently depressed mood

or loss of interest in activities. The Diagnostic and Statistical Manual of Mental Disorders-5
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Running head: COMPREHENSIVE CASE STUDY

identifies the specific criteria for a Major depressive disorder diagnosis. The client must be

experiencing loss of interest in pleasurable activities; changes in appetite; two weeks of

persistent change in mood; a decrease in concentration, activity, or energy; negative self-

worth statements; feelings of guilt; and suicidal attempts or thoughts (Kennedy, 2008).

Children and adolescents are more at risk for developing Major depressive disorder due

to lack of knowledge regarding coping skills and hormonal changes that are taking place

during this developmental stage in life. Mood swings are most commonly observed in the

adolescent population. An important point to take into consideration is whether the highs and

lows are normal or if they go beyond that and become persistent behaviors of depression.

III. Identify the stressors and behaviors.

L.S. was a voluntary admission to Belmont Pines on October 19th, 2020 for suicidal

ideation, along with a diagnosis of Major depressive disorder. The patient states to have been

struggling with symptoms of depression and anxiety over the past few months. The main

stressors that were identified in the patient’s life is feelings of loneliness. L.S. has been

homeschooled for the last two years and does not feel that she has had any opportunities to

make real friends. She relies heavily on her Xbox community for these friend relationships.

When one of her main friends started to ignore her, L.S. claims here depression and

loneliness started to become more severe. L.S. also stated that she feels like she does not get

any kind of support or help from her family and friends. This also contributes to the feelings

of being alone. L.S. told me that because she considers herself bisexual, her family does not

understand her.

The most recent cause for admission to Belmont Pines was due to a minor altercation

with the patient’s mother and an internet friend. According to the medical record and patient,
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Running head: COMPREHENSIVE CASE STUDY

an online friend of the patient was ignoring her for the last few days. This became very

triggering to the patient causing her to become suicidal and was having other bad thoughts.

L.S. decided to bring this up to her mother, but according to L.S. her mother only passed her

behaviors off as “over dramatic.” L.S. then ran away from home and called the police to

report that she was suicidal and had a plan to take her own life. The patient was then brought

to the local emergency department. From there she was then referred to Belmont Pines.

According to the medical records, L.S. has a number of factors that would put her at risk

for depression and suicide. When the patient was 12 years old, she was sexually assaulted by

a fellow male peer. L.S. stated that the male was her current boyfriend but had said that she

did not give consent for any form of sexual interaction to take place. It was also noted that

the patient does not have a good, stable relationship with her father. The poor relationship is

due to the father suffering from alcohol abuse. L.S. stated, “when I was younger and he

would drink, he would become very aggressive. He was more emotionally abusive than he

was physically, but he did hit me a time or two.” She said that although she has not lived

with her father for some time, his actions have left a large impression on her self-esteem.

IV. Patient and family history of mental health

L.S. and her immediate family have a pretty extensive psychiatric history. Starting with

the patient, L.S. has a mental health history of depression and anxiety. The patient has also

had thoughts of suicide on a number of occasions in the past. L.S. claims to have had a plan

to overdose but stopped herself before she was able to go through with her plan. As

previously stated, L.S. records showed a previous inpatient stay at Belmont Pines about 4

months ago and multiple appearances at Akron Children’s Hospital for self-harm acts of

cutting and burning.

The mother and a sister of L.S. has a psychiatric history of suffering from anxiety and

depression. L.S has two other older sisters that also have struggled with depression. The

same two sisters have also attempted suicide but thankfully did not succeed. L.S. stated to

me, “my whole family is messed up and suffers from depression and so you would think that

they would understand me a little more. I remember when my sisters tried to kill themselves.

I just want a little bit of support; I feel like I am nothing but a burden to the rest of them.” As

I touched upon previously, L.S. father has struggled with a history of alcoholism for most of

her life. This has resulted in a large amount of emotional abuse and some physical abuse

directed towards the patient.

V. Psychiatric nursing care

Milieu therapy comes from a French term referring to one’s social environment. This

therapy type involves altering the environment around an individual. The goal is that the

changed environment will encourage new coping skills to form. Milieu therapy assists the

child at finding their own inner strength while dissolving poor behaviors from the past

(Solstice RTC, 2020).

Milieu therapy is demonstrated at Belmont Pines Hospital in a number of ways. Whether

the child is in the acute wing or the residential wing, all of the patients follow a strict, well

organized daily schedule. The schedule rarely changes so it gives the child of sense of

stability and structure.

Group therapy sessions are another way to strengthen the child’s coping techniques.

During the date of care, L.S. attended and participated in a number of group therapies. She

attends group sessions multiple times a day, every day she is there. Groups consist of at least

one adult leader and roughly 8-12 other children. The group topics range from medication
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Running head: COMPREHENSIVE CASE STUDY

education to music therapy to perspective therapy and everything in between. In the group

therapy session that L.S. and myself were present for, she did not show much participation.

Although she did give feedback when asked what she thought/felt about the group topic at

the end of the session. L.S. said that she finds the groups to be helpful at times but can

become overwhelmed easily due to the other participants “dominating the session.” She

explains that this is the reason she chooses to stay quiet during group.

VI. Ethnic, spiritual and cultural influences

L.S. is an African American female. During our conversation L.S. mentioned that she

does not consider herself an extremely religious person but does believe in a God and takes

comfort when praying. She did not, however mention if she uses prayer or church as a form

of coping. L.S. denies any ethical, spiritual, or cultural influences on her mental health.

VII. Patient outcomes.

L.S. expressed that she has a number of goals and outcomes that she hopes to achieve

during her psychiatric hospitalization and in the future after her discharge. One of the goals

L.S. would like to achieve is being able to properly use coping techniques when an anxious

or depressive episode occurs. The patient expressed an interest in music, journaling, and

playing with her pets. She stated that these activities do help to relieve some the anxiety she

has but often forgets to use these during episodes. Another priority outcome would be for

L.S. to stay free of all self-harm behaviors during the current hospitalization and moving

forward. During the day of care, L.S. stated that she was no longer having thoughts of suicide

and has not attempted to harm herself in a number of days.

VIII. Discharge Planning.

Unfortunately, I did not provide care for L.S. during the discharge day. According to L.S.

she had spoken to her mother and the doctor about returning home within the next few days.

Since L.S. was making significant strides in her progress during her time at Belmont Pines,

the doctor was willing to consider sending her home sooner than originally expected. The

plan for discharge was going to include more frequent counseling sessions with her therapist.

There was also mention of sending the patient home with a prescription of an antidepressant.

L.S. said that a part of her own planning was going to include making more of an effort to

talk with her mother regarding her depressive and anxious episodes. Upon discharge, L.S.

will return to her home with her mother and other siblings.

IX. Current Nursing Diagnoses.

a. Impaired social interaction R/T anergia as evidenced by feelings of seclusion,

avoids contact with others, and lack of eye contact.

b. Grieving R/T actual, perceived, or anticipated loss as evidenced by depression,

anger, sleep disturbances, and emotional distress.

c. Chronic low self-esteem R/T impaired cognitive self-appraisal as evidenced by

repeated expression of worthlessness and negative view of self and abilities.

X. Potential Nursing Diagnoses

a. Risk for suicide R/T grief/bereavement/loss of an important relationship as

evidenced by suicidal plan.

b. Risk for self-direct violence R/T loneliness as evidenced by previous attempts of

violence towards self.

XI. Conclusion

L.S. is a pediatric patient who was voluntarily admitted to the Belmont Pines Hospital.

L.S. is admitted with a psychiatric diagnosis of Major depressive disorder, suicidal ideation

and thoughts, and anxiety. Due to an altercation and the loss of a friendship, the patient

confronted her mother and then ran away. L.S. contacted the police for helping, stating her

suicidal thoughts and her plan. On the day of care, there was no discharge order in place, but

discharge planning did include more counseling sessions and adjustments to coping

techniques.
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Running head: COMPREHENSIVE CASE STUDY

Works cited

Haefner, Judy & DNP, PMHNP-BC. (2016). Primary care management of depression in children

and adolescents. Nurse Practitioner, 41, 38-45.

https://doi.org/10.1097/01.NPR.0000483046.97563.4c

Kennedy S. H. (2008). Core symptoms of major depressive disorder: relevance to diagnosis and

treatment. Dialogues in clinical neuroscience, 10(3), 271–277.

https://doi.org/10.31887/DCNS.2008.10.3/shkennedy 

Solstice RTC. (2020, May 15). A safe community: Milieu therapy and how it works. Retrieved

November 28, 2020, from https://solsticertc.com/a-safe-community-milieu-therapy-and-

how-it-works/