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Mood Disorders and Suicide Prevention Case Discussion

A 20 year old college student, L.B., has been coming to class late over the past month and is demonstrating poor academic performance. He looks disheveled and has decreased his social activities. His girlfriend of 2 years broke off the relationship approximately a month ago. He sought help at the college counseling center on the recommendation of his chemistry professor. The counselor has asked that he be evaluated further and recommended possible inpatient admission if indicated. 

You are the psychiatric nurse completing his intake assessment. You observe him to be tearful and have poor eye contact. He reports having insomnia, yet he stays in bed at least 12 hours “just lying there.” he has difficulty getting out of bed in the morning, has a decreased appetite with a weight loss of 10 pounds, is disinterested in prior hobbies, declines offers of close friends to go out socially, experiences fatigue and memory disturbance, and he has poor concentration. He admits he has not been able to study due to difficulty concentrating and memory problems and his academic performance is starting to become affected. You notice his verbal responses to your questions are delayed and that he has psychomotor retardation. He is able to recall two out of three objects after three minutes, and remembers the third object with verbal prompting. He denies use of alcohol, illegal substances, and prescription medications. He is alert and oriented x person, place, time and reason for visit. There is no evidence of psychosis on assessment. 

There is no history of previous suicide attempts, but when questioned regarding current suicidal ideation and plan, he admits to thoughts of suicide. He denies a suicide plan. 

 

1:

1. What symptoms does this patient have that meet criteria for major depression?2. What suicide risk factors and warning signs can you identify? What additional factors and signs not in this assessment would be important to assess for that might increase his risk for suicide?3. What information would you give the provider based on this assessment? Create an SBAR. (Hint: use MSE form to guide you)

 

The student is admitted voluntarily to a mood disorder unit. He agrees to try medication if necessary as part of the treatment regimen. He also informs you that he has healthcare coverage on his parents’ plan. He has notified his parents who are on the way to the hospital. He reports they are concerned about him and he feels guilty for causing them to worry about him. 

 

2:

1. What patient strengths can you identify?2. What interventions, including treatments, do you anticipate for this patient and why? (hint: include concepts from module 1)3. How will you evaluate the effectiveness of your nursing care?

 

The psychiatrist orders Lexapro/escitalopram 10mg po daily. The patient report that the counselor met with him and offered various types of psychotherapy including cognitive behavioral therapy (CBT) and solution focused based therapy (SFBT).

 

3:  

1. What information will you include when teaching the patient and his family about this medication?2. How would each of these therapies help this patient?

 

You notice that L.B. becomes agitated and upset during a visit from a male friend. You approach them and ask if anything is wrong and offer assistance. The visitor responds that he thinks it is time for him to leave and the patient agrees. The patient remains agitated after the visitor leaves. He walks towards you.The patient states he just found out his newly ex-girlfriend of two years has been seeing another man during the last six months. He also states he feels like hurting himself. 

 

4:

1. What therapeutic communication techniques will you use and why?  2. How will this change in the patient’s condition alter your nursing care? 3. What interventions do you anticipate for this patient?

 

5:

After 1 week, L.B. is stabilized and discharged from the hospital.  After a month, he returns for a follow-up outpatient visit. He reports decreased sleep, increased energy, and “feeling on top of the world.” He is experiencing racing thoughts, distractibility, and is very restless at the visit. His speech is pressured throughout the interview. He reports he has spent all his monthly food budget on video gaming equipment. At this time, the patient’s care team is confident that  L.B is suffering from bipolar disorder rather than major depression. The provider stops escitalopram (Lexapro) and starts Lithium 300mg BID.  

9. What are the differences between depression and the bipolar disorders? Compare and contrast.

10. What information will you include when teaching the patient and his family about lithium?

 

 

 

 

 

 

 

 

 

 

 

 

 

SCIENCE
HEALTH SCIENCE
NURSING
MENTAL HEA NRG2008

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