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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Psychiatric Mental Health Comprehensive Case Study

Dannah Lewis

December 6, 2022

Mrs. Teresa Peck

NURS 4842L Mental Health Nursing Laboratory

Youngstown State University

Abstract

KT is a 43-year-old male patient admitted to the inpatient psychiatric unit after calling the police

to his home regarding his wife. He has a mental diagnosis of brief psychotic episode that

includes hallucinations, paranoia, psychosis and major depressive disorder. With medication

treatments including antipsychotics and antidepressants, the symptoms have become more

manageable with an altered thought process still present. Nursing care provides on the unit is

focused on symptom management through pharmacologic methods, as well as therapeutic group

therapy sessions.
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Objective Data

Patient identifier KT

Age 43

Sex Male

Date of admission November 21, 2022

Date of care November 22, 2022

Psychiatric diagnosis Brief psychotic episode

Other diagnoses type 2 diabetes, CKD stage 3, below knee amputation, iron deficiency anemia,

HF, depression

Behaviors on admission KT had called the police to his home in an attempt to have his wife

removed from the house after accusing her of cheating on him. He was brought into the ED after

being pink slipped by the police and denied all psych symptoms and was insistent on the fact that

he “did not belong there”.

Behaviors on day of care KT was polite and willing to speak but was suspicious and defensive

at times and became agitated when talking about his admission and the staff on the unit. He was

disruptive during the first group therapy and did not attend the second one. KT was very

discharge orientated and claimed he had a plane ticket for that day and was supposed to fly to

Arizona to see his sister who was in the hospital. KT was showing flight of ideas, perseveration

and tangentiality along with grandiose delusions. He maintained good eye contact and was

cooperative but avoided questions he did not want to answer. KT had a rapid speech pattern with

loud volume and exaggerated hand gestures. At times he would have mood swings and go from

friendly and open to suspicious or defensive.

Safety and security measures The patient was not permitted off the unit and safety checks were

implemented at periodic intervals. All hazardous items were removed from the patient upon

admission. Markers were the only writing tool provided to the patient. Medications were

administered by the nurse and the nurse verified that all medications were taken at the time of

administration.

Laboratory results

Lab Value Result

Glucose 101
A1C 8.7
BUN 22
Creatinine 1.73
Hbg 11.8
Hct 36.4
WBC 10.8
Toxicology Methadone
and pot

Psychiatric medications

Generic Name Trade Name Class/Category Dose/Frequency Reasoning

Haloperidol Haldol Typical 5mg q6hr prn Acute psych

Summary of psychiatric diagnosis

Brief psychotic disorder is a sudden, short-term display of psychotic behavior, such as

hallucinations or delusions, which occurs with a stressful event (Berger, 2022). According to the

DSM-5, the sudden onset of psychotic behavior lasts less than one month and is followed by
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

complete remission but has possible relapses. This is an acute transient disorder and includes the

onset of one or more of the following symptoms: delusions, hallucinations, disorganized speech

and grossly disorganized or catatonic behavior and often lasts between one day to one month,

with a complete return to premorbid level of functioning in response to antipsychotic

medications. While the etiology of brief psychotic disorder it unclear, it can result from a

stressful event or trauma as well as a genetic, neurological or environmental component as well

(Stephen & Lui, 2022).

KT had multiple stressors that contributed to his brief psychotic episode. These stressors

include his wife cheating on him, his leg amputation and frequent surgeries, having no job, heart

failure, diabetes and stopping his medications. These events are congruent with one of the

specific triggers of brief psychotic disorder which is specified as: the onset of psychotic

symptoms that occur in response to a traumatic event that would be stressful for anyone in

similar circumstances in the same culture (Stephen & Lui, 2022).

Brief psychotic disorder is related to schizoaffective disorder but differs in terms of

presenting symptoms and the duration and magnitude of impairment. The presenting symptoms

that KT had were disorganized speech with his rapid speech pattern, flight of ideas, and

tangentiality, and grandiose delusions. His grandiose delusion was that he was a master at

reading people. KT repetitively insisted on the idea that he could look at a person and study them

for 5 minutes and be able to tell you what would “set that person off”. He was also very

suspicious of staff and claimed that everyone was lying and only working for their paychecks.

Lastly, KT showed perseveration by constantly talking about how he did not belong on the unit

and was very discharge focused claiming he had to get on a plane to go see his sister.
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

Identification of stressors and behaviors precipitating current hospitalization

Prior to admission, KT was non-compliant with his medications. He was taking Zoloft at

home but abruptly stopped. He lives at home with his wife who he claims has been cheating on

him. He stated that he found this out after having a diabetic episode where he claims he was

unable to get off of the couch for days. He also suffered from a leg amputation which he said was

caused by a staph infection that he acquired while in jail. The reasoning for him being in jail was

due a traffic ticket that he claims that he paid but the money was lost so he was arrested for the

unpaid ticket. He had also lost his job in the start of the pandemic and has been unable to get a

job since due to the frequent surgeries that he has for his leg. KT also has a diagnosis of heart

failure and was given 3 years to live around a year and a half ago.

KT would not disclose any information regarding his wife cheating on him, what led to

him calling the cops on his wife or why he was brought into the ED.

Patient and family history of mental illness

KT denied any diagnosis of mental illness. His medical record showed a previous diagnosis for

depression. There is no family history of mental illness that he is aware of. He lives at home with

his wife of whom he has 3 children with. He stated to have a normal childhood with both parents.

He has 1 older brother and 1 older sister who lives in Arizona and also has heart failure. His

father passed away from the flu. He was very adamant about not wanting his family to find out

that he was on the unit.

Psychiatric evidence-based nursing care provided

During his stay on the inpatient unit, KT received nursing care from the mental health

nursing staff. The nurses on the unit used the nursing process to assess, plan and implement care,

and evaluate KT on a daily basis. They would also administer daily medications and check KT’s

blood sugar due to him having type 2 diabetes. KT was prescribed insulin Glargine for his

diabetes, an SSRI for depression as well as a typical antipsychotic for acute psychiatric behavior.

The nurses that provided care to KT were aware of what the medications are used for and any

side effects that may occur.

Before beginning treatment of a brief psychotic episode, it is important to determine if

the person should be hospitalized or treated in an outpatient setting. This is done by evaluating

multiple factors such as presenting symptoms, socioeconomic stability, the patients support

system and any homicidal or suicidal ideations (Stephen & Lui, 2022). The first line of treatment

for brief psychotic disorder is second generation antipsychotics due to the decreased chance of

developing EPS. KT however was prescribed Haloperidol which is a first generation or typical

antipsychotic. There is a greater risk of developing EPS with this class of medication.

Extrapyramidal symptoms to be aware of include dystonia, akathisia, parkinsonism and tardive

dyskinesia.

On the unit, KT is also receiving psychoeducation along with group and ward milieu.

Milieu is used to promote healing and is a basic nursing intervention regarding treatment of

mental health disorders (Bhat et al., 2020). Milieu is also used to ensure and safe and therapeutic

environment for both the staff and the patients on the unit and has been proven to decrease

patient related violence. Psychoeducation consists of systematic and structured information about

an illness and its treatments and is an essential element in nonpharmacologic treatment of

psychiatric disorders (Bossema et al., 2011). It can result in better coping from the patient due to
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

greater knowledge on their disorder. This leads to a decreased chance of rehospitalization and an

overall improvement on the patients quality of life.

Ethnic, spiritual and cultural influences

KT is an African American, married male with three adult children. He is not currently

employed and relies on disability for financial assistance. KT practices Christianity as a religion

and regularly attends church.

Evaluation of patient outcomes

The primary outcome for a brief psychotic episode if the risk of psychotic recurrence.

Other outcomes include improved quality of life, improved functional/vocational status and

decreased mortality (Provenzani et al., 2021). There is a lack of research done on patient

outcomes specific to brief psychotic episodes due to it being categorized with schizophrenia in

the DSM-5. Patient outcomes associated with schizophrenia include expressing thoughts in a

logical and goal directed manner, demonstrating reality-based thought processes, spending time

with one to two people in structured activities, communicating in a manner that can be

understood by others and learning at least one healthy coping mechanism to decrease anxiety.

KT struggled with expressing his thoughts in a logical manner and often jumped from

topic to topic and was unable to focus and provide direct answers to questions asked during the

interview. He did present a reality-based thought process but was having grandiose delusions by

insisting that he could read people within five minutes. He was unable to spend time with

multiple people during a structured activity and was very disruptive during group therapy. His

coping mechanism that he deemed healthy was smoking pot every other day.
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

When asked to rate his depression and anxiety he denied having either and went back to

the topic of him not belonging on the unit.

Plans for discharge

When KT is discharged, the plan is for him to return home to his wife. However, he was very

adamant on flying to Arizona to see his sister. KT will also restart his home medication which

was Zoloft. Further discharge planning had not yet been decided.

Prioritized nursing diagnoses

The following are prioritized nursing diagnoses for KT:

1. Impaired social interaction related to paranoia and suspiciousness

2. Impaired verbal communication related to disorganized speech pattern

3. Disturbed thought process related to overwhelming stressful life events

4. Interrupted family process related to admission to unit and wife cheating (situational

crisis)

5. Defensive coping related to suspicion of others

Potential nursing diagnoses

1. Poor self-image

2. Suspicion

3. Self-care deficit

4. Deficient knowledge

5. Risk for self-directed violence

6. Social isolation

7. Activity intolerance

8. Fear

9. Ineffective health maintenance

10. Impaired memory

Conclusion

Brief psychotic disorder is complicated disorder that is brought on by a stressful event. It is often

categorized with schizophrenia due to the presenting symptoms of delusions, hallucinations,

disorganized speech and thought process and psychosis. It is usually short lived and treated with

antipsychotics. During these episodes, the patient can become a danger to themselves, or others

and treatment is based on severity.

KT exhibited grandiose delusions, disorganized speech, interrupted thought process and

paranoia/suspiciousness. The goal for discharge is patient education and compliance with home

medications. By staying compliant with his home medications, remission of this disorder can be

prevented.
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY

References

Berger, Fred. “Brief Psychotic Disorder: Medlineplus Medical Encyclopedia.” MedlinePlus, U.S.

National Library of Medicine, 30 Apr. 2022,

https://medlineplus.gov/ency/article/001529.htm. 

Bhat, Sandhya, et al. “Effectiveness of Milieu Therapy in Reducing Conflicts and Containment

Rates among Schizophrenia Patients.” Investigacion y Educacion En Enfermeria, U.S.

National Library of Medicine, 26 Feb. 2020,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871472/. 

Bossema, Ercolie R, et al. “Psychoeducation for Patients with a Psychotic Disorder: Effects on

Knowledge and Coping.” The Primary Care Companion for CNS Disorders, U.S. National

Library of Medicine, 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219515/. 

Stephen , Anu, and Forshing Lui. “Brief Psychotic Disorder .” National Library of Medicine ,

StatPearls [Internet], 3 Oct. 2022, https://www.ncbi.nlm.nih.gov/books/NBK539912/. 

Provenzani, U, et al. “Clinical Outcomes in Brief Psychotic Episodes: A Systematic Review and

Meta-Analysis.” Epidemiology and Psychiatric Sciences, U.S. National Library of

Medicine, 4 Nov. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581951/. 

Videbeck, Sheila. Psychiatric - Mental Health Nursing. Lippincott Williams & Wilkins, 2016. 
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Running head: MENTAL HEALTH COMPREHENSIVE CASE STUDY