CASE STUDY OF MAJOR DEPPRESSION By Daniel Khajavi
Note: All names and location in this case study have been changed to maintain patient and clinician confidentiality.
Table of contents
INTRODUCTION
The purpose of this case study is to analyse a mental health case attended by paramedics. This paper will include a brief overview of the case attended, key features of the case, relevant history, a provisional diagnosis, the rationale behind the chosen diagnosis, psychological and biological components of the disorder, a discussion of how this case should have been managed in an out of hospital setting by paramedics, a mental health examination and treatment and medication options for the patient.
CASE HISTORY
At 1600 paramedics were dispatched to a home address of a 25 year male named Gary acting aggressively towards family members and throwing objects around the house. On arrival SAPOL were at the scene. Upon entering the house family members including father, mother and a younger brother were present in the living room. The have stated that earlier Gary had ingested a few Effexor tablets (number of tablets unknown & not prescribed) and had been drinking. Parents stated that Gary had been diagnosed with depression and lately he has been having behavioural changes and issues. At this Gary had locked himself in his room and was uncooperative. 1st paramedic John tried talking to Gary
On Thursday 12/24/2015 at approximately 2307 hours. Security Officer Omar Alonso (420) was contacted by E.D. Charge Nurse Sharey Selover about an uncooperative intoxicated male patient, Jose D. Gonzalez (DOB: 03/30/1977; FIN# 85006354), come in through the EMS Offload area. Officers Alonso and Ayuso reported to the call and observed an intoxicated male being wheeled into the Special Care Unit (SCU) E.D. room # 39. According to his assigned Nurse Sara Lopez, the patient had been involved in a physical altercation and had been kicked hard in the groin area. Patient did not behave badly or disruptive once he saw that Security were present and his Nurse was able to get his vitals, blood work, and urine without having any issues. Security staff
On 10/14/2015 SO EMT Perez was dispatched to HS-406 to apply a bandage. SO EMT Perez knocked and anounced his presence at the door and was verbally invited in by the resident. The resident, a Mrs.Martha Doyle was sitting in her living room chair and was bleeding from the forehead. Mrs. Martha Doyle was washing her face when she attempted to remove a bandage over a previous wound and she wanted it re-bandaged as she stated. SO EMT Perez asked Mrs. Martha Doyle if she wished to go to hospital before he assesed her to which she denied. Mrs.Martha Doyle also denied any care besides the application of a new bandage. After assesing that Mrs. Martha Doyle was A&Ox3 SO EMT Perez applied a head bandage. While Applying the bandage Mrs. Martha Doyle stated
Upon arrival we made contact with Justin Pearce, walking with his girlfriend and his children at the end of the driveway near the Farm to Market Road. While speaking to Justin Pearce I detected the strong odor of an alcoholic beverage emitting from his breath and or person. Justin Pearce stated he and his sister Erica Hammer got into a physical argument and had assaulted one another. I observed Justin Pearce to have obvious signs of injury to his person, including a swollen knot on the left side of his upper
On the night of 5-26-17 at approximately 2145 security recieved a call from Casper Police Department dispatch asking for the ambulance bay door to be opened as Police were responding to a disturbance in the Emergency Department. Previous to this call security knew nothing of a disturbance. Security Officer Ubbes escorted Casper Police Officer who walked through the front entrance. Upon arrival Ubbes was informed by one of the ER nurses that the patient from bed 11 was extremely intoxicated, he was leaving his room wandering the ER without any clothes on and entering other patient rooms. Casper Police arrested the individual without further incident and left at approximately
The reporter said Susan (victim) is afraid to stay there with Charles, but he’s afraid for the Home Health people to come out to the home. 3 or 4 years ago, the victim fell out of the bed and broke her hip, and Charles was in the household with the victim at the time. The neighbors have called the police out to the home, and the police have been out to the home several times, but it is unknown why. The reporter said they came out to the home, due to abuse (unknown when). The reporter spoke to Charles about the concerns, but he acts as if he didn’t do anything wrong. Charles says that Susan has lost her mind. The reporter last saw the victim 2 ½ years ago and discussed the allegations with the alleged
Ms. Webster is a 28 year old female who presented to the ED via LEO under IVC by her mother for suicidal ideation and alcohol dependence. Ms. Webster denies allegations to nursing staff. Per documentation she appears intoxicated. Per documentation Ms. Webster states, "Going through withdrawals". Before assessment this clinician spoke with nursing staff about Ms. Webster, they reports she has been asking for Ativan since she has been placed in her room. They reports she informed them that she had not consumed any alcohol today. At the time of the assessment Ms. Webster is found sitting upright in her room. Ms. Webster reports she had a plan to hang herself. She states, " you know I have to say that to get into detox." Ms. Webster reports alcohol abuse as primary stressor contributing to her distress. She denies depressive symptoms. Ms. Webster states,
Saunders Niece, Rachelle, mother-n-law, and William were contacted for collateral information. Rachelle reports Mr. Saunders stated to her he put a gun into his mouth with suicidal ideation with a plan to end his life. She reports he informed her he was "going to blow his brains out" and "he might do something crazy". Rachelle reports he informed her of these thoughts the past 2 days. William reported Mr. Saunders told him he wanted to kill himself. He reports for the past 3 week he has notice Mr. Saunders has been coming to work under the influence and more depressed. The mother-n-law reports Mr. Saunders has been staying with her and he has informed her as well of putting a gun into his mouth and thoughts of hurting others. Mr. Saunders was confronted about these claims and states he can not recall states due to being under the influence. The mother-n-law informs this clinician Mr. Saunders does stay with her along with his 3 children and she has a gun in the home. She reports he has stated multiple plans to her. She reports he recently talked about putting a gun to his mouth in an attempt to hurt himself and overdosing on
Mr. Stevens is a 39 year old male who presented to the ED via LEO under IVC for alleged threatens towards others, recent delusions, and substance abuse issues. At the time of the assessment Mr. Stevens was calm and cooperative. He reports having a history of misuse of his medications. Mr. Stevens reports recently snoring prescribed medications and taking over the recommended amount. He states, "I have tripped out (referring to experiencing symptoms of psychosis) in the past taking my Adderall." Mr. Stevens reports for the past 6 months he has suspected his wife of having an affair with various people, however most recent his neighbor. Mr. Stevens reports he has stopped using his prescribed Adderall 4 months ago. He states, "Sometimes I would take em and get paranoid, my cousin put me on, and they would make me feel high." Mr. Stevens reports for the daily use of Adderall for the past 2 years. According to Mr. Stevens a Dr. Bill prescribed them to him after he told him he had a history of ADHD as a child. According to Mr. Steven for the
A claim for intentional inflection of emotional distress will be established when the plaintiff is able to prove that: 1) the defendant intended to inflicted emotional distress or knew or should have known emotional distress would likely result from his conduct; 2) the defendant's conduct was extreme and outrageous; 3) the defendant's actions were the cause of the plaintiff's distress; and, 4) the plaintiff suffered severe emotional distress. Agis v. Howard Johnson Co., 355 N.E.2d 315, 319 (Mass. 1976).
Let’s first define what psychology and applied psychology means and how it is applied. Psychology is the
The following essay is a case study of a client named John who is suffering from major depression and was sent to see me for treatment by his concerned wife. I will provide brief background information about John then further discuss interventions and strategies I believe can be applied in each session with my client in order to make John's life more manageable. In the essay, I will be writing as the therapist, and the sessions are based on a ten week period.
In this case study, one day of care for a 28 year old, male patient on a low secure psychiatric unit will be examined and discussed. The main focus will be on implementation and evaluation of the nursing process. These areas will be covered under; physiological, psycho-sociological and pharmacological aspects of the patient’s care. Although, the case study is discussed using third person expression, the care discussed is what was implemented and evaluated by myself, a second year student nurse, under supervision from a qualified member of staff.
Myself and my partner were called to a 46-year-old woman with deteriorating mental health issues, experiencing paranoid psychosis, increased violent outbursts, she was non-compliant with instructions, had a loss of appetite and had increased her alcohol consumption. The patient was located at her residence in Sippy Downs, Queensland. The residence was disordered with empty alcohol bottles, newspapers, and general mess throughout. The patient had covered all electrical devices with linen, the power points were covered with aluminium foil to prevent external sources from stealing her work and preventing her from breaking “The Code”. The patient meets us at the door and was very cautious about letting us in. My Partner and I were ushered to a small table with what appeared to be an alcoholic beverage, a notebook with compulsive repetitive behaviours written in it, “Some big mistakes”. The patient appearance was dishevelled and tired, the patient was wearing multiple glasses, an electrical device around her neck (protecting her from the external electrical intrusions) and a baseball cap. The patient was
REPORTER: The reporter/ Social Services Director (Vernestine) called with concerns for the victim, Tanya. Tanya has had an aneurism, and she has paralysis. The reporter said the victim’s cognition is off, and she cannot perform her daily ADL’s, but she can talk. The reporter said Tanya has two small children, but her mother (Phyllis) may be keeping the children. The alleged perpetrator is Bryan Blakemore (Husband). On Yesterday (03/29/2016), the victim was discharged AMA (on medical advice). The reporter said when the victim is discharged AMA, they are not given any medications. The victim left with out any medications, but Bryan was given a list of all the victim’s medication. Bryan said he was going to see a doctor in Jackson, MS to have
Jessica is a twenty-eight-year-old married female who works at a large hospital. She has high expectations for herself because she has graduated with honors at both college and medical school. For the past few weeks, she has been feeling tired and unhappy. She has had a demanding and high stressful job at a large hospital for two years. She feels that she is unable to perform well at her job and has trouble concentrating at work and at home. She is uninterested in her usual activities and has many negative thoughts that keep her awake at night. Two diagnoses that best fit this case study are Major Depressive Disorder and Generalized Anxiety Disorder.