Case Studies

Running head: CASE STUDIES 1
Case Studies
Case studies
Caring for a person with a mental illness - Christian
Question 1
For a start, Christian has chronic schizophrenia. Thus, he requires psychosocial, psychological,
and medical inputs. At the moment, these are not provided, and being a sole case manager I may
not be in a position to provide the three inputs because they require experts in the fields. Failure
to provide the three inputs poses a serious risk to him (Frankenburg, 2017). A further concern is
that Christian hardly ever stays in the room. Thus, administering his oral medication is always a
problem. This, coupled with the fact that his place of residence is extremely and perpetually
untidy, poses additional health concerns such as lung diseases, cardiovascular diseases, diabetes,
and obesity, which are very common to neglected schizophrenic patients (Pillinger, et al., 2017).
These are some of the risks that I have to deal with at the very start.
Question 2
The first thing to do as a manager in Christian’s case will be to acknowledge that management of
patients suffering from chronic schizophrenia requires familiarity with antipsychotic medications
(Millar, Sands, & Elsom, 2014). These include familiarity with physical healthcare, psychosocial
interventions, and side effect profiles. Due to Christian’s deteriorating health occasioned by poor
hygiene, poor eating habits, and indiscipline to his oral medication, I need to familiarize myself
with and address his physical health care. This includes monitoring his metabolic syndrome,
sexual health counselling, discussing with him to quit smoking, hyperprolactinaemia, and also
monitoring his movement behaviour since from the scenario it is clear that he doesn’t settle at his
place of residence (Leucht, Cipriani, & Spineli, 2013). Before thinking of any pharmacological
care to administer to Christian, it would serve him well if I administer some non-
pharmacological treatment to him. He has already shown signs of developing auditory
hallucinations and also negative symptoms of schizophrenia such as apathy, social isolation and
withdrawal, lethargy and poor self-care (Schweewe, Backx, & Takken, 2013). Therefore, I
would procure the services of a psychologist to administer sessions of Cognitive Behavioural
Therapy (CBT) to him.
Improving Christian’s hygiene is another thing that I would do before engaging him in
medication. This also includes procuring the services of an energetic young man to assist me in
keeping him in his house instead of leaving him to wander alone in the streets. Helping him settle
down is one of the most important initial steps to the psychotic care. It would also help in
administering pharmacological care to him once he settles down (Amir, et al., 2013). I would
also engage the services of a dietician to manage his eating habits with a view to improving his
health. Exercising is also a very important measure for Christian because of his danger of
developing diabetes.
Question 3
The UN Principles of 1991 regarding mental health care have greatly influenced most Mental
Health Acts in Australia and beyond (Hastrup, et al., 2013). Based on those principles, mental
health patients are supposed to be handled in a manner that respects their human dignity and
culture. Mental health patients are supposed to be treated within their community and with
respect to their right to privacy, recreation, education, and communication. Principle 9 of these
principles contains the omnibus provision of respecting the rights of mental health patients
(Brayley, Alston, & Rogers, 2015). Some of the principles that guide the assessment and
treatment of mental health patients in Australia include recovery-oriented practice, culturally-
informed practice, recognition of family and carers, and respect for human rights, careful
assessment of the patient to ensure that they understand the consequences of their decisions to be
treated (Freeman, et al., 2015).
Based on the above principles, Christian has a right to have an assessment of the highest quality
and a mental care that respects his human rights. These are the principles that will guide me in
the process of managing his case.
Question 4
For a start, Christian requires pharmacotherapy. He requires antipsychotic medication to address
the exacerbated schizophrenic symptoms that are coming up. The Olanzapine drug that he is
currently taking is not adequate in itself. He requires such other drugs as Ziprasidone,
Amisulpride, Aripiprazole, Paliperidone, and Clozapine, to name a few. He also requires depot
antipsychotics such as Haloperidol, Paliperidone palmitate, and Fluphenazine, to name a few. In
addition to the pharmacological treatment prescribed here, Christian also requires non-
pharmacological treatment such as Cognitive Behavioural Theraphy (CBT), checking of his
smoking status, weight monitoring, especially now that he hardly eats well, monitoring of his
blood pressure, monitoring of his cholesterol, lipids, and blood sugars, neurological examination,
eye examination, and liver function tests. One other important care is to monitor his diet and also
to initiate exercise sessions to ensure that he fights chances of developing diabetes or obesity.
This can be done by the case manager with assistance from the case management team that will
be selected within the first few days after taking over the case management. Most importantly,
the case manager will come up with a plan to tame him so that he stops wandering everywhere
listening to stereo and watching TV as these can be adverse to his hearing senses.
Question 5
Many ethical and clinical dilemmas emerge when dealing with chronic schizophrenic patients.
First, case managers find themselves having to tell half-truths to their schizophrenic patients so
that they don’t run the risk of losing them for good. Oftentimes the case manager has to withhold
the truth about the health of their patients so that they keep them under watch and medication
(Noordsy, 2016). This may compromise their ethical values. Secondly, the case manager must
sometimes put up with the urge of supporting risky ambitions of the schizophrenic patient to
keep them under watch and also to keep them under medication. For example, Christian may
start considering advancing his education even before fully recovering (Kane, Robinson, &
Schooler, 2015). As his case manager, I should support this ambition because it is meant to
improve the quality of his life, even though it will make him sacrifice a lot at the expense of his
life. In addition to this, sometimes a case manager finds themselves in a position of having to ask
their schizophrenic patients about their wishes regarding their medication (Roberts & Kim,
2015). Whereas this enables their patients to make decisions regarding their health, the decisions
the patients make may not be healthy because of their health condition. They are, however,
decisions that must be made after all. Finally, there are grave ethical and clinical repercussions
when a psychiatrist has to make a decision relating to the life of the patient. Although these
decisions are hard to make, they have to be made after all. The case manager must, however,
make sure that the decisions they make are the best at that particular time and given the
circumstances (Sekar, Bialas, & de Rivera, 2016).
Question 6
As the new case manager, I should be mindful of my own health and welfare, even as I manage
Christian’s case. This way, I will manage this case alongside other specialists like a physical
therapist, psychologist, and medical specialist, among others (Mueser, Deavers, & DL, 2013).
This will provide me with an opportunity to pursue my welfare and career and at the same time
manage Christian’s case. Another reason for managing the case as a group is that Christian’s
health has deteriorated a lot. He is also bordering on having a serious mental condition that could
prove unmanageable if it is not addressed early enough. This, coupled with the fact that he is
becoming verbally and physically abusive to his managers makes a case for a shared
management of the case.
Question 1
Tiffany’s mother was only 16 years old when she gave birth to her. The mother even developed
postnatal depression following the birth. She was born with a low birth weight of 2200 gms., at
35/40 gestation and nursed in intensive care for the first few days due to respiratory distress
syndrome. These are clear risk factors that might have precipitated the development of a mental
health issue. Additionally, Tiffany doesn’t know her father. Her biological father moved away
from his relationship with her mother in her infancy (Kane, Robinson, & Schooler, 2015). This,
coupled with the fact that her subsequent step-fathers have had a history of domestic violence
with her mother and in the process harming her, might have fuelled her chances of developing a
mental health concern. She is prone to developing a Post-Traumatic Stress Disorder as a result of
seeing her mother being harassed by the step-fathers that she has been relating with. The decision
by her step-father to advise her to start dieting on the basis that she was becoming “beefy”
further fuelled her chances of developing a mental health condition (Millar, Sands, & Elsom,
2014). The diet she is undergoing has not been prescribed by a nutritionist and she is, therefore,
denying her body very valuable nutrients. As a result, she has lost self-esteem and confidence in
her body and sees herself as worthless. These, among others, are the key risk factors that have
led to Tiffany developing a mental health disease.
Question 2
Resilience is the ability of a patient suffering from a psychological condition to adapt well to the
said condition. The condition could be a mental disease, trauma, stress, or depression. Tiffany is
suffering from a psychological condition from which she requires resilience. There are certain
protective factors that can facilitate her desire to develop resilience at the midst of the trauma
mental condition that she is undergoing (Leucht, Cipriani, & Spineli, 2013). For a start, she is a
high performer at school and has a group of close friends with whom they engage in co-
curricular and social activities with happiness. This social group and her willingness to
participate in social and co-curricular activities will drive away the mental disease. Secondly, she
is in a religious affiliation and attends church service regularly. She is also a member of the
youth group (Frankenburg, 2017). Such social grouping and membership to a religious group is a
protective factor that can easily drive away any chances of her developing the mental disease. In
addition to this, her teachers have noted her sudden change in behaviour and weight and have
taken an early step to talk to her. In particular, her guidance officer is seized of the matter and is
handling it with all the importance and attention that it disserves. The decision by the guidance
officer to take over the role to address Tiffany’s problems comes at a very critical time and may
act as the solely important step in warding off any risks of her developing the mental disease
(Mueser, Deavers, & DL, 2013).
Question 3
Tiffany is suffering from Anorexia Nervosa, a mental health condition whereby a person keeps
their body weight as low as possible. The anorexic patient usually restricts the amount of food
they eat, as a result of an anxiety regarding their body shape (Amir, et al., 2013). People with
anorexia have a habit of concealing their condition from their family members and friends. This
is exactly what Tiffany is doing. She is wearing oversize clothes to conceal her condition and is
eating a meal a day so that she becomes thinner. She is also very busy at the gym, is underweight
at 43Kg, proceeds to purge after eating the evening meal so that she doesn’t gain weight, and
also uses laxatives such as diet pills and aperients to reduce her weight. She has sleep
disturbances and also has fainted a couple of times after waking up from sleep (Walker, 2014).
All these are symptomatic of Anorexia Nervosa, the medical health condition she is suffering
Question 5
A clinician requires certain skills to develop a therapeutic relationship with a mental health
patient. The very obvious one is that the clinician must have undergone the requisite training for
them to develop a lasting therapeutic relationship with their patients. This includes having
completed training as a clinician and acquired the requisite qualifications (Kane, Robinson, &
Schooler, 2015). Secondly, establishing a therapeutic relationship is a reflective skill. The
clinician must reflect on such issues as self-awareness, empathy, self-knowledge, and knowing
the boundaries of the professional role. Thirdly, the clinician must understand which level of the
relationship they are with the patient to understand the degree of therapeutic relationship they are
supposed to exercise. Further, the relationship must be consistent and not a one-off. Such skills
are very important for a clinician dealing with a mental health patient (Walker, 2014).
Based on her comments at the regional hospital, Daphne poses a serious suicidal threat to herself.
The level of suicide threat is very high because she doesn’t see anything to live for. As a
clinician dealing with Daphne’s case, I would take very serious the case of someone who doesn’t
see anything to live for and only asks those whom she is dealing with to “just let her die.”
Further, she sees no value left in her life after the death of her husband with whom they were
very close and who had been taking care of her medication. Thus, based on the data available in
the case study notes, I would place the case at a very high level of suicide risk so that I give it the
attention that it disserves. She is even not in a position to make decision regarding her own
health and mental condition. She is fatigued, worn out, and teary. Her depressive symptoms have
persisted even after being placed under medication and her treating team has diagnosed her with
Major Depressive Disorder. This kind of data is reminiscent of a person who is tired of life and
sees nothing to live for, especially after losing her husband with whom they had lived happily for
years. It is a very high risk suicide case and I would treat it as such.
Question 2
As a clinician dealing with a patient with a mental disorder, I am bound by the provisions of the
DSM manual on mental disorders. Thus, if I am in doubt as to Daphne’s diagnosis with a Major
Depressive Disorder, the first thing to do is to open the Manual and ascertain that the diagnosis
was correct. Axis IV of the Manual lists Major Depressive Disorder as one of the mental
disorders under that category and it results from, among other causes, important events in e
person’s life, including the death of a loved one (Heffner, 2017). Marriage is also listed as one of
the causes of the disorder. Looking closely at Daphne’s case, the biggest cause of her disorder is
the death of her husband with whom they had lived happily for years. Therefore, it is highly
likely that his death and that fact that she did not have anyone else to finance her medication and
give her the warm company she dearly needed perpetuated the development of the disorder. The
feelings arising from the loss of a loved one may be short-lived. However, when such feelings
become persistent, this is the time that the person develops MDD with the symptoms that
Daphne shows as narrated in the case study notes. The main clinical symptoms of the disorder
are a persistent lack of interest in whatever someone is doing, a feeling of sadness and irritability
with the events of the day, loss of weight, lack of sleep, restlessness, and, above all, a high level
of suicide risk (Kerr, 2017). Daphne has shown all these symptoms and was, therefore, correctly
diagnosed with Major Depressive Disorder.
Question 3
Electroconvulsive therapy is sometimes referred to as “electroshock therapy” and it is carried out
under general anaesthesia. It is administered to people having highly severe and psychotic
suicidal depression like the one that Daphne is suffering from. It is very ideal for high-risk
suicide patients like Daphne and works very well within a short time. However, it is true that
ECT is associated with the side effects of memory loss as Daphne notes. The medication is
supposed to be given with the consent of the patient on whom it is being administered and, just
as is the case with most other types of medication, it should not be forced into someone who
doesn’t want it. However, in England and Wales, the medication can be administered under the
Mental Health Act if two medical doctors, another professional, and another independent
specialist not directly involved with the case determine that it is important for the welfare of the
patient. However, the specialists must also seek the consent of the family members of the patient.
In the case of Daphne, this consent has not yet been sought. Thus, I would take the extra step to
consult other medical specialists, an independent practitioner not directly involved with her case,
and also her immediate family members to determine the possibility of still administering the
Question 4
It is well documented that sleep disturbances in depressed persons are hardly cured through
medical treatment (Emery, Wilson, & Kowal, 2014). Whereas some clinicians still apply
medication to depressed patients having insomnia, there is evidence to show that Cognitive
behavioural Therapy (CBT), when done well, increases the chances of the depressed patient
developing more consistent sleep patterns. Research has shown that an inability to sleep and also
oversleeping are some of the key symptoms of depression. Some clinicians use psychotherapy
comprising counselling and therapy to address sleep disturbance in depressed patients (Emery,
Wilson, & Kowal, 2014). Sometimes antidepressants are used to decrease sadness and
hopelessness to stimulate sleep. As a clinician, I would recommend administer a combination of
antidepressants, psychotherapy, and CBT.
Question 5
I would make use of a combination of behavioural and cognitive therapy on Daphne, noting that
her condition is getting complicated by the day. In behavioural therapy, such approaches as
classical conditioning, desensitizing, operant conditioning, and cognitive behavioural therapy can
be used well to make her feel better, especially with her disturbed sleep patterns (Emery, Wilson,
& Kowal, 2014). In cognitive therapy, I would work on Daphne’s thoughts about suicide to see
to it that she doesn’t contemplate suicide any longer.
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Walker, S. (2014). Engagement and Therapeutic Communication in Mental Health Nursing.

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