MENTAL HEALTH CASE STUDY

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You are working the afternoon shift in an inpatient psychiatric unit. The patients are in the TV room watching a movie when suddenly someone starts yelling. You and other staff rush to the room to find L.L., a 48 year old male patient, crouched in the corner behind a chair, yelling at other patients: “Get down, quick, get down!” You and the other staff are able to calm L.L. and the other patients and take L.L. to his room. He apologizes for his outburst and explains to you that the movie brought back memories of the Gulf War. He had forgotten where he was and thought he was in combat again. He describes to you in detail the memory he had of being ambushed by the enemy and watching several of his comrades be killed. You remember hearing in report that L.L. is a Gulf War veteran admitted with Post Traumatic Stress Disorder. (PTSD)

1. What are common causes of PTSD, and what is the most likely cause of L.L’s condition? Discuss three criteria that must be present for a diagnosis of PTSD.

2. Discuss in detail, the difference between PTSD and acute stress disorder.

3. Which symptom(s) of PTSD did L.L. most likely experience?

4. What therapeutic measures can be done to help L.L. during your shift this afternoon? Give at least 4 measures.

While you are in L.L.’s room, he states that he would like to rest for a while, and he requests something to “calm his nerves.” You check his medication administration record and find the following prn medications listed:

PRN MEDICATIONS:
Acetaminophen: 650mg po every 4 hours as needed for pain scale of 4 to 6
Dulcolax suppository 1 pr daily prn for complaint of constipation
Lorazepam 1mg po every 6 hours prn for anxiety
Zolpidem 12.5 mg po at bedtime prn for insomnia

5. Which medication is most appropriate to give to L.L. ? Thoroughly explain your answer. Why? What classification is this medication? What is it’s mechanism of action to help with anxiety?

6. What are the adverse effects of long term use of benzodiazepine anxiolytics?

7. You notify L.L.’s psychiatrist about his reaction to the movie. She writes an order to start paroxetine daily. How does paroxetine differ from lorazepam?

Be thorough in your response and be sure to include the drug classification of paroxetine. Why is paroxetine used and not other drugs in this classification?

8. What are some potential side effects of paroxetine? BE SPECIFIC
L.L. asks you whether there are other things he can do, in addition to medications, to help his anxiety. He tells you that he has heard about relaxation therapy and wants to hear more about it.

9. What would you discuss with L.L. about relaxation therapy?

10. What other treatment modalities could L.L. be referred after his hospitalization to help treat his PTSD and related problems. Give at least three and briefly describe each one.

 

Sample Solution

ssures including; war, scandals, significant governmental decisions, etc. have shown to be significant factors in the making of social policy. A very current example of this in action would be the plan to ‘merge six benefits into one payment’ (Buchanan, 2018) of universal credit that has been further delayed. ‘The system was supposed to be up and running by April 2017 but is now not expected to be fully operational until December 2023’ (Buchanan, 2018). Following the recent public decision to exit the European Union in 2016, many social policy implementations have not been placed in positions of priority. This therefore demonstrates how external pressures can work as a factor of influencing the making of social policy as they have the power to delay the implementation, or in some cases, completely stop them being implemented at all; regardless of the potential repercussions.

The way that a social problem is framed, and how much support it receives, is often dependent on how the media reports it. If a social problem is framed as a fault of an individual it has a significantly reduced chance of being resolved, than those that are framed as the fault of society not looking after their peers. In the past the issue of poverty was generally targeted as a fault of the individual, with the idea that people were taking advantage of the benefits scheme that the government was offering and that being ‘poor’ is the fault of the individual. Although this stigma can still be seen, it is not as common as it used to be; especially with research being made in the last decade that has shown that ‘for 2011-12 it is estimated that 0.8%, or £1.2bn, of total benefit expenditure was overpaid as a result of fraud. This is far lower than the figures widely believed by the public, as revealed repeatedly in opinion polls’ (Reporter, 2013). This evidence not only disproved the common thought that a large number of the public on benefits do not actually need them, but also proved that the majority of those who are on benefits depend on them. Additional evidence has also shown that the cause of poverty is down to a number of factors including; ‘low wages, insecure jobs and unemployment, lack of skills, ineffective benefit system, high costs including housing, and family problems’ (Foundation, 2016), instead of the conservative idea that it is purely down to the individual being lazy. This common view, of course, is not helped by the way in which the media publishes these sorts of issues. In 2008, The Mail Online published an article in which they wrote ‘David Cameron has unveiled

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