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

plays a role in fostering hate crime towards disabled people. Tabloid newspapers, such as The Sun, often portray negative ideas and beliefs of those who are disabled. For example, one article was ‘Help us stop £1.5bn benefits scroungers’, giving the impression that people who claimed benefits were wasting the government’s financial support, creating this negative image of a handout culture for those who claim benefits (Sloan, 2010). It creates a sense of a moral panic of disabled individuals, making out that they are taking hard earned money from others because they are too lazy to find employment or take advantage of using an illness as an excuse, even though they are capable of work. The media will often report on disabled people with newsworthy stories, rather than actually focus on reporting on the truth, contributing towards the hate crime of disabled people. For example, they will not report on how disabled people are at high risk of crime, as this will not sell as well as reporting on how disabled people are robbing obdurate hard working people. It is almost as if a folk devil of disabled people is created through the media; we should fear those who are claiming benefits as it is portrayed as a negative thing in society. Likewise, people suffering with ‘invisible’ disabilities, such as depression, are often looked down upon as others do not see a physical disability and will just assume the wrong reasons as to why they are claiming benefits; there is still a stigma around mental illness which is not reported enough on throughout the media. Media coverage like this can lead to hate crimes and discrimination towards disabled people. For example, research suggests that there is a startling amount of discrimination targeting disabled people, which will impact their lives on a daily basis. Fifty-six percent of disabled individuals have reported they have experienced negative attitudes towards them because of their condition. Furthermore, fifty percent of disabled people state they have actually faced discrimination on a regular basis, and thirty-seven of these individuals strongly believe that attitudes and views towards them from others have changed in a more over negative way; ideas people hold about disabled people are getting worse (Scope, 2018).

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