NU665 Regis College Suicide Case Study Discussion

Suicide Case Study Assignment

Case History

Mr. C is a 35-year-old Hispanic male with a long-standing history of mental illness. He

was admitted to an inpatient psychiatric facility following a severe suicide attempt. He

stated that he had been feeling progressively more depressed during the past three

months and had been having an increase in suicidal thoughts over the past week. He

felt tired most of the time and had problems concentrating. He felt hopeless about his

life, found his job and personal life unfulfilling, and worried a lot about his critical

financial situation. He was unable to think about reasons to continue living even though

he has an extensive family living close by and several children from other partners. A

few days prior to his admission, he went to a local casino for the first time in a few years

and lost a significant amount of money. He then went back home, drank eight beers,

and slit his wrists. He was found by a friend who stopped by the patient’s house to ask

him to pay back some money he’d loaned the patient.

The patient was brought to the hospital by ambulance, was medically stabilized, and

was sent to the psychiatric unit. He reported passive suicidal ideation but felt safe in the

hospital. Denied any homicidal ideation, thought, or plan, as well as any psychotic

symptoms. Denied recent use of illicit drugs but admitted to having weed once every six

months and drinking two beers and a couple shots of whiskey per day on a regular

basis. Denied any past history of withdrawal symptoms.

Psych Hx: Some elementary school problems with bullying and resulting encounters

with school counselor. Also showed increasing problems with lying and stealing as a

youngster. Recommended mental health counseling, but parents never followed up.

One previous suicide attempt at age 27 resulting in three-day hospital stay.

Intermittently compliant with outpatient treatment. Stopped taking escitalopram 20mg

several months ago because of sexual side effects.

Substances: Extensive abuse of cocaine since age 16. Drinking since age 14-15,

mostly beer and whiskey. Has tried rehab several times but relapses shortly afterwards.

No history of withdrawal. Currently doesn’t see his alcohol use as a problem and denies

using any cocaine for the past two years, saying “it costs too much.”

Legal: Two DUIs. Served six months for robbing a convenience store. Frequent

arguments and fights which have necessitated police involvement but no arrests.

Denies significant problems with gambling except for most recent event, during which

he lost a lot of money.

Family Psych Hx: Mother diagnosed with bipolar and somatization disorder; father has

history of alcoholism.

Social Hx: Third of four boys. Parents divorced when he was 5 years old. Inconsistent

contact with father after that. Remembers father as drunk and physically abusive much

of the time. Some trouble in school; kicked out after cheating incident. Never returned

and only finished 11th grade. Never married, but many relationships, often short-lived,

with three children that he knows of. Little contact with any of them. Works as truck

driver. Has moved to several different places, often as a result of “trouble with paying

back debts.”

Medical Hx: Overweight, denies any medical issues. ED visit following accidental

overdose of cocaine. Thought he was having an MI.

Labs

• Total Cholesterol: 220

• Triglycerides: 172

• SGOT (AST): 48

• SGPT (ALT): 36

• HGB: 16.5gm/dl

• HCT: 45%

• Na: 134

• K: 3.2

• Free T4: 1.1

• TSH: 3.2

During his hospital stay, the patient presented as rather calm and charming with other

patients. Always agreeable but gave little history about himself. Would not participate in

divulging personal details of his life or talk about ways in which he might change in

order to live a happier life. Seemed to always redirect the conversation to irrelevant

subjects unrelated to his treatment. Mood and affect improved significantly over the

course of his stay.

Assignment Instructions

Based on the case history, answer the following questions. Use APA format with a

minimum of three evidence-based journal articles to support your answers and

reference accordingly. Your analysis of this case should be in depth and demonstrate

advanced understanding of the psychodynamic, psychobiological, and psychosocial

factors relevant in this case. Format your paper so that it is clearly noted which

questions are being addressed. Per APA, please use headings.

1. What is your diagnostic formulation? How does the diagnosis(es) meet DSM criteria?

2. What are your rule-outs (differentials)?

3. What screening/assessment tools would you use (if any) and why?

4. Discuss the etiology of your major psychiatric diagnosis(es) and the psychological

underpinnings.

5. Discuss the epidemiology associated with your diagnostic formulation.

6. Discuss medical concerns (if any) and suggested interventions.

7. What would be your therapeutic interventions while the patient is in the hospital?

Outpatient? Include both psychotherapeutic and psychopharmacologic interventions. Be

specific and evidence based when determining your treatment strategies.

8. Discuss key points that might be considered when interviewing this patient considering

his diagnosis(es).

9. What should you keep in mind about counter-transference issues that might come up

with this type of client? How would you manage your feelings and minimize impact on

the therapeutic process?

10. Give the prognostic factors associated with your diagnostic formulation.

11. Discuss the risk assessment for this gentleman.

12. As a resource for nursing staff, what factors would you keep in mind when consulting

with them around the care of this patient?

I forgot to add, APA format 5-10 pages with sources cited and references added. At least 3 references, 2 within past 5 years.