CASE STUDY 3

Scenario B – Perinatal Care

Breeze is a 34-year-old woman with a diagnosis of bipolar affective disorder. She is reported to have had a manic episode when she was a college student but has only ever been hospitalised for depressive episodes. She has type II diabetes. Her diabetes control was poor when she was a young adult but since entering her 30s she has been more careful with her blood sugar monitoring and insulin regime. She has been prescribed carbamazepine 600mg BD for some years, having previously been prescribed lithium and fluoxetine. She works in retail. She smokes cigarettes (~ 10 per day), drinks most nights of the week (4-6 standard drinks). Her weight is 73kg and her height is 168cm. She has been in a stable and supportive relationship with a man for several years with whom she would like to have a baby. She is contemplating having her Implanon removed.

Scenario C – Possible Eating Disorder

Cat is a 21 year old woman who is superficially known to mental health and emergency services for self-harm and suicide attempts. She has attracted a diagnosis of borderline personality disorder. She has had the experience of childhood sexual abuse and in her midteens started self-injuring in response to interpersonal stress. She is estranged from her family. She has been living in a share house with other young people and over the last 6 months has been smoking methamphetamine most weekends. During these occasions she will stay up all night and frequently engages in casual, unprotected sex. She states that she is not worried about pregnancy because she has not had her period for over a year. She states that she used to be fat (around 60kg ~ last year). Her current weight is 43kg (height 159cm). She states that she doesn’t think about food when she is high and about midweek she sometimes becomes ravenous and binges on McDonalds. She then feels guilty and induces vomiting. She often feels quite dizzy when she stands up and she feels her heart bounding in her chest. Her flatmates are worried about her as she has fainted on a couple of occasions.

Scenario D – Depression

Dion is a 55 year old man. His life has not gone to plan. He has spent most of his life working laying concrete. He had a reasonably successful concreting business. He employed a couple of labourers and his wife Joan of twenty years managed the office and kept the books. He was quite physically active for most of his life – Playing footy as a young adult and going fishing on weekends. His last few years of work were tough as he acquired a lower back injury which confined him to the office. Always a drinker at the end of the day, he began starting the day with a beer and would consume a cartoon of beer before “knock off” time. He visited his GP who prescribed him Zoloft 150mg mane. He does not feel any better and no longer goes fishing. A construction downturn and poor management meant he has recently had to close his business and he has sold it for less than he believes it is worth. Dion has reduced his alcohol intake somewhat at Joan’s request as she thinks it is affecting his sexual performance. Dion can’t seem to get an erection at all. Joan says that she has had enough of him moping about the house. She has decided to take “time out” from the relationship and stay with her sister in another town until Dion sorts himself out. Dion is quite depressed and spends most of his day at the pub playing pokies. Since Joan has left two weeks ago he has not had a home cooked meal. His GP says that his liver function tests are a problem (with elevated AST & ALT), his triglycerides are up, he has hypertension and has advised that he needs to stop smoking (20 per day) immediately. Dion doesn’t know where to start or what to do.