Running head: SUICIDE CASE STUDY
Suicide Case Study
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Case Study: Introduction
The patient is a 35-year-old Hispanic male who has a long history of mental illness. Mr. C was
admitted to the inpatient psychiatric facility after an attempted sever suicide. He reveals that he
has been depressed for the last three months and has had progressive suicidal thoughts. The
patient has been having increased suicidal thoughts the past one week, and complains of fatigue,
lack of concentration, feelings of hopelessness. Mr. C's critical financial situation is a major
stressor. The patient has also resorted to gambling, alcoholism, and several suicide attempts. Mr.
C has abused cocaine and alcohol since the age of 14 and has been rehabilitated several times but
always relapsed Sheryl afterward. Mr. C has also involved in illegal and other activities such as
robbery, violence, etc.
Differentials
The differential diagnosis of bipolar disorder includes several conditions that may exhibit manic
symptoms such as organic mood disorders, drug and substance intoxications, as well as tumors.
Any manic simooms occurring in the context of substance abuse are referred to as secondary
mania.
Diagnostic formulation
The diagnosis for this patient's symptoms is Bipolar II (Bipolar Depression). The DSM-5
classifies a hypomania episode as the presence of one or several major depressive episodes as
well as at least one hypomania episode.
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Screening/Assessment
One of the effective screening/assessment tools for bipolar II is the Mood Disorder
Questionnaire (MDQ). Essentially, MDQ was developed to address the vital need for accurate,
timely, and reliable diagnosis of bipolar disorder. In this particular case study, Mr. C must
complete the MDQ and provide more deep insights into the diagnosis. The second assessment
tool is a Clinical Interview for DSM-IV (SCID). Essentially, this is a semi-structured interview
that employs reliable psychiatric diagnoses in accordance with DSM-IV). In this case, SCID-5
will be used to determine DSM-IV Axis I diagnoses. The other assessment tool that could be
used is Schedule for Affective Disorders and Schizophrenia (SADS). This is a collection of
various psychiatric diagnostic criteria as well as symptom rating scales that are organized as a
semi-structured diagnostic interview. These three tools are effective in the assessment and
diagnosis of Mr. C's symptoms.
Etiology
According to Mayo Clinic (2019), there is no well-known cause of Bipolar II Disorder, but
research has established several risk factors for the decoder. These include: coming from a
family with Bipolar Disorder, severe stress, and substance abuse. Essentially, an individual with
bipolar disorder seems to have physical changes in his or her brain. Mayo Clinic states that
"bipolar disorder is more common in people who have a first-degree relative, such as a sibling or
parent, with the condition. Researchers are trying to find genes that may be involved in causing
bipolar disorder."
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Epidemiology
According to the Depression and Bipolar Support Alliance (2020), Bipolar II disorder affects
about 5.7 million individuals in America, which accounts for approximately 2.6 percent of the
population. Also, the median age of the disorder's onset us 25 years, although it can start earlier
or as late as the '40s and 50s. The Depression and Bipolar Support Alliance also reveal that "an
equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic
groups and social classes." About 51% of individuals with bipolar 11 disorder are untreated, and
suicide is the leading cause of premature death among individuals with bipolar disorder. About
15-17 of individuals with bipolar II disorder take their own lives (The Depression and Bipolar
Support Alliance, 2020).
Medical Concerns
If left untreated, this disorder could potentially result in dire problems that may affect the
individual's areas of life. For instance, it could result in drug and substance abuse, suicidal
behavior, legal and financial difficulties, broken relationships, as well as poor performance in
school and work. Also, there are several interventions that could be employed in the treatment of
Mr. C's bipolar symptoms. These include medications, continued treatment, day treatment
programs, substance abuse treatment, and hospitalization. However, the primary treatment for
this disorder basically includes medications and psychotherapy. Some of the groups of
medications that could be used in treating Mr. C's bipolar symptoms include mood stabilizers,
antipsychotics, and antidepressants, antidepressant-antipsychotic, and anti-anxiety medications.
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Therapeutic Interventions
Given the severity of Mr. C's bipolar symptoms, the most appropriate therapeutic intervention is
inpatient. The rationale for choosing inpatient is to ensure close monitoring of the patient and,
more importantly, protect him from continued harming of self and suicide attempts. There are
several psychotherapeutic and psychopharmacologic interventions that could be employed to
help treat Mr. C's bipolar symptoms. The first notable intervention is Interpersonal and social
rhythm therapy (IPSRT). Essentially, IPSRT primarily focuses on the stabilization of the
patient's day-to-day rhythm s, including sleeping patterns, mealtimes, as well as waking. For Mr.
C, a consistent IPSRT routine will enable better mood management and development of daily
routines for important activities such as sleeping, diet, and exercise. The second type of
psychotherapy that may be considered is Cognitive behavioral therapy (CBT). This intervention
majorly focusses on identifying the unhealthy, harmful, and negative beliefs and replacing them
with healthier and more positive ones (Roberts et al. 2014). For this patient, CBT will be used
to identify the potential triggers for his bipolar episodes in order to allow for effective treatment.
For instance, CBT will allow the health care provider to identify how substance abuse and
difficult financial situations could be triggering Mr. C's bipolar episode. Teaching the patient
effective stress management strategies will go a long way in preventing extreme symptoms such
as self-harm and suicidal behavior. The other psychotherapy interventions include
psychoeducation, family-focused therapy.
On the other hand, there are several psychopharmacologic interventions that may be used to
manage and treat bipolar II symptoms. The first category of medication is mood stabilizers.
These are medications used in controlling manic or hypomanic episodes. Some of the effective
mood stabilizers that may be considered include lithium (Lithobid), lamotrigine (Lamictal),
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valproic acid (Depakene), and divalproex sodium (Depakote) among others. The second
category of medications is Antipsychotics. Essentially, antipsychotics are used to manage and
relieve persistent manic episodes and psychotic symptoms such as hallucinations, self-injury,
suicidal thoughts, among others. Examples of antipsychotics include olanzapine (Zyprexa),
asenapine (Saphris), quetiapine (Seroquel), aripiprazole (Abilify), and lurasidone (Latuda).
Noteworthy, the doctor may prescribe any of these medications alone or along with mood
stabilizers depending on the needs of the patient. The other types of medications include
antidepressants, such as anti-anxiety medications. It is also important to note that each of these
medications has potential side effects and contraindications hence the need for close monitoring
of the patient.
Patient Interview
When interviewing this particular patient, the doctor should first take into account respect for
patient privacy and listening. The care provider should respect the patient's right to privacy by
observing all the established rules and regulations. Secondly, the care provider should build
rapport with the patient. Good rapport helps to create a close and harmonious relationship
between the patient and the care prodder. It enables the doctor to understand the patient's feelings
and communicate effectively with them. Essentially, rapport connects the care provider with
patients and can significantly improve patient care (Fountoulakis et al. 2017). The second
important consideration is respect for patient's privacy and autonomy. The care provider should
avoid touchy questions that may possibly erode the patient's trust. For instance, when
questioning the patient about his substance abuse problem, it is important to consider the
environment and the patient. The other important factor to consider is the type of questions. The
care provider should ask open-ended questions each one at a time. It is also important to avoid
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using medical terminologies that may confuse and hamper communication with the patient. The
patient's cultural background should also be taken into account.
Countertransference issues
Hearing the patient's harrowing experience and near-death experiences could potentially make
the care provider lose objectivity and become overwhelmed when listening to the client's story.
For instance, listening to Mr. C's struggle with bipolar symptoms, substance abuse, and other
experiences, such as losing huge amounts of money through gambling, could easily overwhelm
the doctor. There are several ways to manage and overcome countertransference. These include
devaluing the "at the moment" techniques, increasing awareness of countertransference, Self-
awareness and mindfulness.
According to Medscape (, 2018ipolardisorder has significant morbidity as well as mortality rates.
For instance, about 25-50 percent of Americans with bipolar disorder attempt suicide, with 11
percent of them being successful. "Within the first two years after the initial episode, 40-50% of
these patients experience another manic attack—only 50-60% of patients with BPI who are on
lithium gain control of their symptoms. In 7% of these patients, symptoms do not recur, 45% of
patients experience more episodes, and 40% go on to have a persistent disorder" (Soreff, 2019).
Essentially, there are several factors that may suggest a worse prognosis of the patient's bipolar
disorder. These include substance abuse, psychotic features, male sex, depression, and manic
episodes.
Patient risk assessment
The patient is currently at a significant risk of suicidal behavior, self-harm, poor self-care, and
homicide. Given his extreme symptoms, such as attempted suicide, Mr. C should be kept under
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close monitoring during the treatment. He also poses a risk to other individuals around him hence
the need for inpatient care. According to Medscape (2019), due to these dramatic mood shifts,
individuals with bipolar disorder are at greater risk for suicide and homicide, incarceration, and
violent acts.
As a resource for nursing staff, what factors would you keep in mind when consulting with
them around the care of this patient?
One of the important factors that should be taken into is patient history. This includes details
such as the number of episodes, types, and severity of episodes, comorbidity, past treatment, and
family history. Such information is vital because it helps the care provider to monitor the
treatment progress and outcomes. It is also important to take into account the patient's lifestyle,
employment, as well as a social support network. The care provider should closely monitor the
numerous stressors that may be impacting the patient's treatment and recovery. The care provider
should also work in partnership with other professionals such as psychiatrists, doctors, therapists,
and family.
References
Depression and Bipolar Support Alliance (2019). Bipolar Disorder Statistics. Retrieved from
https://www.dbsalliance.org/education/bipolar-disorder/bipolar-disorder-statistics/
Fountoulakis, K. N., Grunze, H., Vieta, E., Young, A., Yatham, L., Blier, P., ... & Moeller, H. J.
(2017). The International College of Neuro-Psychopharmacology (CINP) treatment
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guidelines for Bipolar disorder in adults (CINP-BD-2017), part 3: the clinical guidelines.
International Journal of Neuropsychopharmacology, 20(2), 180-195.
Mayo Clinic (2019). Bipolar disorder. Retrieved from https://www.mayoclinic.org/diseases-
conditions/bipolar-disorder/symptoms-causes/syc-20355955
Roberts, S. M. M., Sylvia, L. G., & Reilly-Harrington, N. A. (2014). The Bipolar II Disorder
Workbook: Managing Recurring Depression, Hypomania, and Anxiety. Oakland: New
Harbinger Publications.
Soreff, S. (2019). What are the indications for inpatient treatment in bipolar affective disorder
(manic-depressive illness)?. Medscape. Retrieved from
https://www.medscape.com/answers/286342-101607/what-are-the-indications-for-
inpatient-treatment-in-bipolar-affective-disorder-manic-depressive-illness
