Running head: SUICIDE CASE STUDY
Suicide Case Study
Author's Name
Institutional Affiliation
SUICIDE CASE STUDY
Suicide Case Study
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.
SUICIDE CASE STUDY
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).
SUICIDE CASE STUDY
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?
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.
Diagnostic Formulation:
Mr. C presents with a complex array of symptoms indicative of multiple mental health disorders,
contributing psychodynamic factors, substance abuse issues, and significant psychosocial
stressors. Based on the provided case history, the following diagnostic formulation is proposed:
Major Depressive Disorder (MDD), Severe, with Psychotic Features (F32.3): Mr. C exhibits
symptoms consistent with a major depressive episode, including pervasive sadness,
SUICIDE CASE STUDY
hopelessness, fatigue, difficulty concentrating, and passive suicidal ideation. The severity of his
symptoms is severe, as evidenced by the recent suicide attempt and impaired functioning. The
psychotic features are suggested by his suicidal behavior and impaired reality testing during the
episode.
Substance Use Disorder (SUD), Cocaine and Alcohol, Severe (F14.10, F10.20): Mr. C has a
long-standing history of substance abuse, particularly cocaine and alcohol. His extensive abuse
of cocaine since adolescence, multiple failed attempts at rehabilitation, and ongoing daily alcohol
consumption despite consequences all meet criteria for severe substance use disorders.
Intermittent Explosive Disorder (IED) (F63.81): Mr. C's history of frequent arguments, fights,
and involvement with law enforcement suggests difficulties with impulse control and anger
management. This pattern aligns with the diagnosis of intermittent explosive disorder,
contributing to his overall psychosocial dysfunction.
Borderline Personality Disorder (BPD) Traits (F60.30): While not meeting full criteria for BPD,
Mr. C demonstrates several traits associated with the disorder, such as impulsivity (evidenced by
substance abuse and criminal behavior), unstable relationships, and emotional dysregulation.
These traits likely stem from his tumultuous upbringing and unresolved childhood trauma.
DSM Criteria:
Major Depressive Disorder: Mr. C meets DSM-5 criteria for MDD, evidenced by the presence of
five or more symptoms during the same two-week period, including depressed mood, diminished
interest or pleasure, significant weight loss or gain, insomnia or hypersomnia, psychomotor
agitation or retardation, fatigue, feelings of worthlessness or excessive guilt, diminished ability
to think or concentrate, and recurrent thoughts of death or suicidal ideation.
SUICIDE CASE STUDY
Substance Use Disorder: Mr. C meets DSM-5 criteria for substance use disorder, as evidenced by
a pattern of substance use leading to clinically significant impairment or distress, manifested by
failure to fulfill major role obligations, recurrent substance use in situations where it is physically
hazardous, continued use despite social or interpersonal problems, tolerance, and withdrawal
symptoms.
Intermittent Explosive Disorder: Mr. C meets DSM-5 criteria for intermittent explosive disorder,
characterized by recurrent behavioral outbursts representing a failure to control aggressive
impulses, resulting in serious assaults or destruction of property.
Borderline Personality Disorder Traits: Mr. C exhibits several traits associated with borderline
personality disorder, such as frantic efforts to avoid abandonment, unstable and intense
interpersonal relationships, impulsivity in at least two areas that are potentially self-damaging,
affective instability, chronic feelings of emptiness, and inappropriate, intense anger or difficulty
controlling anger.
This diagnostic formulation comprehensively captures Mr. C's presenting symptoms, addressing
the interplay between his mental health disorders, substance abuse, and psychosocial stressors. It
provides a framework for understanding his current difficulties and guiding appropriate
treatment interventions.
Psychodynamic Factors:
Mr. C's psychodynamic formulation suggests underlying unresolved conflicts and developmental
issues contributing to his mental health difficulties:
Early Childhood Trauma: Mr. C's childhood was marked by parental divorce, inconsistent
contact with his father, and exposure to paternal alcoholism and abuse. These early experiences
SUICIDE CASE STUDY
likely contributed to his feelings of abandonment, low self-worth, and difficulties in forming
stable relationships.
Attachment Disruptions: The lack of consistent parental figures and exposure to parental
substance abuse may have disrupted Mr. C's ability to form secure attachments and regulate his
emotions effectively. This could manifest in his unstable relationships, impulsivity, and
emotional dysregulation.
Defense Mechanisms: Mr. C's use of avoidance and redirection during therapy sessions may
reflect underlying defense mechanisms such as repression or denial, which serve to protect him
from confronting painful emotions or conflicts. Exploring and addressing these defense
mechanisms is essential for facilitating therapeutic progress.
Psychobiological Factors:
Neurobiological Vulnerability: Mr. C's family history of mental illness (mother diagnosed with
bipolar disorder) and substance abuse (father with alcoholism) suggests a genetic predisposition
to psychiatric disorders. Neurobiological factors, including neurotransmitter dysregulation and
alterations in brain structure and function, likely contribute to his vulnerability to depression,
substance abuse, and impulsive behaviors.
Dual Diagnosis of Depression and Substance Use Disorder: The comorbidity between MDD and
SUD in Mr. C highlights the bidirectional relationship between mental health and substance
abuse. Chronic substance abuse can exacerbate depressive symptoms through neurobiological
mechanisms, while depression may increase vulnerability to substance use as a maladaptive
coping mechanism.
Psychosocial Factors:
SUICIDE CASE STUDY
Financial Stressors: Mr. C's financial difficulties, including job dissatisfaction, significant debt,
and recent loss of money at the casino, contribute to his sense of hopelessness and exacerbate his
depressive symptoms. Financial stressors may also act as triggers for impulsive behaviors, such
as substance use or reckless spending.
Interpersonal Conflict and Trauma: Mr. C's history of tumultuous relationships, familial discord,
and exposure to parental abuse suggest ongoing interpersonal conflict and unresolved trauma.
These psychosocial stressors contribute to his emotional dysregulation, impulsivity, and
difficulties in forming stable connections with others.
Environmental Influences: Mr. C's transient lifestyle, characterized by frequent relocations and
involvement in legal troubles, reflects environmental stressors that perpetuate his cycle of
instability and maladaptive coping strategies. Addressing these environmental factors, such as
providing stable housing and employment opportunities, is crucial for supporting Mr. C's long-
term recovery.
In summary, a comprehensive understanding of Mr. C's case requires consideration of
psychodynamic, psychobiological, and psychosocial factors. Integrating these perspectives
facilitates a holistic approach to assessment and treatment planning, addressing the underlying
contributors to his mental health difficulties and promoting sustainable recovery.
Psychodynamic Factors:
Defense Mechanisms: Mr. C's use of avoidance and redirection during therapy sessions may
reflect underlying defense mechanisms such as repression or denial, which serve to protect him
from confronting painful emotions or conflicts. Exploring and addressing these defense
mechanisms is essential for facilitating therapeutic progress.
SUICIDE CASE STUDY
Attachment Disruptions: The lack of consistent parental figures and exposure to parental
substance abuse may have disrupted Mr. C's ability to form secure attachments and regulate his
emotions effectively. This could manifest in his unstable relationships, impulsivity, and
emotional dysregulation.
Identity Issues: Mr. C's experiences of bullying, lying, and stealing during childhood may have
contributed to difficulties in developing a cohesive sense of self. This lack of identity clarity can
lead to feelings of emptiness and confusion, exacerbating his vulnerability to depression and
substance abuse.
Psychobiological Factors:
Neurobiological Vulnerability: Mr. C's family history of mental illness (mother diagnosed with
bipolar disorder) and substance abuse (father with alcoholism) suggests a genetic predisposition
to psychiatric disorders. Neurobiological factors, including neurotransmitter dysregulation and
alterations in brain structure and function, likely contribute to his vulnerability to depression,
substance abuse, and impulsive behaviors.
Dual Diagnosis of Depression and Substance Use Disorder: The comorbidity between MDD and
SUD in Mr. C highlights the bidirectional relationship between mental health and substance
abuse. Chronic substance abuse can exacerbate depressive symptoms through neurobiological
mechanisms, while depression may increase vulnerability to substance use as a maladaptive
coping mechanism.
Psychosocial Factors:
Financial Stressors: Mr. C's financial difficulties, including job dissatisfaction, significant debt,
and recent loss of money at the casino, contribute to his sense of hopelessness and exacerbate his
SUICIDE CASE STUDY
depressive symptoms. Financial stressors may also act as triggers for impulsive behaviors, such
as substance use or reckless spending.
Substance-Induced Neuroadaptations: Chronic cocaine and alcohol abuse can lead to
neuroadaptive changes in the brain, including alterations in reward circuitry and neurotransmitter
systems. These neurobiological changes contribute to the development and maintenance of
substance use disorders, as well as exacerbate symptoms of depression and impulsivity.
Addressing these substance-induced neuroadaptations is crucial for successful treatment
outcomes and preventing relapse.
Psychosocial Factors:
Environmental Stressors: Mr. C's experiences of financial instability, job dissatisfaction, and
legal troubles represent significant psychosocial stressors that contribute to his overall distress
and exacerbate symptoms of depression and substance abuse. Addressing these environmental
stressors through practical interventions, such as financial counseling, vocational training, and
legal assistance, can help alleviate Mr. C's burden and improve his overall well-being.
Interpersonal Relationships: Mr. C's history of tumultuous relationships and familial discord
underscore the importance of addressing interpersonal dynamics in treatment. Exploring Mr. C's
relational patterns, attachment style, and communication skills can help identify maladaptive
patterns and promote healthier interactions with others. Additionally, involving family members
in therapy can provide valuable support and facilitate healing within the familial system.
Trauma and Adverse Childhood Experiences (ACEs): Mr. C's exposure to parental abuse and
familial dysfunction during childhood represents significant trauma and adverse childhood
experiences that contribute to his current mental health difficulties. Integrating trauma-informed
SUICIDE CASE STUDY
approaches into treatment can help Mr. C process past traumas, develop coping strategies, and
promote resilience in the face of adversity.
In summary, a comprehensive understanding of Mr. C's case requires consideration of
psychodynamic, psychobiological, and psychosocial factors. These interconnected factors
contribute to the complexity of his presentation and underscore the importance of a holistic
approach to assessment and treatment planning. By addressing underlying contributors to Mr. C's
mental health difficulties, clinicians can develop tailored interventions aimed at promoting
recovery and improving overall quality of life.
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.
In addition to the primary diagnoses of Major Depressive Disorder (MDD), Substance Use
Disorder (SUD), Intermittent Explosive Disorder (IED), and Borderline Personality Disorder
(BPD) traits, several other differential diagnoses should be considered based on Mr. C's
presentation. These differentials help ensure a comprehensive assessment and appropriate
treatment planning:
Bipolar Disorder (Type II): Mr. C's history of depressive episodes interspersed with periods of
impulsivity, irritability, and aggression may warrant consideration of bipolar disorder type II.
Although he does not report clear manic or hypomanic episodes, subtle hypomanic symptoms,
SUICIDE CASE STUDY
such as increased energy or risky behavior during periods of gambling or substance use, may be
present. Further exploration of his mood fluctuations and longitudinal course is necessary for
accurate diagnosis.
Antisocial Personality Disorder (ASPD): Given Mr. C's history of legal troubles, substance
abuse, and disregard for social norms, ASPD should be considered as a potential differential
diagnosis. Symptoms such as deceitfulness, irresponsibility, and lack of remorse are consistent
with this diagnosis. However, differentiating between ASPD and BPD requires careful
assessment of underlying motivations and affective instability.
Generalized Anxiety Disorder (GAD): Mr. C's chronic worry, financial stressors, and difficulties
concentrating may indicate comorbid generalized anxiety disorder. Although depressive
symptoms predominate in his presentation, anxiety symptoms may contribute to his overall
distress and impairment. Assessment tools such as the Generalized Anxiety Disorder 7-item
(GAD-7) scale can help elucidate the presence and severity of anxiety symptoms.
Post-Traumatic Stress Disorder (PTSD): Mr. C's history of childhood trauma, exposure to
parental abuse, and interpersonal conflict suggest the possibility of post-traumatic stress disorder.
Symptoms such as intrusive memories, hypervigilance, and emotional numbing may be present
but overshadowed by his depressive and substance use symptoms. Screening for PTSD and
trauma-focused interventions may be warranted, particularly if trauma-related symptoms persist
despite treatment.
Attention-Deficit/Hyperactivity Disorder (ADHD): Mr. C's impulsivity, distractibility, and
difficulties with authority figures may reflect underlying attention-deficit/hyperactivity disorder.
Although symptoms of ADHD typically manifest in childhood, they can persist into adulthood
SUICIDE CASE STUDY
and contribute to functional impairment, particularly in individuals with comorbid substance use
disorders. Structured interviews and collateral information from childhood may help clarify the
presence of ADHD symptoms.
Adjustment Disorder: Mr. C's recent stressors, including financial difficulties, legal troubles, and
relationship conflicts, may precipitate an adjustment disorder with depressed mood. Although his
symptoms exceed the expected response to stressors, the temporal relationship between stressors
and symptom onset should be carefully evaluated. Psychoeducation and supportive interventions
targeting stress management may be indicated in addition to standard treatments for depression
and substance use.
Generalized Anxiety Disorder (GAD):
GAD involves excessive worry and anxiety about various aspects of life, including work,
relationships, and health.
Physical symptoms such as restlessness, muscle tension, and difficulty concentrating may
accompany the psychological symptoms of anxiety.
Clinicians should assess the duration, severity, and impact of anxiety symptoms to differentiate
GAD from transient stressors or other anxiety disorders.
Post-Traumatic Stress Disorder (PTSD):
PTSD can develop after exposure to traumatic events such as physical or sexual abuse, accidents,
or combat.
Symptoms include intrusive memories, flashbacks, hypervigilance, avoidance, and negative
alterations in mood and cognition.
SUICIDE CASE STUDY
Clinicians should inquire about past traumatic experiences, assess for PTSD symptoms, and
consider trauma-focused interventions if indicated.
Attention-Deficit/Hyperactivity Disorder (ADHD):
ADHD is characterized by symptoms of inattention, hyperactivity, and impulsivity that cause
impairment in daily functioning.
While symptoms typically present in childhood, they can persist into adulthood and co-occur
with other mental health disorders.
Clinicians should assess for childhood symptoms of ADHD, functional impairment, and
response to previous interventions to differentiate from other psychiatric conditions.
Adjustment Disorder:
Adjustment disorder involves the development of emotional or behavioral symptoms in response
to identifiable stressors.
Symptoms may include depressed mood, anxiety, irritability, and impaired functioning.
Clinicians should assess the timing, severity, and duration of symptoms in relation to identifiable
stressors to diagnose adjustment disorder accurately.
Obsessive-Compulsive Personality Disorder (OCPD):
OCPD is characterized by a preoccupation with orderliness, perfectionism, and control, leading
to inflexibility and difficulty with interpersonal relationships.
Core features include perfectionism, rigidity, and reluctance to delegate tasks.
SUICIDE CASE STUDY
Clinicians should differentiate OCPD from obsessive-compulsive disorder (OCD) by assessing
for the presence of obsessions and compulsions.
Schizoid Personality Disorder:
Schizoid personality disorder involves a pervasive pattern of detachment from social
relationships and a restricted range of emotional expression.
Individuals with schizoid personality disorder prefer solitary activities, lack close relationships,
and appear indifferent to praise or criticism.
Clinicians should assess for personality functioning, social behavior, and the presence of other
psychiatric conditions to differentiate schizoid personality disorder from other personality
disorders or social anxiety disorder.
By thoroughly exploring these potential differential diagnoses, clinicians can gain a deeper
understanding of Mr. C's clinical presentation, guide further assessment and treatment planning,
and ensure comprehensive care tailored to his individual needs.
Bipolar Disorder (Type II):
Bipolar II disorder is characterized by recurrent depressive episodes alternating with hypomanic
episodes.
Hypomanic episodes involve elevated mood, increased energy, and impulsivity, but to a lesser
degree than full manic episodes.
Clinicians should explore Mr. C's history for any episodes of elevated mood, increased goal-
directed activity, or risky behavior that may indicate past hypomanic episodes.
SUICIDE CASE STUDY
Family history of bipolar disorder and longitudinal assessment of mood patterns are also
important considerations.
By exploring these potential differential diagnoses in more detail, clinicians can gather a
comprehensive understanding of Mr. C's clinical presentation and guide further assessment and
treatment planning effectively.
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.
Based on the information provided, Mr. C's diagnostic formulation includes:
Primary Diagnoses: a. Major Depressive Disorder (MDD): Mr. C exhibits symptoms consistent
with MDD, including depressed mood, feelings of hopelessness, fatigue, problems with
concentration, and suicidal ideation. His symptoms have persisted for at least three months,
significantly impairing his functioning.
b. Substance Use Disorder (SUD): Mr. C has a history of extensive cocaine abuse since
adolescence and ongoing alcohol use. Despite periods of attempted rehabilitation, he continues to
struggle with substance abuse, leading to legal issues, financial instability, and negative
consequences in various areas of his life.
Secondary Diagnoses and Considerations: a. Intermittent Explosive Disorder (IED): Mr. C's
history of frequent arguments, fights, and legal issues suggests difficulties with impulse control
SUICIDE CASE STUDY
and anger management. While these symptoms may overlap with his substance use and
personality traits, further assessment is needed to determine the presence of IED.
b. Borderline Personality Disorder (BPD) Traits: Mr. C exhibits several features consistent with
BPD, including unstable relationships, impulsivity, identity disturbance, and emotional
dysregulation. However, a thorough assessment is required to ascertain whether these traits meet
the criteria for a formal diagnosis of BPD.
Psychosocial and Environmental Factors: a. Early Childhood Trauma: Mr. C's history of parental
divorce, exposure to parental substance abuse, and childhood experiences of bullying and
familial conflict contribute to his psychological distress and may influence his current
symptomatology.
b. Financial Stressors: Ongoing financial difficulties, including job dissatisfaction, significant
debt, and recent losses at the casino, exacerbate Mr. C's depressive symptoms and contribute to
his sense of hopelessness and despair.
c. Substance Abuse: Chronic cocaine abuse and alcohol dependence significantly impact Mr. C's
mental health and functioning, exacerbating his depressive symptoms, impairing his decision-
making abilities, and contributing to interpersonal conflicts and legal issues.
This comprehensive diagnostic formulation considers Mr. C's presenting symptoms, psychiatric
history, psychosocial context, and biological factors to guide treatment planning and intervention
strategies tailored to his individual needs and circumstances. Ongoing assessment and
collaboration with multidisciplinary healthcare providers are essential for optimizing Mr. C's
outcomes and promoting his recovery.
Screening/Assessment
SUICIDE CASE STUDY
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.
To conduct a thorough screening and assessment for Mr. C, a comprehensive approach is needed
to gather information about his presenting concerns, psychiatric history, substance use patterns,
psychosocial context, and potential co-occurring disorders. Here's a suggested framework for
screening and assessment:
Initial Screening:
Begin with a brief initial screening using standardized assessment tools such as the Patient
Health Questionnaire (PHQ-9) for depression and the Alcohol Use Disorders Identification Test
(AUDIT) for alcohol use.
Use screening questions to assess for suicidal ideation, substance use, and history of trauma or
adverse childhood experiences.
SUICIDE CASE STUDY
Evaluate Mr. C's current safety and need for immediate intervention or referral to emergency
services if suicidal ideation or imminent risk is identified.
Comprehensive Assessment: a. Clinical Interview:
Conduct a comprehensive clinical interview to gather detailed information about Mr. C's
presenting concerns, psychiatric history, family history, social support, and substance use
patterns.
Specialized Assessments:
Consider specialized assessments or consultations as needed based on specific clinical
indications, such as neuropsychological testing for cognitive impairment, trauma-focused
assessments for PTSD, or personality assessments for personality disorders.
Cultural Considerations:
Take into account Mr. C's cultural background, beliefs, values, and preferences in the assessment
process to ensure culturally competent and sensitive care.
Use interpreters or cultural liaisons as necessary to overcome language barriers and facilitate
effective communication and rapport-building.
Documentation and Formulation:
Document the findings of the assessment process in a comprehensive and systematic manner,
including relevant history, clinical observations, assessment results, diagnostic formulation,
treatment recommendations, and safety planning.
Collaborate with Mr. C to develop a shared understanding of his concerns, treatment goals, and
preferences, and incorporate his input into the formulation and treatment planning process.
SUICIDE CASE STUDY
By following this comprehensive approach to screening and assessment, clinicians can gather the
necessary information to formulate an accurate diagnosis, develop an individualized treatment
plan, and initiate appropriate interventions to address Mr. C's presenting concerns and support
his recovery journey. Regular reassessment and monitoring are essential to track treatment
progress, adjust interventions as needed, and ensure optimal outcomes for Mr. C.
Initial Screening:
Use standardized screening tools such as the PHQ-9 for depression and the AUDIT for alcohol
use to quickly identify potential issues.
If Mr. C screens positive for depression or alcohol use, conduct a more comprehensive
assessment to gather additional details and determine the severity and impact of his symptoms.
Comprehensive Clinical Interview:
Establish rapport and trust with Mr. C to create a safe and supportive environment for disclosure.
Gather information about his presenting concerns, including the onset, duration, and severity of
depressive symptoms, suicidal ideation, and substance use patterns.
Explore Mr. C's psychiatric history, including any past diagnoses, treatments, hospitalizations,
and response to previous interventions.
Assess for co-occurring mental health disorders, such as anxiety disorders, PTSD, personality
disorders, or psychotic disorders.
Inquire about Mr. C's psychosocial context, including living situation, employment status, family
dynamics, social support network, and recent stressors or traumatic experiences.
SUICIDE CASE STUDY
Ask about Mr. C's substance use history, including the type, frequency, quantity, and duration of
substance use, as well as any previous attempts to quit or cut down.
Assess for withdrawal symptoms, tolerance, cravings, triggers for use, and consequences of
substance use on various areas of his life.
Mental Status Examination (MSE):
Systematically evaluate Mr. C's appearance, behavior, speech, mood, affect, thought content,
thought process, cognition, and insight.
Note any observable signs of depression, such as psychomotor agitation or retardation, flat or
labile affect, pessimistic or hopeless thoughts, and impaired concentration or memory.
Assess for suicidal ideation, intent, plan, and access to lethal means, and determine Mr. C's level
of risk for self-harm or harm to others.
Evaluate Mr. C's level of insight into his symptoms, understanding of treatment options, and
motivation for change.
Substance Use Assessment:
Use validated screening tools such as the DAST-10 or the SASSI to assess for substance use
disorders and related problems.
Obtain detailed information about Mr. C's substance use history, including age of onset,
frequency, quantity, and route of administration of substance use.
Explore triggers for substance use, situations associated with use, and patterns of cravings or
urges to use substances.
SUICIDE CASE STUDY
By following this structured approach to screening and assessment, clinicians can gather the
necessary information to formulate an accurate diagnosis, develop an individualized treatment
plan, and initiate appropriate interventions to address Mr. C's presenting concerns and support
his recovery journey effectively. Regular reassessment and monitoring are essential to track
treatment progress, adjust interventions as needed, and ensure optimal outcomes for Mr. C.
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."
The etiology of Mr. C's presentation is likely multifactorial, influenced by a combination of
biological, psychological, social, and environmental factors. Here's a breakdown of the potential
etiological factors contributing to his current condition:
Biological Factors:
Genetic Predisposition: Mr. C may have a genetic vulnerability to mental illness and substance
use disorders, as evidenced by his family history of bipolar disorder, alcoholism, and potentially
other psychiatric conditions. Genetic factors can influence susceptibility to mood disorders,
addiction, and impulsivity.
SUICIDE CASE STUDY
Neurobiological Changes: Chronic substance abuse, particularly cocaine and alcohol, can lead to
neurobiological alterations affecting mood regulation, reward pathways, and impulse control.
These changes may contribute to depressive symptoms, cravings, and difficulties in managing
emotions and behaviors.
Psychological Factors:
Trauma and Childhood Adversity: Mr. C's history of childhood trauma, including parental
divorce, exposure to parental substance abuse, bullying, and familial conflict, may have lasting
psychological effects. Traumatic experiences can contribute to the development of mood
disorders, personality disturbances, and maladaptive coping strategies, such as substance abuse.
Personality Traits: Mr. C exhibits personality traits consistent with impulsivity, emotional
dysregulation, and interpersonal instability, which may predispose him to mood disorders,
substance abuse, and difficulties in managing stress and conflict.
Social and Environmental Factors:
Stressful Life Events: Ongoing stressors, such as financial difficulties, job dissatisfaction, legal
issues, and relationship conflicts, exacerbate Mr. C's depressive symptoms and contribute to
feelings of hopelessness and despair. Chronic stressors can increase vulnerability to mood
disorders and substance abuse.
Social Isolation: Mr. C's history of unstable relationships, limited social support, and transient
living situations may contribute to feelings of loneliness, isolation, and alienation. Social support
plays a protective role against mental health problems and substance abuse.
Substance Use and Addiction:
SUICIDE CASE STUDY
Cocaine Abuse: Mr. C's extensive history of cocaine abuse since adolescence likely plays a
central role in his current presentation. Cocaine abuse can lead to mood disturbances, cognitive
impairments, and heightened impulsivity, exacerbating depressive symptoms and contributing to
maladaptive coping strategies.
Alcohol Dependence: Mr. C's daily alcohol consumption, despite denying it as a problem,
suggests alcohol dependence. Alcohol use can exacerbate depressive symptoms, impair judgment
and decision-making, and contribute to interpersonal conflicts and legal issues.
In summary, Mr. C's presentation is likely influenced by a complex interplay of biological
vulnerabilities, psychological factors, social and environmental stressors, and substance use
patterns. Understanding the multifactorial etiology of his condition is essential for developing a
comprehensive treatment approach that addresses his unique needs and challenges. A holistic
treatment plan should integrate pharmacotherapy, psychotherapy, substance abuse treatment,
social support interventions, and lifestyle modifications to promote Mr. C's recovery and overall
well-being.
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
SUICIDE CASE STUDY
15-17 of individuals with bipolar II disorder take their own lives (The Depression and Bipolar
Support Alliance, 2020).
Understanding the epidemiology of Mr. C's conditions can provide insights into their prevalence,
risk factors, and potential public health implications. Here's an overview of the epidemiology of
major depressive disorder (MDD) and substance use disorder (SUD), focusing on relevant
factors for Mr. C's case:
Major Depressive Disorder (MDD):
Prevalence: MDD is one of the most common mental health disorders globally, affecting people
of all ages and demographics. The lifetime prevalence of MDD is estimated to be around 16%,
with higher rates in females compared to males.
Age of Onset: MDD can develop at any age, but the typical age of onset is in late adolescence or
early adulthood. However, Mr. C's history suggests that he may have experienced depressive
symptoms since his youth, which could indicate an earlier onset.
Risk Factors: Risk factors for MDD include a family history of depression or other mental health
disorders, exposure to early-life stress or trauma, chronic medical conditions, substance abuse,
and psychosocial stressors such as financial difficulties or interpersonal conflicts.
Comorbidity: MDD commonly co-occurs with other mental health disorders, including anxiety
disorders, substance use disorders, and personality disorders. The presence of comorbid
conditions can complicate diagnosis, treatment, and prognosis.
Substance Use Disorder (SUD):
SUICIDE CASE STUDY
Prevalence: SUDs are prevalent worldwide, with estimates varying depending on the specific
substance and population studied. In the United States, approximately 8.1% of the population
aged 12 and older met criteria for illicit drug use disorder, and 14.5% met criteria for alcohol use
disorder in 2019.
Age of Onset: The age of onset for SUDs varies depending on the substance, but early initiation
of substance use during adolescence is a significant risk factor for the development of SUDs later
in life. Mr. C's history of cocaine abuse since age 16 and alcohol use since adolescence aligns
with this pattern.
Treatment Implications:
Integrated Treatment: Given the high prevalence and complex interplay between MDD and
SUDs, integrated treatment approaches that address both conditions concurrently are
recommended. Integrated treatments, such as cognitive-behavioral therapy for depression and
substance use, or medications that target both mood and substance use symptoms, have shown
promising outcomes.
Relapse Prevention: Relapse prevention strategies are essential in the treatment of co-occurring
MDD and SUDs. Addressing triggers, developing coping skills, enhancing social support, and
ongoing monitoring and support are crucial for maintaining recovery and preventing relapse.
In summary, MDD and SUDs are prevalent mental health disorders with significant overlap in
risk factors, comorbidity, and treatment implications. Understanding the epidemiology of these
conditions can inform assessment, treatment planning, and public health interventions aimed at
addressing the needs of individuals like Mr. C who present with complex and interconnected
mental health and substance use concerns.
SUICIDE CASE STUDY
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.
In Mr. C's case, several medical concerns warrant attention due to their potential impact on his
mental health and overall well-being. Here are the key medical considerations:
Substance-Related Medical Issues:
Cocaine Use: Chronic cocaine abuse can lead to various medical complications, including
cardiovascular issues such as hypertension, arrhythmias, myocardial infarction, and stroke.
Additionally, cocaine use may result in respiratory problems, seizures, and neurological
impairments.
Alcohol Use: Long-term alcohol abuse can cause liver damage (e.g., alcoholic liver disease,
cirrhosis), gastrointestinal issues (e.g., gastritis, pancreatitis), cardiovascular problems (e.g.,
hypertension, cardiomyopathy), and neurological impairments (e.g., cognitive deficits,
neuropathy).
SUICIDE CASE STUDY
Monitoring: Regular monitoring of blood pressure, lipid levels, and cardiac function is essential
to assess Mr. C's cardiovascular health and mitigate the risk of cardiovascular complications
associated with substance abuse and other risk factors.
Nutritional Status:
Poor Diet: Mr. C's lifestyle, including his history of substance abuse and financial difficulties,
may contribute to inadequate nutrition and poor dietary habits. Malnutrition or deficiencies in
essential nutrients can exacerbate physical and mental health problems, including depressive
symptoms and cognitive impairments.
Assessment and Intervention: Assessing Mr. C's nutritional status and providing education on
healthy eating habits, dietary supplements, and nutritional support may be beneficial for
optimizing his physical and mental well-being.
Endocrine Function:
Thyroid Function: Mr. C's thyroid function tests (Free T4 and TSH) indicate subclinical
hypothyroidism, which may contribute to depressive symptoms, fatigue, and cognitive
impairments. Thyroid dysfunction can be exacerbated by substance abuse and may require
further evaluation and management.
Monitoring and Treatment: Regular monitoring of thyroid function and consideration of thyroid
hormone replacement therapy may be indicated if Mr. C's symptoms are attributable to thyroid
dysfunction.
Psychosomatic Symptoms:
SUICIDE CASE STUDY
Somatization Disorder: Mr. C's family history of somatization disorder and his presentation of
physical symptoms (e.g., fatigue, gastrointestinal issues) in the context of his mental health and
substance use concerns raise the possibility of psychosomatic symptoms. Psychosomatic
symptoms may require a holistic approach that addresses both physical and psychological factors
contributing to symptomatology.
Medical Management and Collaboration:
Integrated Care: Collaboration between psychiatric and medical providers is essential for
managing Mr. C's complex medical and psychiatric needs effectively. Integrated care models that
address both physical and mental health concerns can improve outcomes and promote holistic
well-being.
Medication Considerations: When prescribing psychiatric medications, consideration of potential
interactions with substances of abuse and monitoring for adverse effects is crucial. Collaboration
with medical providers can help optimize medication management and minimize risks.
In summary, Mr. C's medical concerns, including substance-related issues, cardiovascular health,
nutritional status, endocrine function, and psychosomatic symptoms, underscore the importance
of a comprehensive medical evaluation and integrated care approach. Addressing these medical
concerns alongside psychiatric treatment can enhance Mr. C's overall health and facilitate
recovery from his mental health and substance use disorders. Regular monitoring and
collaboration among healthcare providers are essential for managing his complex medical needs
effectively.
Therapeutic Interventions
SUICIDE CASE STUDY
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.
Given the complexity of Mr. C's case, a comprehensive and integrated approach to therapeutic
interventions is warranted. The following therapeutic interventions may be beneficial for
addressing his mental health concerns, substance use disorder, and psychosocial difficulties:
Psychotherapy:
SUICIDE CASE STUDY
Cognitive-Behavioral Therapy (CBT): CBT can help Mr. C identify and challenge negative
thought patterns and develop coping strategies to manage depressive symptoms, cravings, and
maladaptive behaviors associated with substance use.
Dialectical Behavior Therapy (DBT): DBT focuses on enhancing emotion regulation, distress
tolerance, interpersonal effectiveness, and mindfulness skills, which can be particularly
beneficial for individuals with co-occurring mood disorders and substance use disorders.
Trauma-Focused Therapy: Given Mr. C's history of childhood trauma and adverse experiences,
trauma-focused therapies such as Eye Movement Desensitization and Reprocessing (EMDR) or
trauma-focused CBT may be helpful in addressing unresolved trauma and its impact on his
mental health and substance use.
Medication Management:
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine
reuptake inhibitors (SNRIs) may be prescribed to alleviate depressive symptoms and improve
mood regulation. Close monitoring for side effects and adherence is essential, considering Mr.
C's history of medication non-compliance.
Medications for Substance Use Disorders: Pharmacotherapies such as naltrexone, acamprosate,
or disulfiram may be considered as adjuncts to psychotherapy for treating alcohol use disorder.
Medications for opioid use disorder, such as buprenorphine or methadone, may also be indicated
if Mr. C has a history of opioid dependence.
Psychotropic Medications: Psychotropic medications may be prescribed to address co-occurring
psychiatric symptoms, such as anxiety or impulsivity, which may contribute to substance use and
exacerbate depressive symptoms.
SUICIDE CASE STUDY
Integrated Treatment Programs:
Dual Diagnosis Treatment: Mr. C may benefit from specialized dual diagnosis treatment
programs that address both his mental health and substance use disorders concurrently. These
programs typically offer integrated treatment modalities, including psychotherapy, medication
management, substance abuse counseling, and relapse prevention strategies.
Motivational Enhancement Therapy (MET): MET can help Mr. C explore and resolve
ambivalence about changing his substance use behavior, enhance his motivation for treatment
engagement, and increase readiness for change.
Supportive Services:
Case Management: Engaging Mr. C with a case manager or care coordinator can help coordinate
his medical, psychiatric, and social service needs, facilitate access to resources, and provide
ongoing support and advocacy.
Peer Support Groups: Participation in peer support groups such as Alcoholics Anonymous (AA),
Narcotics Anonymous (NA), or Dual Recovery Anonymous (DRA) can provide Mr. C with
social support, encouragement, and guidance from individuals with shared experiences.
Family Therapy: Involving Mr. C's family members in therapy can address family dynamics,
communication patterns, and sources of support or conflict, enhancing family understanding and
involvement in his recovery process.
Psychoeducation:
SUICIDE CASE STUDY
Substance Abuse Education: Providing psychoeducation to Mr. C about the effects of substance
abuse on mental health, physical health, and overall well-being can enhance his understanding of
the risks associated with continued use and motivate him to engage in treatment.
Relapse Prevention Skills: Teaching Mr. C relapse prevention strategies, coping skills, and stress
management techniques can empower him to recognize and manage triggers for substance use
and depressive symptoms effectively.
Holistic Approaches:
Exercise and Nutrition: Encouraging Mr. C to engage in regular exercise and adopt a healthy diet
can improve his physical health, mood, and overall well-being. Exercise has been shown to have
antidepressant effects and may help reduce cravings and stress.
Mindfulness and Meditation: Incorporating mindfulness-based practices and meditation
techniques into Mr. C's routine can promote emotional regulation, stress reduction, and increased
self-awareness, which may complement other therapeutic interventions.
Continued Monitoring and Follow-Up:
Regular Assessments: Ongoing monitoring of Mr. C's mental health symptoms, substance use
patterns, medication adherence, and psychosocial functioning is essential for tracking progress,
identifying areas of concern, and adjusting treatment interventions as needed.
Crisis Planning: Collaborating with Mr. C to develop a crisis plan that outlines steps to take in
the event of a mental health or substance-related crisis can help mitigate risks and ensure timely
access to appropriate support and interventions.
SUICIDE CASE STUDY
In summary, a comprehensive and individualized approach to therapeutic interventions is
necessary to address Mr. C's complex needs effectively. Integrating psychotherapy, medication
management, supportive services, psychoeducation, and holistic approaches within a
collaborative and multidisciplinary treatment framework can optimize outcomes and promote
Mr. C's recovery and overall well-being. Regular monitoring, follow-up, and ongoing support are
essential components of Mr. C's treatment plan to facilitate long-term success in managing his
mental health and substance use disorders.
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),
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
SUICIDE CASE STUDY
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
using medical terminologies that may confuse and hamper communication with the patient. The
patient's cultural background should also be taken into account.
Conducting a patient interview with Mr. C is a crucial step in understanding his concerns,
gathering relevant information, and establishing rapport. Here's an outline of the patient
interview process:
Introduction and Rapport Building:
Begin by introducing yourself and explaining the purpose of the interview.
Establish rapport by demonstrating empathy, active listening, and a nonjudgmental attitude.
Assure Mr. C of confidentiality and encourage him to share his thoughts and feelings openly.
SUICIDE CASE STUDY
Assessment of Presenting Concerns:
Invite Mr. C to describe his current symptoms, concerns, and reasons for seeking treatment.
Use open-ended questions to explore the nature, onset, duration, and severity of his depressive
symptoms, suicidal ideation, and substance use.
Inquire about any recent stressors, life events, or triggers that may have contributed to his current
difficulties.
Validate Mr. C's experiences and express understanding of the challenges he's facing.
Psychiatric History:
Gather information about Mr. C's psychiatric history, including past diagnoses, treatments,
hospitalizations, and responses to previous interventions.
Explore any family history of mental illness, substance abuse, or traumatic experiences that may
be relevant to Mr. C's presentation.
Inquire about his experiences with medications, therapy, and other forms of treatment in the past,
including any perceived benefits or challenges.
Substance Use History:
Ask Mr. C about his substance use history, including types of substances used, frequency,
quantity, and duration of use.
Explore triggers for substance use, patterns of use, cravings, and consequences of substance
abuse on various areas of his life.
SUICIDE CASE STUDY
Inquire about any previous attempts to quit or cut down on substance use and his motivation for
seeking treatment at this time.
Medical History:
Obtain information about Mr. C's medical history, including any chronic medical conditions,
previous surgeries, or hospitalizations.
Inquire about any current medications, allergies, or treatments he's receiving for medical
concerns.
Explore any recent changes in physical health, symptoms, or concerns related to his overall well-
being.
Psychosocial History:
Explore Mr. C's psychosocial context, including his living situation, employment status, financial
stability, social support network, and relationships.
Inquire about any recent life stressors, relationship conflicts, or significant life events that may
be impacting his mental health and functioning.
Ask about his hobbies, interests, and sources of enjoyment or fulfillment in his life.
Safety Assessment:
Conduct a thorough assessment of Mr. C's current safety, including the presence of suicidal
ideation, intent, plan, and access to lethal means.
Inquire about any history of self-harm, suicide attempts, or thoughts of harming others.
SUICIDE CASE STUDY
Develop a safety plan in collaboration with Mr. C to address any immediate safety concerns and
ensure appropriate follow-up and support.
Collaborative Goal Setting:
Engage Mr. C in collaborative goal setting by identifying his treatment goals, priorities, and
preferences.
Explore Mr. C's motivations for change, strengths, and resources that can support his recovery
journey.
Discuss the importance of treatment adherence, active participation in therapy, and engagement
in supportive services.
Closing and Next Steps:
Summarize key points from the interview and validate Mr. C's experiences and concerns.
Provide information about the treatment options available, including psychotherapy, medication
management, and supportive services.
Collaborate with Mr. C to develop a preliminary treatment plan, including referrals, follow-up
appointments, and ongoing support.
Follow-Up and Monitoring:
Schedule follow-up appointments to monitor Mr. C's progress, reassess his symptoms, and adjust
treatment interventions as needed.
Encourage Mr. C to reach out if he experiences any worsening symptoms, side effects from
medications, or difficulties in implementing treatment recommendations.
SUICIDE CASE STUDY
Reiterate your commitment to supporting Mr. C throughout his recovery journey and encourage
ongoing communication and collaboration.
By following this structured approach to the patient interview, clinicians can gather essential
information, establish rapport, and collaboratively develop a treatment plan tailored to Mr. C's
unique needs and preferences. Active listening, empathy, and a collaborative stance are essential
components of a therapeutic alliance that supports Mr. C's engagement and investment in the
treatment process.
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).
SUICIDE CASE STUDY
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.
Countertransference refers to the therapist's emotional reactions, attitudes, and unconscious
biases toward the client, which may stem from the therapist's own unresolved issues, past
experiences, or personal characteristics. In Mr. C's case, several countertransference issues may
arise due to the complexity and severity of his presentation. Here are some potential
countertransference issues that the therapist may encounter:
Compassion Fatigue and Burnout: Mr. C's history of chronic mental health issues, substance
abuse, and traumatic experiences may evoke feelings of frustration, helplessness, or emotional
exhaustion in the therapist. The therapist may experience burnout or compassion fatigue, leading
to diminished empathy or engagement in the therapeutic process.
Frustration or Impatience: Mr. C's repeated relapses, non-compliance with treatment
recommendations, or resistance to change may trigger feelings of frustration or impatience in the
therapist. The therapist may struggle with maintaining a nonjudgmental stance and may
inadvertently convey disapproval or criticism toward Mr. C.
Overidentification or Projection: The therapist may overidentify with Mr. C's struggles,
particularly if they have personal experiences with mental health issues, substance abuse, or
trauma. This overidentification may lead to boundary violations, enmeshment, or excessive self-
disclosure on the part of the therapist. Alternatively, the therapist may project their own
unresolved issues onto Mr. C, distorting their perception of him and the therapeutic relationship.
SUICIDE CASE STUDY
Countertransference Resistance: The therapist may experience resistance or avoidance in
addressing certain aspects of Mr. C's presentation, such as his substance abuse, history of trauma,
or risky behaviors. This resistance may stem from the therapist's discomfort with discussing
sensitive topics or from their own biases, judgments, or preconceived notions about addiction or
mental illness.
Transference Reactions: Mr. C's behavior, attitudes, or interpersonal style may evoke
transference reactions in the therapist, wherein the therapist unconsciously attributes qualities or
characteristics from their own past relationships onto Mr. C. These transference reactions may
influence the therapist's perceptions, interpretations, or responses within the therapeutic
relationship.
Countertransference Enactments: The therapist may unintentionally act out their
countertransference reactions in the therapeutic relationship, resulting in countertransference
enactments. For example, the therapist may become overly protective, confrontational, or
rescuing toward Mr. C, mirroring dynamics from their own past experiences or unresolved
conflicts.
Boundary Issues: Mr. C's challenging behavior, resistance to treatment, or boundary violations
may pose challenges for maintaining therapeutic boundaries. The therapist may struggle with
setting appropriate limits, asserting boundaries, or addressing boundary violations effectively,
leading to boundary crossings or boundary dissolution in the therapeutic relationship.
Addressing countertransference issues requires self-awareness, supervision, and ongoing
reflection on the part of the therapist. Supervision provides a safe space for therapists to explore
their emotional reactions, identify potential countertransference issues, and develop strategies for
SUICIDE CASE STUDY
managing them effectively. Additionally, therapists can engage in self-care practices, seek
personal therapy, and participate in continuing education to enhance their emotional resilience
and therapeutic effectiveness. By acknowledging and addressing countertransference issues,
therapists can cultivate a therapeutic relationship characterized by empathy, authenticity, and
trust, thereby promoting positive treatment outcomes for clients like Mr. C.
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
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.
Conducting a comprehensive risk assessment is essential when working with a patient like Mr.
C, who presents with significant mental health concerns, substance abuse issues, and a history of
suicidal behavior. Here's a structured approach to conducting a risk assessment:
Suicidal Ideation:
Inquire about the presence and severity of suicidal thoughts, including frequency, intensity, and
duration.
Assess for suicidal intent, plan, and access to lethal means.
SUICIDE CASE STUDY
Determine any past suicide attempts, including methods used and circumstances surrounding the
attempts.
Explore factors contributing to suicidal ideation, such as hopelessness, despair, perceived
burdensomeness, and lack of social support.
Self-Harm and Non-Suicidal Self-Injury (NSSI):
Inquire about any history of self-harm or non-suicidal self-injury, including cutting, burning, or
other self-inflicted injuries.
Assess triggers, functions, and frequency of self-harm behaviors.
Explore coping strategies and resources Mr. C utilizes when experiencing distress or urges to
self-harm.
Protective Factors:
Identify protective factors that mitigate suicide risk, such as social support networks, coping
skills, religious or spiritual beliefs, and reasons for living.
Explore Mr. C's willingness to engage with supportive services, adhere to treatment
recommendations, and utilize coping strategies during times of crisis.
Substance Use:
Assess Mr. C's current substance use patterns, including types of substances used, frequency,
quantity, and duration of use.
SUICIDE CASE STUDY
Explore the relationship between substance use and suicidal ideation or behavior, including
whether Mr. C engages in substance use as a means of coping with emotional distress or suicidal
thoughts.
Evaluate Mr. C's readiness to address substance abuse issues and engage in treatment for
substance use disorders.
Psychiatric Symptoms:
Evaluate the severity and impact of psychiatric symptoms, such as depressive symptoms,
anxiety, psychosis, or mood instability.
Assess for co-occurring mental health disorders and their contribution to suicide risk.
Consider the presence of psychotic symptoms or command hallucinations that may increase the
risk of self-harm or harm to others.
Psychosocial Stressors:
Explore current stressors, life events, or interpersonal conflicts that may exacerbate Mr. C's
emotional distress and increase suicide risk.
Assess for recent losses, financial difficulties, legal issues, or relationship problems that may
contribute to feelings of hopelessness or despair.
Medical and Psychiatric History:
Review Mr. C's medical history, including any chronic medical conditions, medications, or
recent hospitalizations.
SUICIDE CASE STUDY
Explore past psychiatric diagnoses, treatments, hospitalizations, and responses to previous
interventions.
Consider the impact of medical or psychiatric comorbidities on Mr. C's suicide risk and overall
functioning.
Safety Planning:
Collaborate with Mr. C to develop a safety plan that outlines steps to take during a crisis,
including coping strategies, social supports, and emergency contacts.
Identify warning signs, triggers, and coping skills that Mr. C can utilize to manage suicidal urges
or emotional distress.
Establish a list of resources and crisis hotlines that Mr. C can access for immediate support or
intervention.
Documentation and Follow-Up:
Document the results of the risk assessment, including the presence of suicidal ideation, risk
factors, protective factors, and safety plan.
Establish a plan for ongoing monitoring and follow-up to reassess suicide risk, treatment
progress, and response to interventions.
Communicate with other members of the treatment team, including psychiatrists, social workers,
or case managers, to ensure coordinated care and support for Mr. C.
Emergency Response Protocol:
SUICIDE CASE STUDY
Clarify the procedures for responding to acute suicide risk, including when and how to initiate
emergency psychiatric evaluation or hospitalization.
Ensure that Mr. C understands the importance of seeking help immediately if he experiences
severe distress, suicidal urges, or thoughts of self-harm.
Provide Mr. C with emergency contact information and instructions for accessing crisis services
or contacting emergency services if needed.
By conducting a thorough risk assessment and implementing appropriate safety measures,
clinicians can mitigate suicide risk and ensure the safety and well-being of patients like Mr. C.
Ongoing monitoring, collaboration with other treatment providers, and timely intervention are
essential components of a comprehensive approach to suicide prevention and crisis management.
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.
SUICIDE CASE STUDY
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
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
SUICIDE CASE STUDY
