FREDLESA JOHNSON
2/6/23
CASE STUDY 1
Introduction
LL is a 42 years old female who was committed on involuntary bases for bizarre
behaviors. She thinks that her family has stolen her identity and has been taking money from her
for three years, also says her family is under investigation by the FBI. Despite having tubes tied
16 years ago, she also thinks she is pregnant, even after being shown a negative pregnancy test.
Reports only sleeping a few hours at night. The family tried to get LL committed by EMT 2-3
weeks ago, but she did not meet the criticizes for her to be committed, so the family got a court
order.
Background
The patient has no history of psychological issues and no family history of psych issues.
The patient used to smoke a packet of cigarettes a day but quit years ago. Does report some
marijuana use.
Medication
Aripiprazole 10 mg daily PO
Haloperidol 5 mg q 4 hrs. PRN PO or IM
Lorazepam 2 mg q 4 hrs. PRN IM or PO
Assessment Finding
LL was clean, neat, and appropriately dressed. She appeared to have good hygiene. She
was very open and talkative about why she was there. She reported that she slept well. She made
eye contact. LL appetite was good, reported eating all her breakfast and lunch. She confirmed
FREDLESA JOHNSON
2/6/23
CASE STUDY 1
that she was admitted on involuntary bases. She also stated that she has no previous history of
psych problems.
Mental Status Exam
LL was clean, made eye contact, and the student nurse was able to build great rapport
with the patient. Her speech was clear, assertive (pressured), and direct. Thought form is
irrational. She speaks in a delusional obsessive manner. She perceptive her family as being a
danger to her and her freedom and stated, “they couldn’t get over on the EMTs, so they when and
got a court order to put me here”. She was friendly but her mood would change to anger when
talking about family. The affect was labile but congruent with mood. She had poor insight as to
what she did that caused her to be committed. Judgment is impaired when it comes to the family
because the patient sees her family as a danger to her freedom and well-being.
Theoretical Statement
Bipolar disorder- this condition is assisted with mood swings. Manic episodes include
symptoms such as elevated energy and decreased need for sleep. Patients with bipolar may also
have episodes where they lose of touch with reality. Depressive episodes include symptoms such
as decreased energy, lack of motivation, and loss of interest in daily activities. These episodes
can last days to months. May be associated with suicidal thoughts ("Bipolar disorder - Symptoms
and causes," 2021).
Sign and symptoms:
Unusually upbeat
Heightened activity level
FREDLESA JOHNSON
2/6/23
CASE STUDY 1
An exaggerated sense of well-being and self-confidence
euphoria
Diminished need for sleep
talkativeness
Racing thoughts
Signs and symptoms can vary depending on the type of mood swings the patient is
having ("Bipolar disorder - Symptoms and causes," 2021).
Epidemiology: 5 per 100,000 people, peaks around 21-25 years old, higher in whites
than blacks, bipolar 1 is higher in males than females, bipolar 2 is higher in females than males
("Epidemiology and risk factors for bipolar disorder," n.d.).
Medication/treatment:
Medication-like mood stabilizers may be these medications are ithium (Lithobid),
valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro,
others), and lamotrigine (Lamictal), Antipsychotics like olanzapine (Zyprexa), risperidone
(Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone
(Latuda) or asenapine (Saphris) ("Bipolar disorder - Diagnosis and treatment - Mayo Clinic,"
2021).
Cognitive behavioral therapy (CBT) helps with identifying negative behaviors and beliefs
and replaces them with positive beliefs and behaviors. Family focus therapy helps build a
FREDLESA JOHNSON
2/6/23
CASE STUDY 1
support system and helps you and your family identify warning signs of mood swings ("Bipolar
disorder - Diagnosis and treatment - Mayo Clinic," 2021).
Nursing Diagnosis:
Impaired Social Interaction
Ineffective Individual Coping
Interrupted Family Processes
Total Self-Care Deficit
BAS-dysregulation theory says that both negative and positive events trigger episodes of
bipolar disorder only specific events can trigger bipolar mood swings ("role of the behavioral
approach system (BAS) in bipolar spectrum disorders," 1).
Discussion
This theory relays to my patient because her bipolar mood swing was triggered by
someone telling her family members stole from her. After learning this she and her family begin
getting into verbal altercations which the police were called. Even though the theory focuses on
hypomania, a negative event may be able to trigger the patient to have delusions of persecution.
My patient is only on one medication which seems to have decreased her bizarre behaviors, but
she still has delusions about her family being a danger to her and her freedom. It is beneficial
that she is very talkative and open to discussion. She would probably benefit from cognitive
behavior therapy and family therapy that could help get to the core of her beliefs and bring her
and her family closer to together.
FREDLESA JOHNSON
2/6/23
CASE STUDY 1
Conclusion
I found this case study interesting because she was 42 years old with no previous history
of mental illness. I feel like the theory works for this situation because once someone told her she
was being taken advantage of she started behaving bizarrely. This case just shows that mental
illness can happen at any age.
FREDLESA JOHNSON
2/6/23
CASE STUDY 1
References
Bipolar disorder - Diagnosis and treatment - Mayo Clinic. (2021, February 16). Mayo Clinic Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosistreatment/drc-20355961
Bipolar disorder - Symptoms and causes. (2021, February 16). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc20355955
Epidemiology and risk factors for bipolar disorder. (n.d.). PubMed Central (PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116765/
The role of the behavioral approach system (BAS) in bipolar spectrum disorders. (1). PubMed
Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894637