Treatment of the Suicidal Patient: A Comprehensive Approach
Introduction:
This case study is designed for mental health nurse practitioner students to explore the assessment and treatment of a suicidal patient, John, with a focus on a comprehensive approach. The case emphasizes the critical role mental health nurse practitioners play in assessing and managing patients at risk of suicide.
Case Study:
Patient Information: John is a 36-year-old man who was referred to a mental health nurse practitioner, Sarah, after expressing thoughts of suicide. He is divorced, lives alone, and has recently lost his job due to the COVID-19 pandemic. John reports feeling overwhelmed, and hopeless and has difficulty sleeping. He has a history of major depressive disorder and has previously attempted suicide in his early twenties.
Review of Systems:
General: John reports feeling fatigued, with low energy and motivation. Mood: He describes persistent sadness, hopelessness, and feelings of worthlessness. Sleep: John reports significant insomnia, with difficulty falling asleep and frequent awakenings. Appetite/Weight: He has experienced a loss of appetite and has lost 15 pounds over the past two months. Concentration: John struggles with concentration and decision-making, which affects his daily functioning. Energy: He frequently feels exhausted and lacks interest in activities he once enjoyed. Psychomotor: John reports psychomotor agitation at times, such as restlessness and pacing.
Medical History:
Major Depressive Disorder: John has a history of major depressive disorder and has received therapy and medication treatment in the past. Previous Suicide Attempt: In his early twenties, John attempted suicide by overdose but survived and received psychiatric care. Current Stressors: John has recently experienced significant life stressors, including job loss due to the pandemic and a recent divorce.
Surgical History:
John has no significant surgical history. He has never undergone any major surgical procedures.
Medication History:
John’s medication history includes previous prescriptions for:
Sertraline (Zoloft) for depression and anxiety. Escitalopram (Lexapro) for depression. Lorazepam (Ativan) for acute anxiety or panic attacks. None of these medications provided long-term relief.
Previous Suicide Attempts:
John attempted suicide in his early twenties by taking an overdose of medication. He survived this attempt and received psychiatric care.
Family History:
John’s family history includes:
A maternal aunt who has a history of bipolar disorder. His paternal grandfather had a history of alcoholism and depression.
Physical Examination:
During the physical examination, John presents with the following findings:
General appearance: John appears disheveled, with poor grooming and hygiene. Vital signs: Blood pressure 140/90 mm Hg, heart rate 96 bpm, respiratory rate 18 bpm, temperature 98.2°F (36.8°C). General physical examination: There are no significant abnormalities observed during the examination of his skin, head, neck, chest, and abdomen. Neurological examination: No focal neurological deficits are noted.
Mental Examination:
During the mental examination, John presents with the following characteristics:
Affect: John’s affect is consistently sad and constricted, with minimal emotional expressiveness. Mood: He reports a pervasive low mood, hopelessness, and thoughts of suicide. Thought Process: His thought process is organized, but he demonstrates rumination and self-criticism. Perception: John denies any hallucinations or delusions. Cognition: His cognitive functioning appears intact, with no signs of disorientation or impairment in attention, memory, or abstract thinking. Insight and Judgment: John acknowledges the need for help and expresses concern about his suicidal thoughts.
Students are to complete the sections below.
Assessment: As mental health nurse practitioner students, your task is to conduct a thorough assessment of John using a comprehensive approach.
Suicidal Ideation Assessment: Psychiatric and Medical History: Social and Environmental Assessment: Substance Use Assessment: Safety Assessment:
Diagnosis:
Based on your assessment, provide a provisional diagnosis for John. Consider specific mental health diagnoses, including major depressive disorder, and assess the level of suicide risk.
Treatment Plan:
Develop a comprehensive treatment plan for John that addresses his suicidal ideation and underlying mental health needs. Consider the following elements:
Crisis Intervention: Psychotherapy: Medication Management: Social Support: Safety Planning: Follow-Up and Monitoring:
Conclusion:
The treatment of suicidal patients requires a comprehensive and vigilant approach by mental health nurse practitioners. This case study of John underscores the importance of thorough assessment, risk evaluation, crisis intervention, and ongoing support in managing individuals at risk of suicide. Mental health nurse practitioner students must develop the skills and knowledge necessary to provide effective care to patients like John, with a focus on ensuring their safety and well-being.
Case Study Analysis Rubric
Case Study Analysis
Rubric
Criteria
Ratings
Pts
This criterion is linked
to a Learning OutcomeAccuracy and Detail
Part 1: Understand of
Case Details
40 pts
Excellent
Demonstrates the comprehensive criteria of the DSM-5, meticulous
recap of all case details.
30 pts
Good
Demonstrates the comprehensive criteria of the DSM-5 and main points
of the case but may miss or misinterpret some nuances.
20 pts
Needs Improvement
Demonstrates some of the comprehensive criteria of the DSM-5,
Frequently misses or misinterprets important case details.
40 pts
This criterion is linked
to a Learning OutcomeDiagnostic Assessment
Part 2: Clinical
Reasoning
20 pts
Excellent
Provides a comprehensive diagnostic assessment based on presented
information.
15 pts
Good
Provides a mostly accurate diagnosis but may miss a few subtleties.
10 pts
Needs Improvement
Struggles to provide an accurate diagnosis or misses key diagnostic
criteria.
20 pts
This criterion is linked
to a Learning OutcomeTreatment Options
Part 2: Clinical
Reasoning
20 pts
Excellent
Thoroughly analyzes and recommends appropriate treatment options with
a clear rationale.
15 pts
Good
Generally recommends appropriate treatments but may lack detailed
reasoning.
10 pts
Needs Improvement
Misses or recommends inappropriate treatment options without
sufficient justification.
20 pts
This criterion is linked
to a Learning OutcomeRecognition of Issues
Part 3: Ethical and
Cultural Considerations
15 pts
Excellent
Clearly identifies any ethical or cultural issues present in the
case.
10 pts
Good
Recognizes some issues but may miss subtleties or depth.
7.5 pts
Needs Improvement
Struggles to identify clear ethical or cultural issues present.
15 pts
This criterion is linked
to a Learning OutcomeAddressing Concerns
Part 3: Ethical and
Cultural Considerations
15 pts
Excellent
Demonstrates a sensitive and informed approach to addressing these
issues.
10 pts
Good
Addresses concerns but may lack depth or clarity.
7.5 pts
Needs Improvement
Fails to adequately address or respond to the recognized concerns.
15 pts
This criterion is linked
to a Learning OutcomeRecognition of Need
Part 4:
Interdisciplinary Collaboration
10 pts
Excellent
Clearly identifies when and why interdisciplinary collaboration is
necessary.
8 pts
Good
Clearly identifies when and why interdisciplinary collaboration is
necessary. Mostly recognizes the need but may lack detailed rationale.
4 pts
Needs Improvement
Frequently overlooks the importance or relevance of interdisciplinary
collaboration.
10 pts
This criterion is linked
to a Learning OutcomeEffective
Collaboration
Part 4: Interdisciplinary
Collaboration
10 pts
Excellent
Provides detailed strategies for effective collaboration with other
professionals.
8 pts
Good
Generally outlines collaboration, but strategies may lack depth.
4 pts
Needs Improvement
Struggles to provide clear or actionable strategies for
collaboration.
10 pts
This criterion is linked
to a Learning OutcomePresentation of
Analysis
Part 5: Clarity and
Organization
10 pts
Excellent
Analysis is clear, well-organized, and logically structured.
8 pts
Good
Analysis is mostly clear, but may have minor organizational issues.
4 pts
Needs Improvement
Analysis is disorganized or lacks a clear structure, making it hard
to follow.
10 pts
This criterion is linked
to a Learning OutcomeWriting Style
Part 5: Clarity and
Organization
10 pts
Excellent
Writing is concise, free of errors, and uses appropriate clinical
terminology.
8 pts
Good
Writing is mostly clear with minor errors or inconsistencies.
4 pts
Needs Improvement
Writing contains multiple errors, lacks clarity, or does not use
appropriate terminology.
