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. Joh

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.