Suicide Case Study Assignment
Case History
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. 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).
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?
I forgot to add, APA format 5-10 pages with sources cited and references added. At least 3 references, 2 within past 5 years.
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