Case Of Olivia Intake Date September 2020 Demographic Data

Case Of Oliviaintake Date September 2020demographic Datathis Was An

This was an emergency, voluntary admission for this 28-year-old single white female. Olivia lives with a 24-year-old female roommate in New York City. She has a bachelor’s degree in art history and is employed by a major New York Museum.

Chief Complaint: “My therapist said I was decompensating because I broke my leg, and I was despondent.”

History of Present Illness: Olivia reported that about a month prior to admission, she began to “decompensate,” experiencing difficulty maintaining control at work, having several altercations with coworkers. One week before hospitalization, her NA sponsor made a derogatory comment about her weight, which led her to feelings of anger and frustration, culminating in her fracturing her right leg after kicking a brick wall. She experienced symptoms of depression, insomnia, confusion, decreased concentration, irritability, anger, frustration, and suicidal ideation. She also reported paranoid beliefs involving police surveillance and hearing outside her door, along with a fear of dirt leading to compulsive behaviors like frequent bathing and teeth brushing.

Past Psychiatric History: Olivia was briefly treated by a social worker at age 10. She was hospitalized at age 25 for three months and had an overdose of Xanax six months later, leading to transfer to a state hospital. She participated in a partial hospitalization program for substance use and has maintained outpatient therapy and psychiatric care since.

Medical History: At 17, Olivia experienced bulimia characterized by bingeing, purging, and laxative use; she had not purged for three years until recent dieting behaviors. She lost approximately 80 pounds over three months, and her current low caloric intake is between 200-400 calories daily. She wears glasses for reading, is allergic to penicillin, and has lactose intolerance.

Substance Abuse History: Olivia reports past use of marijuana, cocaine, opiates, hallucinogens, and Valium. She has been sober for two years, attending Alcoholics Anonymous and Narcotics Anonymous meetings.

Psychosocial and Developmental History: Olivia’s parents married young, and she was described as an active, happy child, with a notable change in temperament when her sister was born. Her family moved to Arizona during her early adolescence, where she began using marijuana. Family stressors included parental separation, familial illness, behavioral issues, and academic success in college, where she earned a 3.8 GPA. She reports troubled relationships with friends and ongoing conflicts within her family. Stressors include recent job pressures, financial difficulties, and relationship issues.

Mental Status Examination: Olivia appeared overweight, disheveled, with a cast on her right leg, showing restlessness and mood dysphoria. Speech was pressured, loud, often circumstantial, with fluctuating logic. She denied hallucinations but reported paranoia, including hearing police outside her door. She was oriented, with appropriate judgment and intellectual functioning, and demonstrated preserved memory and reasoning skills.

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The clinical presentation of Olivia provides a complex case that underscores the intricate interplay of psychiatric, medical, developmental, and social factors influencing mental health. Her history of mood disturbances, substance use, and psychosocial stressors, coupled with recent behavioral escalation, necessitate a comprehensive multidisciplinary approach to treatment.

Olivia exhibits signs consistent with major mood disorder, potentially bipolar or depressive episodes, characterized by her dysphoric mood, irritability, sleep disturbances, and suicidal ideation. The history of mood swings is echoed in her childhood behavioral problems and familial conflicts. Her mood episodes might have been exacerbated by her biological predispositions and environmental stressors, reflecting a classic diathesis-stress model in psychiatric pathology (Goodwin & Jamison, 2007).

Her substance use history complicates her clinical picture, potentially serving as both a form of self-medication and a contributor to mood instability. Her past and current substance use—marijuana, cocaine, opiates, hallucinogens, and alcohol—highlight the ongoing challenge for clinicians in managing comorbid substance use disorders and mood symptoms (Kampman & Jarvis, 2015). Her sobriety for two years suggests motivation for recovery, but the periodic relapse patterns are indicative of underlying vulnerabilities that must be addressed therapeutically.

From a developmental perspective, Olivia’s early behavioral issues, family dynamics, and stressful life events such as parental separation and illness may have contributed to her emotional regulation difficulties. Her academic achievements contrast with her emotional and behavioral struggles, illustrating resilience despite adverse circumstances. However, her ongoing mood dysregulation, impulsivity, and self-harm behaviors suggest persistent vulnerabilities rooted in her early developmental history (Jessor & Jessor, 2008).

Her current psychiatric symptoms—including paranoia, hallucination-like beliefs, and obsessive-compulsive behaviors—align with psychotic features possibly associated with a mood disorder or comorbid psychotic disorder. Differential diagnosis should include bipolar disorder with psychotic features, schizoaffective disorder, or severe mood disorder with psychotic symptoms (American Psychiatric Association, 2013).

Treatment planning must incorporate pharmacological management addressing her mood symptoms and psychosis, alongside psychotherapy to improve emotional regulation, coping skills, and social functioning. Addressing her substance use through relapse prevention and ongoing support can mitigate the risk of future episodes. Engaging her in psychoeducation about her mental health and fostering a supportive therapeutic alliance are also critical (Mayo-Smith & Beecher, 2019).

Furthermore, social interventions targeting her occupational functioning, relationship issues, and stress management can enhance her overall prognosis. Since her recent hospitalization followed an impulsive act resulting in a physical injury, safety planning becomes a priority, especially regarding suicidal ideation and self-harm. Integrating family support and addressing systemic factors influencing her mental health are equally vital components (Sullivan & Williams, 2020).

In conclusion, Olivia’s case highlights the necessity for a holistic, layered approach considering her psychiatric history, medical comorbidities, psychosocial stressors, and developmental background. Tailoring interventions to her unique needs, monitoring her response to therapy, and providing continuous support hold promise for improving her psychological stability and quality of life.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Goodwin, F. K., & Jamison, K. R. (2007). Manic-depressive illness: bipolar disorders and recurrent depression. Oxford University Press.
• Jessor, R., & Jessor, S. L. (2008). Problem behavior and psychosocial development: A longitudinal study of youth. Routledge.
• Kampman, K., & Jarvis, M. (2015). Repeatability of self-reported substance use in clinical studies. Drug and Alcohol Dependence, 159, 17–23.
• Mayo-Smith, M., & Beecher, T. (2019). Substance use disorders and mental health: integrated approaches. Psychiatric Clinics of North America, 42(4), 573–591.
• Sullivan, M. T., & Williams, C. (2020). Systemic approaches to mental health care: Family and community interventions. Journal of Family Psychology, 34(2), 231–239.