CASE STUDY 2: Rebecca

Rebecca is a 30 year old woman who is married with twelve month old daughter. Rebecca has had two (2) previous admissions to the mental health unit after attempting suicide, this is her third admission. Her husband Paul rang the triage team expressing concern that Rebecca was relapsing, he reported that she had been staying in bed saying she was tired all the time, crying and unable to care for their daughter. Rebecca’s husband reports their relationship is under strain. Both sets of parents are helping with the care of their child.

Family History

Rebecca is the youngest child of three siblings with two older brothers aged 39 and 36 years; her parents are very supportive and have a good relationship with Rebecca and her husband. Rebecca’s maternal grandmother and her aunt have a diagnosis of major depression. Rebecca and Paul live in the same suburb as her parents. Rebecca’s parents are active members of the carer’s group run by the local Mental Health service. Rebecca is to be discharged next week.

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Medical History

– Nil physical problems

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Psychiatric History

Rebecca was first diagnosed with Major Depressive Disorder at the age of 25 and has had three admissions to inpatient care in the past 5 years. Rebecca is currently being managed on mianserin hydrochloride – 120mg PO daily.

Current Mental State Examination Appearance & Behaviour:

– Looks stated age of 30

– Average height and weight

– Black hair, unkempt

– Dressed appropriate to weather, slightly dishevelled

– Has scars on both wrists

– Reluctant to be involved in conversation with intermittent eye contact

Cognition:

-Orientated to time, place and person. Not able to maintain concentration throughout interview.

Mood:

– Rebecca says she is very sad and tired

Affect:

– Congruent when discussing events leading to admission

Speech:

– Slow with monosyllabic responses

Form of thought:

– Logical and sequential

Content of thought:

– Believes that her husband and daughter would have a better life if she wasn’t

around. She states that she is not a good mother.

Perception:

– No perceptual disturbances elicited

Insight:

?- Moderate insight into illness, states she knows she has depression and will take medication but doesn’t believe that it will do any good.

Judgement:

– Judgement is poor, however, she is willing to take medication, and try to stay well. – Is accepting of the need for case-management, has agreed to attend counselling

with her husband.

Please do NOT seek out medication management plan templates from the web. The assignment is to be presented in a question/answer format, No dot points and not as and essay (i.e. no introduction or conclusion). Each answer must be supported with citations.

You will need to reference according to APA referencing.(valid in Australia only articles and journals minimum 10. )

These are the question

Q1. What physical health considerations should be undertaken prior to giving this medication to the consumer?

Q2. Provide rationales for the use of this medication in this consumer.

Q3. What are the side effects / adverse effects of this medication? Indicate the management strategies that would be used to deal with these effects?

Q4. Discuss the relationship between medication management and recovery principles in mental health.