Case Studies

Case 9: Mental illness

Margaret is 48 years old and has a moderate learning disability and very poor communication skills. She lives in a residential home with three other women with moderate learning disabilities. Margaret has lived there happily for 12 years. She attends a day service 4 days per week.

Recently, staff have expressed concerns about her behaviour, stating that they are concerned that she is becoming 'obsessional'. They have reported, for example, that Margaret can spend up to over an hour every day folding her clothes before putting them away. There are other manifestations that staff have noted, including repeated washing of her hands and face, to the point that Margaret's hands have become sore and chapped.

The community learning disability (CLD) nurse refers Margaret to the Consultant Psychiatrist, and Margaret attends an out-patient appointment, and is subsequently diagnosed with obsessional compulsive disorder (OCD). Margaret is prescribed an anti-depressant and within a 3-month period shows little improvement.

• 1. What can the LD nurse do?

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  Correct answer:

  • Refer back to the psychiatrist for further treatment options.
  • Ensure that Margaret is taking the medication prescribed and checking that staff employed in the home are giving the drugs at the correct time each day.
  • Carry out a nursing assessment to ensure there are no other causes for this change in behaviour.
  • Provide Margaret and the staff with coping strategies in the short term.
  • Encourage Margaret to use hand cream to prevent soreness of her hands.

• 2. What other treatment options are available?

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  Correct answer:

  • Different anti-depressant medication
  • Art therapy
  • Music therapy
  • Drama therapy
  • Relaxation therapy
  • Cognitive behaviour therapy

  The aim of all these is to address Margaret's biological, psychological and social needs.

• 3. What is the purpose of the proposed intervention?

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  Correct answer:

  • To reduce signs and symptoms of the presenting mental health issue
  • To reduce the distress caused to the individual
  • To increase social inclusion as this is likely to lessen isolation
  • To improve the person's quality of life
  • To reduce the likelihood of relapse.
  • The assessment helps lead to an understanding of what made the individual vulnerable to developing a mental health issue and therefore helps us to act proactively where possible.