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Maria Case Study 1:

Maria is a 19-year-old University student who has just been transported to the chemical dependency unit at the local hospital. You are asked to do an assessment on her to see if she needs to be admitted for a drug problem or sent to the psychiatric unit for further observation.

You meet with Jane and notice that she is barefoot, wearing loose 60’s style clothing and her eyes are much dilated. She tells you the following story in a rapid pressured pattern of speech.

“A few hours ago I was at the Metallica concert and got to thinking that James (lead singer) was talking to me in my head. He told me not to leave the stadium, so I didn’t. Everyone else left, my ride left, but I just couldn’t.

Then I got here somehow. I remember thinking I wouldn’t get through and would really lose my mind, especially when that pay phone I was using started melting in my hand. I felt I had to talk really fast before it melted. I really don’t remember much of the concert or anything from this morning. I do remember that I had trouble getting to my feet to walk up the stairs to my seat. I remember we all passed around something and the next thing I knew, I started feeling really restless. I just couldn’t sit still. I was jumpy, nervous, and sick to my stomach. My heart was racing and I was sweating, even though it wasn’t very warm out. I was high and really got into the people and the whole scene. The scenery was fantastic and I could actually see the sounds— there were waves and triangles dancing in front of my eyes to the music. Then it got scary. Things got blurry and faces started looking mean and ugly. That’s when I started hearing James in my head telling me not to leave the stadium. Then I was all alone and called for help.”

Jane has no previous history of mental health problems and she has no police record. Though young, she does have a long history of drug use. Jane started smoking “pot” daily at age 13. Her weekends were spent doing many different types of hallucinogens. LSD, XTC, mescaline and “shrooms”. Jane tells you her mother and father divorced when she was 10 years old. He was career military and they moved about every two years. She remembers always feeling lonely and started taking drugs because she felt it made her more interesting to be with. It also was a way to relieve the boredom and loneliness. She finished high school with average grades and wasn’t sure what to do next. But, when her Mom was about to get married, she told Jane she had to “go away to college.”

1. What drugs does Maria seem to be regularly using that may be contributing to her present mental health problems? (2 points) Maria smokes pot daily since the age of thirteen, which is mentioned to help her deal with loneliness and boredom after her parents divorced, which she used to help her with her depressive disorder at that age. Smoking pot leads her to an increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, and substance use disorders. Although I do believe her recent use of LSD, XTC, mescaline and “shrooms”on weekends are the ones contributing to her mental health problems now. LSD and XTC are hallucinogens that after a long period of time can cause bipolar disorder and or Schizophrenia. 
2. Is it possible for Maria to be addicted to marijuana? What about the other hallucinogens? Why or why not for both. Please explain your response in detail. (5 points) Maria does have a Marijuana use disorder. She consumes it daily since the age of 13; she is now 19. Jane also consumes other psychedelic drugs on weekends, making her a polysubstance user. Jane uses LSD, XTC, mescaline and shrooms and Marijuana.
3. What part of Maria’s family history and social life seem significant in her decision to use drugs? Why is this part of her family history important? Please explain your rationale in detail. (5 points)
4. What mental health condition(s) would you want to rule out before making your decision on where to place Jane for treatment and why?  (5 points)
5. Would you consider Jane to have a drug problem, a mental health problem, or both? Why? (2 points)
6. Based on the case information and your assessment what clinical impressions (or diagnoses would) do you observe and which (if any) hospital ward would you more likely to be recommending to Jane for further treatment? Please specify the rationale for your responses. (5 points)
7. What would you estimate this client’s prognosis to be? (1 point)

 

 

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