Suicidal Ideation and Muscle Twitches | Case Study

A new case study in which the patient, a 40 yr-old mixed-race woman presents to her primary care physician with concerns about suicidal ideation. She has some other troubling symptoms as well including muscle twitches, fatigue, difficulty concentrating and memory lapses. Nurses General Nursing Case Study

Updated: Feb 23, 2023

This article was reviewed and fact-checked by our Editorial Team.

Suicidal Ideation and Muscle Twitches | Case Study

Chief Complaint

Suicidal ideation, fatigue, difficulty concentrating, memory lapses and muscle twitches.

History of Present Illness

"My children begged me to come in. They are so worried about me. The other day, my son started yelling at me – he said I had been standing in front of the open....um...oh what is it called...where you keep your food cold...for 20 minutes, just staring.” Patient states she has been experiencing symptoms for more than a year. "They came on so gradually. I used to be such an upbeat, happy person. My best friend called me a few months ago and I couldn't remember her name, so I stopped returning her calls. I've been thinking lately about ending it all. I just can't take it anymore, but my kids need me.” She can't think of any precipitating reason for onset of symptoms. She states low mood and other mental symptoms began over a year ago, muscle twitches have been happening for at least 6 months.

General Appearance

She appears her stated race, age and gender. She is slender with short hair and a downcast expression. She doesn't make eye contact and her clothing is wrinkled and stained. "I'm sorry for how I look. I just can't seem to find the energy to do anything.” During her assessment you notice her head jerk to the side (toward the right shoulder) and she flexes her fingers continuously.

Past Medical History

Unremarkable. No complications with either pregnancy.

Family History

Patient was adopted when an infant. Her family history is unknown because she was found in a basket at the local fire station when she was only three weeks old. She has been divorced for five years and has a 21 yr-old daughter who is away at college and a 17 yr-old son who lives at home. Her adoptive parents are alive and well and living 1000 miles away.

Social History

Drinks 5- 6 alcoholic beverages weekly, smokes 3 cigarettes per day. "I'm trying to quit. I'm down from half a pack a day 6 months ago.” She works from home as a medical coder. "I've had to take a lot of time off. I can't seem to concentrate. I'm worried I'm going to get fired.”

Medications

Multi vitamin, occasional acetaminophen for headaches, melatonin for insomnia

Allergies

NKA

Vital Signs

BP 138/80 sitting, LA
HR 70 and regular
RR 18 unlabored
T 98.8oF
HT 5'4"
WT 110 lbs

What information will help with diagnosis? What labs do you want? What other diagnostic tests should we run?

DISCLAIMER: These case studies are presented for learning purposes only and with full understanding that it is outside the scope of practice for a nurse to make a medical diagnosis. When participating, assume that a licensed healthcare provider is making the actual diagnosis, ordering all the tests and interpreting the results. You are looking at the case retrospectively to learn from the data presented – the idea is to increase your knowledge so you can sharpen your assessment and teaching skills.

4 Votes

About SafetyNurse1968, ADN, BSN, MSN, PhD

Patient Safety Columnist / Educator

Dr. Kristi Miller, aka Safety Nurse, is an Assistant Professor of nursing at USC-Upstate and a Certified Professional in Patient Safety. She is obsessed with patient safety. Please read her blog, "Safety Rules!", on allnurses.com.

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