Reference no: EM133868731

Assignment:

CASE STUDY

Identifying Information: The patient is a 19-year-old male, single, in his second year of college, fall semester, major in Chemistry. He is financially supported by his parents and financial aid. He is an only child. He lives at home with his parents and commutes to college.

Setting: Community psychiatric crisis clinic.

Past Psychiatric History: The patient has never been hospitalized for psychiatric reasons. He was in family therapy with his parents at age 13 for several months when the parents split up for a period of three months. The parents later got back together, and the patient has not been in therapy since. He has never been on any psychotropic medications.

Medical History & Current Medications: (1) He was diagnosed with hypertension one year ago, a condition which he inherited from both parents who carry the same diagnosis. Presently he is on Avapro, 150 mg PO QD, and has had no side-effects from this medication. (2) He was diagnosed with psoriasis at age 12 and utilizes Triamcinolone Acetonide Cream 0.1% to affected areas on a daily basis; he has had no complaints of side-effects from this medication, and the condition is under good control.

Present Psychiatric Circumstances & History: The patient had a 3.8 GPA in his first year of college and seemed to adjust well to the transition from High School to university, but he made few friends his first year. His parents describe him as always "intense and academically driven." He is now two months into his fall semester of sophomore year. He switched to online classes for the semester, which he told his parents was because he wanted a semester away from the campus because other students were getting on his nerves.

About six weeks ago the patient began to exhibit a pronounced diminished emotional expression. His parents believed this was probably due to the intense workload of his classes. His mother was walking by his room (door closed) about five weeks ago and she heard him talking in an aggressive manner, but he was not on his cell phone, as he had left the phone in the living room. She was puzzled by this and knocked on his door to see what was wrong. He immediately stopped talking and through the door he told her he was alright and was just memorizing school material out loud. Over these next five weeks he increasingly demonstrated this behavior of talking to himself. The parents listened outside his door several times when he was especially loud. The contents of his speech consisted of talking to people of several names about a variety of topics, including something about the planet Mars, helium infiltrating people's minds, and nanotechnology taking over the neighborhood. He isolated himself during this period, only coming out of his room for food and drink when his parents were out of their house or in their bedroom. They called a family friend who is an Obstetrician and he came over and tried to talk to the patient last week, but the patient said he was too busy with school and would not open the door to his bedroom. The friend suggested that the parents bring him to a psychiatrist. The parents tried to talk to the patient about such an appointment, but he refused.

Two days ago, he came out of his room while his mother was in the kitchen. He was disheveled, had grown his facial hair, and smelled of urine. She started to talk to him about what was happening to him, and his speech was quite disorganized and easily derailed. She followed him into his room, only to find that the room was a complete mess, and he had built a barricade of some sort in front of his bedroom window. She called '911' and the paramedics said they could not take him to the Emergency Room because he denied feeling suicidal or homicidal.

Today, his father came home from a short work-related trip and found the patient's bedroom door opened. The patient was standing on top of his bed yelling about nanotechnology and helium. The father called the police and when they arrived he was shouting that he'd kill everyone in the house if anyone came near him. The police placed the patient on a 72-hour involuntary hold as a danger to others and gravely disabled. He was transported to the Community psychiatric crisis clinic. Upon arrival at the crisis clinic, a locked facility, he tried to AWOL through the front door when the ambulance dropped him off, began screaming and pounding on the door, pushed a security guard, and was accusing the staff of being involved in a conspiracy to destroy the world through nanotechnology.

CASE STUDY

QUESTIONS

(While the patient is in the community crisis psychiatric clinic):

(1) What is the current diagnosis for this patient?

(2) What are the differential diagnoses?

(3) What emergent medications would you order in this situation and why?

(4) What are the implications of the patient being on an involuntary hold?

(Once the patient is admitted to the inpatient psychiatric unit):

(5) What laboratories would be appropriate to order and why?

(6) What factors will determine the patient's length of stay?

(7) It is decided to place him on Latuda. Does this medication have any drug interactions with any other medications?

(8) The parents ask you during a meeting with them to explain the patient's diagnosis, and will he ever get better. The patient has signed a consent form for you to talk to the parents. What education would you provide his parents with their questions?

(9) What aftercare planning will the patient need?

(10) What are two different psychotherapy modalities that may be helpful for this patient once he is home and stabilized? Write one paragraph explaining the basics of each.

(11) Involuntary Movement Disorder is always a risk with anti-psychotic medication; how would you assess for this on an out-patient basis?