Acute Psychosis Case Study

Mr. Davis is a 33 year old male who presented to the ED with homicidal ideation with a plan. Mr. Davis states he has a plan to go out in his yard with a machete and kill someone. Per documentation he states, "I'm going out into the yard with my machete and I am afraid I am going to kill someone. I feel really crazy." He states he has these thoughts towards anyone that does him wrong. At the time of the assessment Mr. Davis is asleep, however becomes awaken and 4x oriented by hearing his name called. He has a history of Bipolar. He denies current suicidal ideation, homicidal ideation, and visual hallucinations. He does endorse auditory hallucination. Mr. Davis reports hearing several people telling him things. He reports his outpatient provider is DayMark and he usually go there twice a month for his Depakote injections, however has not been there since

America seems to be trapped in the illusion of believing that it is the most powerful country and “ continue to embrace the illusion of inevitable progress, personal success and rising prosperity( American Psychosis).” However, in reality American continues to engage in war, augment its debt and millions of Americans rely on food stamps to survive. While a good percent of America is struggling from day to day, the rest of the general public are trapped in a psychosis and concerned with the next voted-off contestant of “America’s next top Model”, or “Survivor” rather than the adverse current events transpiring today. In Chris Hedges article “American Psychosis” all these points are emphasized through use of strong language and pathos.

Patient remains calm and safe in her bed without any further harm being done. One to one supervision reports no recent mood changes that suspect intentions of harm.

There are several key issues apparent for Belinda, one of which is social isolation. Belinda has withdrawn from her family and no longer spends time with her friends. In becoming socially isolated, Belinda is at risk of disruption to her social development leading to an increased likelihood of failure to achieve in the future (EPPIC, 2001). This is evidenced by the fact that Belinda’s grades have dropped significantly over the past six months.

Mr. Gillespie is a 21 year old male who presented to the ED after an intentional overdose on 20 600mg of Gabapentin. Per documentation from ED staff Mr. Gillespie reported he became angry at his grandmother tonight and tried to "prove a point." Mr. Gillespe reported to staff threatened to overdose on his on pills, however dumped them in the toilet. He expressed after making threats to overdose on his prescribed Celexa did not phase his grandmother, he proceeded to take her Gabapentin. Per documentation Mr. Gillespe has been living with grandmother for 2 weeks and before that was living with his mother in Cary. At the time of the assessment Mr. Gillespie was calm and cooperative. He denies current suicidal ideation, homicidal ideation, and symptoms of psychosis. He appears guarded during the assessment. He reports tonight his grandmother and he got into an argument over him getting a job. He reports his grandmother informed him he has to be out by Friday. Mr. Gillespe denies history of self harm. He

Mr. Saunders is a 60 year old male who presented to the ED via LEO under petition by his niece, Rachelle, for allegedly putting a gun into his mouth, him putting a gun in another individuals mouth called "legs", and increasing alcohol consumption. At the time of the assessment Mr. Saunders is calm and cooperative. He denies suicidal ideation, homicidal ideation, and symptoms of psychosis. Mr. Saunders reports he has been depressed for several months and has been binge drinking alcohol. He reports relational issues with his wife has been the primary stressor contributing to his distress. He express feelings of hopelessness, worthlessness, irritability, and isolation. He does admit to informing a friend, William, he see no reason to leave if he can not be with his wife. Patient does not appear to be exhibiting signs of agitation,

Ms. Webster is a 28 year old female who presented to the ED via LEO under IVC by her mother for suicidal ideation and alcohol dependence. Ms. Webster denies allegations to nursing staff. Per documentation she appears intoxicated. Per documentation Ms. Webster states, "Going through withdrawals". Before assessment this clinician spoke with nursing staff about Ms. Webster, they reports she has been asking for Ativan since she has been placed in her room. They reports she informed them that she had not consumed any alcohol today. At the time of the assessment Ms. Webster is found sitting upright in her room. Ms. Webster reports she had a plan to hang herself. She states, " you know I have to say that to get into detox." Ms. Webster reports alcohol abuse as primary stressor contributing to her distress. She denies depressive symptoms. Ms. Webster states,

T.R. is a 69 year old, Caucasian female with a history of schizophrenia who presented to University Hospital Medical Center Emergency Room under Baker Act for recent suicidal attempt. According to the Baker Act report, she ran out of her retirement facility, trying to be hit by vehicles. She suffered a slight injury to her right ankle, as the slightly slightly hit her in an effort to abruptly stop the vehicle. She verbalized to police officers she wanted to die. She reported that peers in her retirement community learned about her history and had been gossiping about her. She reported increased paranoia due to this. She was hospitalized in the same psychiatric unit two months ago, after she was diagnosed with depression. Patient states the reason she was diagnosed with depression is because her two sons are not willing to talk to her. She states that she is separated and living without her family in an Assisted Living Facility. As per patient and chart review, the patient was born and raised in New Jersey and moved to South Florida. The patient currently lives in a retirement home and had to move several times to the different Assisted Living Facility, due to her paranoia and delusional behavior. She is currently retired and reports that she used to work from home as a home health aide. She has two sons and tries to maintain a good relationship with them, but denies any contact with them. She reports the biggest stressor is basically a relationship with her

Dr. Gentry requested an assessment for Kaitlin Bradley, an 19 year old female who presented to Randolph Hospital ER reporting suicidal ideation, with a plan, and symptoms of psychosis, and homicidal ideation. She stated " I plan to do some stupid shit". Ms. Bradley reports she has had suicidal ideation daily since the age of 10, She reports that in the past two weeks her suicidal ideation has gotten worse. She reports yesterday she was suicidal and reports if she was going to kill herself she would overdose no whatever pills she can get her hands on. Ms. Bradley reported cocaine and marijuana use, which was confirmed in her drug screening. She reports she came to the hospital so she would not harm herself. Ms. Bradley has a history of suicide

Mr. Moore is a 24 year old male who presented to the ED with reports of experiencing depressive symptoms, vague suicidal ideation without a plan, and recent episodes of anxiety. At the time of the assessment Mr. Moore denies current suicidal ideation, homicidal ideation, and symptoms of psychosis. He reported to suicidal ideation would come and go, however never had a plan . Mr. Moore appears calm, cooperative and in good spirits during assessment. He reports a history of anxiety, depression, and emotional trauma by father at the age of 8 years old. Mr. Moore expressed he started noticing increase anxiety when he had to speak in large groups, present in school, driving, and engaging in social actives. He states, "Over the past 16 years my father has been out my live, when I was younger he would hit me if he felt I said anything out of line." Mr. Moore reports recent relationship issues and separation with his fiance. He reports due to him not engaging in many social actives his fiance has left him. He reports for many year going to Randolph Counseling Center for his anxiety. He reports positive results from services. Mr. Moore mention coming to the hospital last Thursday for his anxiety and bring prescribed a 30day supply of Ativan, which he reports has helped him become more stable when engaging in actives,like driving his mother's car. He reports depressive comes and goes depending on the mood he is in. He describes symptoms on occasion as feelings of

Mrs. Passmore is a 31 year old female who presented to the ED via LEO attempting to harm herself. Per documentation Mrs. Passmore reports someone taking her Klonopin several days ago and has not been able to take it. Today she allegedly tried to cut her wrist. She denies suicidal ideation, homicidal ideation, and symptoms of psychosis to nursing staff. At the time of the assessment Mrs. Passmore reports a mental health history of bipolar, anxiety, and depression. Mrs. Passmore noted she has only been hospitalized when she was 15 year old for behavior issues. She denies having a history of self harm or suicidal attempts. Mrs. Passmore reports recently she has been going through a lot. She reports her father died 3 weeks ago, financial issues,

a 44 year old Divorced African Male came into Henry Ford Hospital ED as a walk-in and told the HFHS staff that he was having mental health issues he does still struggle with depression and anxiety. The consumer stated that he initially went into the hospital after his brother was shot twice in the head. At that time the client reports that he was placed on Risperdal, while at Kingswood in January, and he became a zombie at that time. He stated that he has been in and of the hospital multiple times since then, and each time, he has been placed on Risperdal and he doesn't feel that his meds were ever adjusted correctly.

Therapy for psychosis often works best when combined with medication, although this is not always

People have many different opinions on what psychosis really is. Many define it as crazy or not normal, but really, the illnesses vary. It could be schizophrenia, bipolar disorder, hallucinations and delusions, anxiety, even Alzheimer’s and Dementia. It is characterized in all of these illnesses. Psychosis is usually genetic and passed down through different family members. It is an illness that distorts the brain, making thinking unclear. The main question is what really causes someone to be psychotic? What really defines psychosis?

           The patient M. is a 26 year old married female who was brought to the ER by her husband after increased anxiety and depression worsened after a “spiritual attack” that lasted for over four days.  While in the ER the patient admitted to hearing multiple distant male and female voices all around her head and outside of her head.  She states not being able to make out the message but interprets them to be negative in nature. She told the ER Doc she felt people were trying to harm her and that “people in her life have used things against her.”  She felt her extended family may have used witchcraft and “chakra dolls” to cast spells on her.  She is cognizant of the strangeness of her claims but believes them to be real