Explosive Stress Disorder: A Case Study

Pt is a 14 y/o African American male presented to NNBHC with his mother with a dx of ADHD, ODD, PTSD and Depressive D/O. Pt states that he had an episode of enuresis last night when he had a nightmare about killing his family. Pt states that when he woke up he began to have intrusive thoughts of wanting to kill his family and himself so he wouldn’t have to go jail. Pt states that recently he have been blamed for everything in the home that is missing, or goes wrong. Pt states that he has taken ownership over all the negative things in the home, so none of the his sibilings wont get in trouble. Pt states “I am pretending to be happy, this is not my family”. Pt states when he cam home from residential that his biological

The client has high motivation for treatment within MRFH. The client was diagnosed with Alcohol Use Disorder: Severe and Cocaine Use Disorder (crack): Moderate. The client sought treatment at MRFH when he realized he had lost control of using alcohol and crack cocaine. The client stated he attended the MRFH program in the 1980 's but does not remember the exact date of attendance. The client stated he was diagnosed with Mild Depression by a primary care physician when he was 56-years-old. The client reports he has no history of suicidal or homicidal attempts, and currently denies having any suicidal ideations or homicidal ideations. The client stated one to two times per week he experiences muscle tension and worrying about things that he often realizes have no significance. The client stated prior to the age of 18-years-old, "I would knock over my neighbors mailboxes and destroy their gardens, because they would make my parents aware of my wrong doings and that was way of getting them back." The client stated, there was one time that I started a fire and blamed it on my brother. I would break things as well and blame someone else. The client stated if there was an event taking place that he wanted to participate in, he would rush and complete what he was doing so he could become involved in other events taking place around him. The client stated, "I started using drugs and alcohol without thinking about what the consequences. The client appeared to be oriented to the

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

D.D. is a 50-year-old, African American male presenting with a number of anxiety and depressive symptoms. The client reports that he came to counseling for “extra support and someone to talk to.” D.D. has been struggling with mental health issues since he was young. Since the age of 15 he has been hospitalized on and off for “hearing voices.” In the early 1980’s he was diagnosed with schizophrenia and prescribed Risperdal to treat the symptoms. Since then, D.D. has been in a variety of mental health settings, including hospitals, day programs, and outpatient treatment. The client has an extensive alcohol and drug use history that he believes impacted his Schizophrenia. In the early 1980’s the client would use alcohol every day “to avoid the voices,” drinking “anything he could get his hands on.” He was also heavily involved with drugs at that time and regularly used marijuana, PCP, cocaine, and heroine. In 2000, the client was sentenced to eight years in jail for four bank robberies. While in jail, D.D. received mental health treatment and alcohol and drug treatment, which was greatly beneficial. When the client was released from jail in 2008, he was drug and alcohol free and was taken off of Risperdal.

Presenting Problem: Zachary has required x3 inpatient hospitalization within a 6 month time frame. Zachary struggles with communication in the family dynamics that generally evoke anger, irritability, physical aggression, and suicidal statements. Most recently he was admitted at NNBHC due to SI, HI statements and AWOL behaviors. He is not compliant with medication compliance or participating in outpatient treatment. He states overall mood has been on and off with periods of feeling down. He reports decrease interest in activities.

Kimmy is presenting for “anger outbursts”, homicidal threats, and behavioral problems. The client reports these behaviors began eight months ago after the death of her mother. Her mother died in an auto accident, for which the children were not present. Kimmy has been hospitalized three times in the past 8 months for anger outburst towards her Uncle, older brother, and peers. She has made homicidal threats towards her older brother. Prior to her most

Sara is in need of residential treatment due to her history of self-injurious behaviors, and multiple attempts of suicidal gestures. Sara requires a higher level of care which outpatient care is currently failing to provide her at this time. Sara continues to have depressive symptoms and anxious feelings for the last few months. The patient has had two acute inpatient admissions within the last 3 months and requires long term stabilization. At this time Sara requires 24 hour supervision and ongoing intervention and treatment.

Client appears to have displayed behavior consistent with Intermittent Explosive Disorder, with several incidents in the past consisting of fits of rage, aggressive behavior and physical altercations. Behaviors are often a result of ruminating on the moment when client found his wife and another man in the shower. Client experiences delusions and hallucinations such as hearing “My Cherie Amour” when it is not playing or thinking that his wife and other teachers at the high school are plotting against him. Additionally, client seems to be on automatic pilot and unable to control thoughts and impulses.

Pt is a 15 y/o biracial female that presented at NNBHC by her father with a dx of persistent depressive disorder with intermittent major depsressive episode, with current episode, severe; rule out PTSD, chronice; marijuana use disorder, mild; and parent child relational problems. Pt presents appropriately dress, pt eye contact was poor. Throughout the assessment the pt demonstrated intermittent of tearfulness. Pt expressed that she have been feeling worthless, helplessness, and hoplessness. Pt describe that since her mother died she has not seen any motivation for living. Pt states that she has been feeling suicidal for weeks, however lately it has became more intrusive. Pt states that she has a plan to either overdose

J.C., is a 41 year old female with a history of bipolar disease, who presented to the psychiatric department by EMS activated by shelter staff. She was brought in since she was presenting with manic behavior and psychotic thoughts. She currently lives in uptown Manhattan in an independent home but previously lived in a women’s shelter. She returned to the shelter, where she spoke words of retaliation and guns, and talked about her acquaintances at the shelter and her ex-husband however, she did not speak of any plan. The staff called EMS reporting this behavior and EMS then brought her to the hospital. On admission, she reported walking to and from Manhattan and the Bronx. She also has psychomotor agitation and has difficulty sitting down. She reports not taking her psychotic medication for the past 9 months. In addition, she reports no suicidal ideation, and has no history of violence. She also reports using substances such as marijuana, cocaine, and alcohol. She also smokes ¼ pack of cigarettes a day.

The following information was obtained by shadowing interviews and therapy sessions with numerous mental health professionals and the client, John Doe. John Doe is a 46 year-old, newly single, Caucasian male who was recently admitted to Chestnut Ridge Center’s Day Hospital,

Client is a 35 year old African American female with an 12th grade education level who presented with signs and symptoms of forgetfulness, depression, severe anxiety, stress, uncontrollable mood swings and difficulty making decisions. During the assessment, the client struggled with bouts of crying triggered by memories of her past. The client was recently hospitalized at VCU Hospital for signs and symptoms related to a panic attack. The client has been given the diagnosis of Major Depressive and Anxiety. The client has been prescribed Prozac. Currently the client does not have a PCP or psychiatrist.

a 24 yo SAAM who presented independently to COPE today. He stated that he is homeless and seeking transitional housing, however he also is exhibiting symptoms of psychosis. Patient is having command hallucinations to hurt himself and was observed responding to internal stimuli during assessment. Patient denies paranoia, but does have some delusional thinking. He stated sleep/appetite are decreased, grooming/hygiene poor and is unable to contract for safety at this time. He has had multiple suicide attempts, and showed me an old scar on his wrist from "2015 I used plastic from a container, I didn't know how to do it the right way". He also showed me several cuts on his chest that appear fresh, the nurse was able to look at them and determine

A client that has expressed he has been suffering from severe bipolar disorder and his quality of life is so compromised by his illness that he logically and rationally chooses suicide, should be involuntary admitted to a mental health facility. As a counselor for the client it is ethically necessary to try to minimize harm where it is foreseeable and unavoidable (3.04, American Psychological Association, 2002). Subsequently, petitioning to have the client admitted to a mental health facility will serve as a means of trying to minimize harm to the client. According to Illinois law the client is a candidate for involuntary admission to a mental health facility because due to his illness he is reasonably expected to engage in dangerous conduct which places him in harm (405 ILCS 5/1 119). According to Illinois law, as a counselor of at least 18 years of age for the client and who has direct knowledge of the client’s desire to harm himself, I would present a petition for admittance to a mental facility to the facility director (405 ILCS 5/3 601). The petition would include the descriptions of client’s symptoms of bi polar disorder such as his reports of terrifying and tormenting episodes of depressive psychosis as well as his feelings of helplessness and hopelessness. Most important, the petition would also include his announcement that he has decided to commit suicide, rather than fight his recurrent mental illness. In addition to the reasons

The intake form I used is a mental health intake form I found on the internet, see attached form. It is extensive, seven pages long, and asks about current and past problems. The intake form asks about the current symptoms the client is experiencing, examples: depressed mood, fatigue, loss of interest, and other symptoms used to assess the client’s current mood and mental illness. The intake form includes a suicide risk assessment, and inquires about the client’s substance abuse and usage. The list of questions goes on to include medications and family medical history. It also covers things such as: education level, amount of weekly exercise, and family background and childhood history.