Medical Case Study: Caucasian Patient With Self-Rearing Behaviors

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

The intent of the AUDIT or the Alcohol Use Disorders Identification Test is to recognize individuals whose alcohol ingesting has become risky or damaging to their well-being (Bradly, Debenedetti, Volk, & Williams, 2007). The AUDIT is a 10-item device with fluctuating numbers of reply selections per item, vacillating from three to six selections; its objective is to measure three facets of alcohol misuse; consumption, dependence, and interrelated complications (Bradley, et al., 2007). Reactions are differentially biased such that between zero and four points are conceivable per element (Bradley, et al., 2007). A score of eight or greater is evocative of alcohol problems (Bradley, et al., 2007). This screening implement takes less than four minutes to administrate and performs to be more sensitive to current drinking involvements such as binge drinking in the last 30 days or the regularity of drinking and driving incidents in the last 12 months (Bradley, et al., 2007).

The client Suzanne is a seven year old girl placed in a treatment center for emotionally disturbed children. This center helps children ages six through twelve years old. Suzanne has been diagnosed with an attachment disorder and has been placed in a group home for two years. There are two types of attachment disorders, attachment and reactive attachment (Smith, 2014). She has been meeting with a facility caseworker weekly for the last eight months. Her three year old sister, Cindy, is also placed in the facility with her. Parental rights are currently being processed to be terminated. The caseworker is looking into alternative long-term placement for the sisters. Each sister has a

Pt. is a 10 y/o African American female presented at NNBHC with a dx of Oppsitonal Defiant Disorder, Mood Disorder NOS and ADHD, who have demonstrated out of control behaviors that are assaultive towards family members in home.

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

Pt is a 15 y/o African American male presented at NNBHC with a dx of PTSD, ODD, ADHD, Bipolar Disorder, and Depression, who have been demonstate emotional instability and aggressive episodes in the home. Pt discussed that he have been having difficulty controlling his anger when triggered for getting trouble. Pt stated that he god in troubled for hiding soiled clothes in his drawer, where his mother found them. Pt stated he became upset and demonstrated verbal aggression which includes threats and foul language. Pt states that he black outs and have mind/body experiences where he lose control over his actions. Pt states that during his anger outburst typically one of his parents have to tell him what he has done. Pt states he is easily trigger by being called “fat” or discussion of his bed wetting. Pt discussed he frequently have phobias in new places due to believing he may be sexually assaulted again which intensify his nighmares and nocturnal enuereis.

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.

Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. This is evidenced by Mr. Holliday’s self-report that he has continued to consume alcohol after the accident in spite of his hospitalization from a car accident.

Client’s foster mother has reported the client’s aggressive behaviors occur daily at home and at school. The client has been subjected to witness domestic violence through his biological mother and her boyfriend. The client’s foster mother stated the client has moments where he is talking to someone (imaginary) and becomes visibly upsets by screaming “leave me alone”, in addition to the client’s hallucinations, the client experience night terror which occurs at least twice a week. The client is potty-trained, but continues to have accidents and when he is asked to change his clothes; the client becomes upsets and exhibits aggressive behaviors towards others.

The first assessment is the Alcohol Use Disorders Identification Test (AUDIT). The AUDIT’s purpose is to recognize how one’s alcohol consumption is an issue (Ash, 2001). This assessment will help the counselor to find out how detrimental the use of the substance is to the individual (Ash, 2001). The AUDIT has a few strengths that would encourage the counselor to use this assessment. The assessment allows the counselor to examine the possible options for the client and what treatment is the most appropriate (Ash, 2001). This assessment should not be used to diagnose the client (Bischoff, 2001). It has been proven that the assessment is reliable by using

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.

Pt is a 12 y/o Biracial male presented at NNBHC with his mother due to increase aggression, assaultive behaviors and setting fires. Pt has a dx of ADHD. 8/5/15 Pt mother states the pt started a fire on her carpet, and a trash can with leaves. Pt also got bug spray lighting it on fire going after his older brother. Pt attacked older brother in sleep where he helped a knife to his neck to obtain his cell phone. Pt punched his brother in gentials today to obtain cell phone. Pt stated “ I hate my brother” “ cause he constantly telling my friends I have anger problems”. “ I lie a lot to get out of trouble”, stated the Pt. Pt stated “ I don’t want to kill but I want to beat the crap out of him”, “I stabbed his new shoes yesterday”. Pt stated

alcohol in the morning to elude withdrawal and to steady their nerves (Aertgeerts, et al., 2004). These transitional questions, in spite of missing discriminative value, are beneficial for familiarizing the subject, as well as making the consultation less threatening (Aertgeerts, et al., 2004). Item responses are scored zero to one, with a higher score a suggestion of alcohol problems. The total score can range from zero to four (Aertgeerts, et al., 2004).

Patient A was raised in a tumultuous situation. Her mother was married to her father for the first year or so of her life but her parents then divorced. Custody of Patient A went with the mother. The mother was disengaged as a parent and was allegedly more focused on chasing men rather than a parent. Patient A was the subject of intense and ongoing mental abuse with some physical abuse at times. She was forced to raise her younger brother in many ways and this continued until the mother lost custody when the patient was seven years old.

Mandy (pseudo name) is a twenty-two-year-old Caucasian female who was currently having suicidal ideations which brought her in to the Behavioral Health Unit on a voluntary basis. Mandy is engaged to a supportive fiancée and together they are expecting a baby. The patient has a long history of depression, anxiety and PTSD but since her discharge from the Navy in March of this year her depression and anxiety have gotten worse. Most recently, the patient was living with her fiancée and her grandparents in her grandparent’s home. The patient was medically discharged from the Navy due to her PTSD. The PTSD is not military related, in fact, it was caused due to being drugged and raped at the age of 18 while she was away at college.