In Context Case Summaries Profile of Adult Patient Cases pages 2-37

Profile of Learning Disability Case 01-098


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Profile of Learning Disability Case 01-098

Case summary

The story starts with a meeting between Paul’s [the client is referred to has Paul throughout the case file] teacher and the psychiatrist. Paul started school two years ago, and his teacher states that Paul’s behaviour started to deteriorate nine months ago in association with the court decision with regard to him and his sister, that they should be removed from the family and put in the care of Social Services. Since that decision there has been a steady decline, even though he has been quite happy with his foster carer for the last two years. There has been an increase in the intensity and frequency of his disturbed behaviour in school. The disturbed behaviour seems to be of an attention seeking type, where he makes demands by outbursts of behaviour. It does not seem to be a classic temper tantrum in that he carries out his disordered activities and looks to see if anyone is noticing. There is a considerable doubt as to what extent he is not in control of this behaviour. He has seen an Educational Psychologist recently, who thinks Paul is depressed and seriously disturbed.

The story recounts how Paul’s relationship with his foster parents becomes strained and then breaks down because of his challenging behaviours. The decision is taken to move him from the foster home into a residential home.

Paul’s behaviour improves while at the residential home becoming settled and exhibiting appropriate behaviour, nursing entry reports….met with children’s home staff….staff report him as continuing to be settled. There have been no reported behavioural concerns. He is not going to bed inappropriately dressed, bed-wetting or stealing at the present time. School reports continued positive behaviour in school. Has been better behaved and more manageable on contact visits.

Profile of Learning Disability Case 01-099

Case summary

The client and his brother (12yrs) were abandoned by their birthmother. They now live with their half-sister. At present, Children and Families Team are putting a Section 37 report together, to recommend that she remains the guardian for himself and his brother. He is due to move to Special School, but no firm arrangements have been made as yet. His half-sister has three of her own children and requires support to recognise and understand his needs. He has behavioural problems linked to his LD. he has been living with his half-sister for five months. Contact with his birth mother is supervised and structured by Social Services and occurs during holidays only.

He is displaying sexual behaviour towards little girls. Watching girls in the bath - sneakily. Nieces - 12yrs, 10 yrs, 4yrs. recently has pulled one onto his knee and made rocking movements. Was arrested by police age seven yrs for having sexual intercourse with a five old girl. Police dropped charges due to his lack of understanding of what he had done.

The client exhibits challenging behaviour at school very disruptive at times and absconding. Generally stable in the home environment but beginning to display similar challenging behaviours e.g. he ‘trashed’ his bedroom at one point.

Profile of Learning Disability Case 01-100

Case summary

Much of this case files relate to two parents who have borderline learning difficulties [mum assessed at IQ 72]. They have three children, two boys and one girl. The children have been removed from the parent’s home because of parental abuse/neglect and placed with foster parents.

The parents are making a case through the courts that their children should be placed back in their care; up to the point of closure of this file they have been unsuccessful.

The recommendation from an independent organisation is that the middle and eldest child are placed back with the parents. Both of these children have been diagnosed as suffering from Autistic Spectrum Disorder and in the case of the girl she has some challenging behaviour including smearing herself and other children with her faeces.

Profile of Mental Health Case 00-100

Case summary

Crisis admission. Status on Admission: Informal.

Police were called when the patient became violent at home. He had used a piece of wood as a weapon. Family had become concerned due to his increased use of amphetamines over the past few weeks. Floridly psychotic on admission. Believes he is a quadruplet, has telepathic powers. Thinks he is a faith healer and has psychic abilities.

The patient claims that his elder brother threatened him with a knife which led to his violent outburst today. Believes his brother is having sex with under aged girls their activity is keeping him awake at night. He is generally in good physical health. A heavy smoker and user of illicit substances particularly Cannabis and Speed (amphetamines) which both tend to exacerbate his psychotic symptoms.

Has been living with his mother but family feel this is no longer appropriate due to his violence and aggression.

Remained an In-patient for seventy-one days with periods of home leave. Exhibited severe thought disorder, flight of ideas and auditory hallucinations. Treated with anti-psychotic medications including oral and IM depot injections.

Gradually improved over the course of his in-patient stay but continued to display quite grandiose delusions: “I am noble, I am royalty, I am an emperor” took to wearing a green headband at one stage to denote his royal heritage. Several instances of physical and verbal violent outbursts while on the ward. On one occasion, he carried out a vicious and serious assault on a patient.

The patient’s story concludes with extended periods of home leave care of his family. His behaviour remains bizarre at times and his auditory hallucinations endure; final nursing entry reads: “Patient’s step father informed us that patient made sexual comments towards his 13yr old daughter.”

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