Acute admission via Ambulance. Status on Admission: Section 3 accompanied by S/W and two ambulance men.
This lady was admitted when the Police were called to attend as there was a disturbance in the street where the patient was being very abusive to neighbours.
Family state her mental health has deteriorated over last 2 weeks with her spending large amounts of money i.e. on a car, caravan, from a bank loan of £7,000. Apparently stopped taking her medication in two months ago as she was told she shouldn’t drive on medication.
The ladies mental state steadily improved following admission on medication, Lorazepam and Haloperidol. She remained stable on her medication but past history suggested that she would be non compliant with medication when discharged back into the community. The medical staff wanted to prescribe Risperidone depot injection as an alternative to oral medication ensuring compliance; she was initially reluctant to consent to this as she had heard ‘bad things’ about this treatment regime. However, she did finally consent to Risperidone depot injections. Unfortunately, she experienced severe and extremely debilitating side effects from the drug particularly severe akisthesia manifesting as not being able to sit still constantly pacing. The medical staff reported “Patient is low in mood, secondary to akisthesia. The prescription for Risperidone depot has appeared to decompensate her & cause unacceptable side effects.” Risperidone was withdrawn and Lorazepam and Haloperidol recommenced. Her akisthesia gradually subsided and she remained stable and pleasant.
The story concludes with the lady being allowed extended leave care of her family. Not long into the leave she stops taking her medication and becomes more and more agitated; final nursing report reads.. “Received a telephone call from patient’s daughter who explained leave did not go well. She said the patient had pulled her own house and her daughter’s house apart. She was playing music in the back garden very loud and all the neighbours have complained.
The lady has a high fasting blood sugar treated with Metformin 500 mg and diet and monitored by regular blood glucose measurements BM by the nursing staff.
Profile of Mental Health Case 00-102
Type of admission crisis. Status informal.
Admitted via AE where see was seen exhibiting anxiety/panic symptoms. Admissions in the past with similar symptoms and presentation. Although she was not voicing any suicidal ideation or desire to self harm it was felt she was vulnerable and needed admitting at least overnight. She was deemed vulnerable as her mum, main carer, had been admitted to hospital suffering from carcinoma of the lung (mum subsequently died).
The medical diagnosis is classified as depersonalisation. The patient often voices feelings of ‘not being here’ and having the ‘unreals.’ This is captured in a nursing that reports: ‘When speaking to patient she states she is at the bottom of a deep pit and feels she is about to lose her mind. She is unable to concentrate on anything.’
The notes pick the story up on day 164 of admission with the patient awaiting relocation to sheltered secure accommodation.
Her records portray her as a ‘worrier’ often tearful and anxious with occasional bouts of extreme agitation and distress requiring administration of Chlorpromazine. Between such bouts she sits in the lounge knitting. The nursing strategy is to use diversionary tactics, talking, walking, occupying etc. but the patient lacks any real motivation to participate preferring instead to dwell on her anxieties and feelings. When she does participate in occasional occupational therapy activities; the therapist describe her as emotionally labile with poor eye contact. They use STOP techniques and breathing exercises divert her attention away from her panic attacks and anxieties
The patient’s story concludes with the patient being very anxious and low in mood not feeling that she can carry on much longer expressing thoughts of wanting to die to be with her mother.
Profile of Mental Health Case 00-103
Admission Crisis. Informal Status:
Admitted to the psychiatric intensive care unit because of his deteriorating mental condition. Resident in a local mental health care rehabilitation unit immediately prior to this admission.
Nursing Staff from the rehabilitation unit report a dramatic deterioration in the patient’s mental state over last ten weeks leading up to this admission. He has increasingly become more agitated and restless, and has gone A.W.O.L. from the unit on several occasions. Staff also states that he has attempted to ‘run away’ on occasions by getting out through windows. The rehabilitation unit environment is no longer thought to be appropriate or capable of meeting his current mental health needs.
Medical entries query auditory and visual hallucinations however the patient refuses to elaborate upon this. Very agitated and restless on admission but unable to say why.
His agitation settled quite quickly on the unit treated with Haloperidol PRN and Clozaril. Periods of hyper salivation treated with Procyclidine and Hyocine. He regularly sought reassurance and company of the staff who reported his conversation has been ‘short & disjointed with him apparently losing the trail of conversation regularly.’
He gradually improved over the period of his in patient hospital stay and presented no real management problems. The story concludes with him having longer periods of leave at the rehabilitation unit with a view to his ultimate discharge back to there.
Profile of Mental Health Case 00-104
On going for one year:
This lady was admitted as a psychiatric emergency (reason not apparent). Her mental ill health commenced following the death of her husband. Diagnosed anxiety/vertigo and prescribed selective serotonin re-uptake inhibitor; note contraindications. On admission she is given Amlodepine (also note contraindications).
During length of stay she is often reported to ‘put herself on the floor’, usually when requested to go for meals. On more than one occasion, she states that she has to fall before she can walk. The notes inform that there is no change in mental state over 12 month period, with comments ranging between ‘interacting well, calm and quiet’ to ‘tearful, anxious and shouting’. This lady apparently often crawls back to the lounge from the dinning-room. On one occasion she takes her food to the lounge where it is taken from her. It is noted that she is willing to forego food rather than enter the dinning-room. Her risk assessment reports a normal diet.
There is an indication of a post-operative psychosis some 20 years earlier, but a clear psychiatric history is absent. She is also receiving medication for Parkinson’s disease and pain.