Mother entered a drop in GP medical centre & subsequently CPN was involved, Patient has recently moved to stay with mother with her child Son aged four. Mother has been concerned with her daughter’s neglectful behaviour towards the child & her aggression towards the child. Also mother states Patient is hearing voices & believes something controls her behaviour/actions, Mood swings- charming one minute & aggressive the next, Concerns regarding violence acts towards baby -> an incident where she prevented patient from throwing baby across the room. The patient admits to aggression towards the child: “I hit him on Friday on his eye” “Just got mad and upset,” } explains actions towards the child,
‘I regret it so much”. Reduced sleep “Haven’t slept properly for a long time doing stupid things like staying up all time.”
Admits to hearing voices in her head and expresses ideas of being controlled by some form of ‘possession’ but is quite guarded & gives tangential answers to specific questioning about this.
She makes steady progress throughout her in-patient stay with improving mental health. The core issue to be addressed is the continued care of the baby. The baby is currently staying with the patient’s mum who herself has mental health problems and over the past weekend attempted to slash her wrists. Patient is concerned for the well-being of her child and is torn between meeting her own needs for treatment and meeting the needs to care for her child. Social Services become involved in assessment of the child and the family’s needs but their resources are overstretched resulting in long delays in assessment and support structures being put in place?
The story concludes with the patient being ready for discharge with no evidence of hearing voices and the medical staff querying postnatal psychosis or schizophrenia as the primary diagnosis. The baby is placed on the ‘At Risk Register’ and social services suggest placing the baby in care until housing has been sorted patient has told them that this is not what she wants. Social services are at present arranging a child protection case conference for the baby but as yet a date has not been set.
Says he drink too much’ ‘All right when I’m working, not working I get depressed.
Eye opener + uses alcohol first thing in the morning. Drinks in the house – not in pub
Drinks beer & strong larger (5 cans of strong larger) drinks till about 10pm.
Wants to get off the drink feels guilty feels it is affecting his relationship with his son and daughter. Managed on the ward through abstinence and Chlordiazepoxide medication. Very pleasant and amiable. No problems during detoxification other than a couple of episodes of epileptiform seizures; known epileptic on Valproate. The patient attributes his seizures to the large amount of coffee he is drinking; advised to limit his coffee intake.
Successfully completes detoxification and is discharged form hospital on day ten.
Profile of Mental Health Case 01-081
Admission for Assessment. Status on Admission: Informal
Lady admitted for assessment of her mental state. Known to have suffered in the past from a bipolar affective disorder, alcohol abuse and cognitive impairment secondary to alcohol related brain damage. On admission she was non co-operative, sitting huddled with a blanket around her shoulders, with no eye contact. Her mood seemed agitated and labile, annoyed at everything that was happening to her and pre-occupied with her past. Her speech was soft but normal in rate. There were some flights of ideas. She believed she was having physical problems such as a stroke or epilepsy. Her cognition was normal but she had no insight into her condition.
Focus for her mental health problems appear to relate to the sheltered accommodation she currently resides at. Believes that the water supply is poisoned with lead and that ‘they’ are putting faeces in the water. She complains that the home is filthy and that there is a lot of prostitution and the staff are unqualified. She is adamant that she will not go back to live there.
Quickly settles on the ward. Has several occasions when she goes out and returns to the ward intoxicated usually attributes this to some emotional event in her life such as the anniversary of her sons death. Goes AWOL on at least two occasions.
Profile of Mental Health Case 01-082
Crisis admission. Status on Admission: Section 3 Mental Health Act
This lady is well known to the psychiatric services, thirty previous admission for manic type symptoms in the past twelve years. Though to be non compliant with medication
Admitted via A&E where she had presented in a high and agitated mood could not remember why she rang the ambulance ‘Can’t remember why I rang for an ambulance’. ‘I want to stop smoking’. Believes that she is pregnant ‘I am pregnant husband told me’ believes she is a doctor “I am GP and Psychiatrist.” Pressure of speech and flight of ideas a key feature “Got plenty of ideas in my mind.”
Disinhibited in the early part of her admission, refusing to wear underclothes, talking to fellow patients and staff in an inappropriate way about sexual matters and her periods. Prolactin levels noted to be high and thought to be side effect of her Risperidone medication. One episode of going AWOL from the ward and turning up in a pub, contacted on her mobile phone by the ward staff and returned without mishap.
Gradually improves with periods of leave being granted under section 17 of the Mental Health Act 1983. On one such leave she was returned to the ward by the police as she had become disruptive and aggressive at home. Appeal against compulsory detention under Section 3 of the MHA unsuccessful. Medical and nursing staff all believe that she is a danger to herself and that she will not comply with her medication regime voluntarily. Marked improvement in her mental state following increase in her Risperidone dose.
The story concludes with her being settled and stating that she wants to find a job. Remains on section 3 and states she has no intentions of appealing against this. The raised Prolactin levels are not resolved.