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

Profile of Mental Health Case 01-083


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Profile of Mental Health Case 01-083

Case summary

Crisis admission. Status on Admission: Section 2 of the MHA.

Brought in by ambulance Paramedics from a neighbours house who contacted the hospital stating the patient had been behaving bizarrely, elated, scratching him self, scrabbling about on the floor, taking about Spirits and Ghosts. Was dressed only in Tracksuit bottoms and was loud and threatening in manner. Patients own flat is in a mess, yogurt on the floor, water thrown about to combat spirits. Diagnosed as Bi-polar affective disorder. Denies Auditory & visual hallucinations, but has stated that the Dr ‘Glowed Green’.

Twenty-eight years past history of metal health, problems first episode when he was sixteen years old. Regular cannabis user since the age of thirteen; past four months been smoking cannabis heavily up to twenty pipes per day of ‘skunk weed,’ a very strong derivation of cannabis.

Many of his delusions refer to spirits and ghosts and persons travelling back in time from the fifteenth century to silence him as he knows the ‘truth.’ His beliefs appear to map to a series of ghost stories by an author he names and in particular ‘Gino’ a key player in these stories.

His early in-patient stay is defined by agitation and bizarre behaviour and hostility and aggression towards staff and fellow patients; affect flattens probably as a consequence of his medications. Gradually improves over time with less bizarre behaviour and improving mood.

The story concludes with the patient settled and calm but frightened about being alone. Housing placement and self care issues are key problems needing to be addressed before discharge can be considered.

Profile of Mental Health Case 01-084

Case summary

Crisis admission. Status on Admission: Informal. Reviewed at request of Crisis Resolution team. Previous episode like this twenty years ago but not as bad as this time.

Partner out of prison for several weeks. Alcohol consumption increased. Recently drinking eight cans of lager / day + sherry. (Whilst at work, drinking less). Using as self - medication. Was drinking through the day. Withdrawal symptoms +. In addition uses cannabis ‘one joint every night to knock her down for sleep.’

Exhibits some classical symptoms of depression and low mood. On going for past four years but deteriorated significantly in the past four months: concentration very poor, can’t recall watching TV, losing track of time, poor, sleep pattern sleeping for only a couple of hours, wakes at 2am, no energy needs to push her self to carry out daily activities of living, poor appetite ‘none at all,’ not eating much. Feels hopeless, ‘bleak’, suicide doesn’t scare her, no plans at moment but is worried about the potential to act on this.

Trigger for the recent deterioration in mood appears to be release of partner from prison following a three/half year sentence. Fell out six months ago does not know where he is believes that he is having an affair, sees that there was no evidence for this, decided to take OD.

Settles on to the ward quite quickly, describe by the nursing staff as tremulous, quite anxious, and pleasant on contact. Patient’s mother worried at the marked weight loss down to 55Kg (8½ Stones) weekly weight measurements and supplementary drinks (Fortisip) implemented. Patient unwilling to drink the supplementary drinks, as she believes that they contain milk extracts, it is not clear (not investigated) why she feels she should not take foods containing milk extracts.

Mood improves steadily, often reported to be laughing and joking with fellow patients. Discharged care of mother and community team on day thirteen.

Profile of Mental Health Case 01-085

Case summary

Crisis admission. Status on Admission: Informal.

GP referred following low mood and a H/O self harm and stated suicidal intent. Weepy.

Attempted and superficially cut over wrists two weeks ago, has had similar attempts in the past about six times in the past eighteen months.

Currently on police bail for assault due to appear in court six days from admission date. Mood lightens quickly following admission but mum requests that discharge is not considered prematurely for her daughter as she feels she may attempt to take her own life.

Attends court for her hearing and the case is adjourned for three months. Patient requests and is granted leave the day after her court appearance and actually discharged while on leave on day twenty one.

Profile of Mental Health Case 01-086

Case summary

Crisis admission. Status on Admission: Informal. Admitted following referral from A&E.

Patient is well known to the psychiatric services diagnosed with Schizophrenia currently taking Clozapine and Procyclidine. Possible trigger for current mental state are concerns that she has regarding her mother’s recent crisis of an eye condition and the patient feared her mother may go blind

Yesterday took an overdose of Clozapine (twenty-eight tablets of 100mg), sister found her and brought her to A&E after calling an ambulance, and she vomited after taking the overdose. On admission feels medically stable but says ‘I’m feeling paranoid’ believes people know what she is thinking (? thought broadcasting) and states “Feel like people can control me inside my head.” Does experience auditory hallucination occasionally but not concerned too much about it “except when I am trying to sleep.”

She says she took an overdose because she was generally fed up with life, she thinks she has improved with Clozapine but still remains paranoid and thinks that “life is not worth living,” says family and friends don’t understand her illness, lives alone.

Initially her mood improved and was stable although when questioned admits to thoughts of suicide and self-harm. Several episodes of deliberate self-harm during the admission usually involving superficial gauges and scratches to her wrists using a pen. Nursed in an outer seclusion room following one such attempt of deliberate self-harm, she set fire to her clothing requiring dousing using a fire extinguisher. Sustained burns to her chest that needed medical treatment. States that she set fire to herself because she was experiencing thoughts of suicide.

The story concludes with her mood significantly improved, improving, and looking forward to living in her new flat. Several periods of successful leave from the ward culminate in a plan for discharge.

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