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

Profile of Mental Health Case 01-087

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Profile of Mental Health Case 01-087

Case summary

Crisis admission. Status on Admission: Informal. Active problems delusional Ideas, paranoid, minor Impairment in hearing.

Recent breakdown in her relationship with her husband. States that her husband bullied her and because of this she decided to leave and live on her own. Believes that her husband and sister are getting in to the house and stealing her jewellery.

Finds paper in the drive saying she is going off her trolley gets upset and tearful when people don’t believe her. Accusing people of stealing things and family says she has misplaced things. Believes that her telephone is bugged, neighbour wants her dead – as she’s worth more dead. She’s talking in riddles, wouldn’t agree to move nearer family.

Treated with Risperidol, two weeks into admission noted to be pleasant, quite dramatic expressions and hand gestures almost comical. Speech – circumstantial, no delusions at present – ‘I thought people were against me and things – I don’t know any more, the medications have made the difference.’ No hallucinations – no thoughts of self harm cognition intact. Insight good.

Takes long days out with her ex partner trips to the coast etc. Successful days out and home leave periods culminates in plans for discharge following home assessment and recommendation for discharge from the occupational therapist.

Profile of Mental Health Case 01-088

Case summary

Status on Admission: Informal.

Admitted for anxiety & for alcohol detoxification regime. Known patient of having alcoholic problems, having feeling low and had thought of self harming which he planned last week but resist harming himself as has many reasons to live. He denies drinking spirits and having too many drinks during the day, but admits he drinks during the day and has desire to drink all the day, he thinks he should stop drinking but can’t resist.

Patient states he’s been having problems with wife for 34yrs, states she’s very argumentative, feels his wife never thinks he’s good enough whatever he does. States they argue a lot until he eventually ‘snaps’ resulting in binge drinking. This happened recently and he has been drinking approx six cans of beer per day in order to ‘block it out’ Has suffered cold sweats passed out on one occasion and has ‘wet himself.’

Describes feeling anxious, agitated and flat in mood, feels responsible about marriage not working out as planned, states he has considered leaving wife but is too financially ‘tangled’.

Describes no appetite for last three days, but sleep remains same i.e. no problem.

Uneventful detoxification with minimal problems. Makes a pact with his son not to drink alcohol anymore. Discharged on day eight.

Profile of Mental Health Case 01-089

Case summary

Crisis team referral, following urgent request for assessment by CPN.

Patient has been suffering from anxiety for last two weeks, His Olanzapine was increased from 5mg-10mg last week, Last two days he has been shivering constantly, Denies non compliance with medication. Some evidence of depression.

Doesn’t know what is going to help him out of this. He didn’t sleep well last night. His wife is concerned about his health. ?suicidal risk – patient is unwilling to discuss any details. Still attending psychodynamics/psychotherapy once a week. Repeatedly told us that he has been having catastrophic thoughts but unable to explain it. B-blocker was tried in the past with no effect. Tremulous, difficulty with speaking, stuttering and long pauses. He says that he would end up saying what he did not mean.

A key feature of his presentation is panic attacks and feelings that some catastrophic event is about to happen. Extremely anxious & restless, severe flapping shakes of clenched hands clutched to his sides and bend at the elbow. Gets more and more worked up worried about not having his job, fulfilling his obligations, worried about being alone when his wife goes to work, worried about being financially dependable. Catastrophic thoughts – youngest step son may never come back from his holiday overseas. Wishing to fade away. No active suicidal thoughts -says he is in hell trapped by his worries nothing seems to help.

Had four Electroplexy (ECT) treatments, scheduled for six but did not feel they were helping. Makes little progress on his anxieties during is hospital stay. Mother wants him to be transferred to a well-known specialist private mental health unit for intensive treatment; patient is unwilling to do this but feels dominated by his mother.

One episode of threatening to kill his wife whilst on home leave, patient escorted back to the ward by police. Trying to put his hands around people’s throats wanting to kill everyone

Referred for MRI scan to exclude any pathological changes in his brain and spine that may explain is tremulous movements, MRI no abnormality detected.

The story concludes with very little evidence of improvement or change in his overall mental health status and the patient requesting discharge with some structured home activities.

Profile of Mental Health Case 01-090

Case summary

Status on Admission: Informal.

Admitted because she complains of feeling low and depressed for the past 5-6 weeks, known case of MDP on lithium from 1991, on Cipramil for the past 2 years, Sleep disturbed, wakes up in the night, I get depressed for nothing I have good husband, good friends, good house’ ‘I don’t have energy to do anything sometimes I watch TV.

Started with depression at the age of fourteen years, prescribed medications, which she didn’t take regularly, had another episode at the age of twenty-one years. Diagnosed with when she was 24 she was diagnosed as Manic Depressive Psychosis (MDP) and started on Lithium. One attempt at suicide three years back, took around 30-40 tablets, She doesn’t remember the name of the tablets.

Settled quickly on the ward with improvements in both appetite and sleeping patterns, although she complained that she was sleeping excessively. Appeared to appreciate the sanctuary of the ward referring to it as a ‘acting like a safety net.’

The story concludes with her discharge care of her family and being advised to build a structure in her life, motivation etc rather than change in pharmacological regime. Citalopram was increased to 60mg daily. Has some misgivings about her discharge and the risks this poses, though these are not elaborated on.

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