Short Friction

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Posts Tagged ‘Psychiatrist

Admission

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12/11/2004 17:30 22 year old male brought in by police after being charged with vandalising public property. Police observed Wayne behaving oddly prior to his arrest and report that his unusual behaviour escalated during interview until they became concerned about his mental health.

MSE

22 year old male appears stated age. Dress inappropriate for today’s 30 degree heat: wearing a thick woolen winter coat and black parachute pants. Behaviour agitated, restless, but no aggression evident. Poor eye contact – patient looking down at hands for most of interview. Reduced speech production with lack of spontaneity. Incoherent at times. Normal rate, low volume. Mood euthymic. Denies suicidal or homicidal ideation. Affect reactive. Cognition normal: MMSE 30/30. Nil FTD. No evidence of hallucinations. Denies same. Some grandiose and paranoid delusions: Believes that he can and must prevent unspecified harm to others by shaking aerosols. Believes he knows this because of messages written on the aerosol cans. Poor insight: states he does not have a mental illness, believes he just has a problem with “addictive habits”. Has refused all oral medication since admission. Judgment impaired – it appears he was acting on delusions and ?command hallucinations when he was picked up by police engaged in an act of vandalism in Brunswick.

Past psychiatric history

Wayne presents with no known psych history. He reports no prior presentations to mental health services. Denies any family history of mental illness. He states his first symptoms began around 18 months ago when he found himself worrying excessively about the potential consequences if he failed to shake his personal aerosols (e.g., deodorant, shaving cream).

Presenting problem

Wayne was picked up by police with a female friend vandalising the wall of a Brunswick business. At the police station Wayne was observed to be behaving in an anxious and suspicious manner. He was described as erratic and dangerous. He lunged at a police officer who removed a can of spraypaint from his backpack to take as evidence. After he was prevented from attacking the officer and placed in a cell for observation Wayne was seen to be pacing and talking to himself. Wayne says he had thought the officer was going to discharge the spray can, with disastrous consequences. When asked why he was talking to himself he states he was trying to find the right thing to say to prevent anything bad happening.

Impression

  • Schizophreniform disorder
  • No medical problems
  • Requires further treatment – has not been compliant with medication so far
  • Absconding risk

Plan

  • Commence olanzapine wafers 10mg BD
  • CT head
  • Half hourly obs for risk of absconding/aggression
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Written by shortfriction

06/12/2009 at 20:50