Referral information so far:
Tom is a 19 year old labourer who lives with his mother (Theresa). His father was an alcoholic and left the family when Tom was 8 years old. Tom was brought in by police under section 22 of the Mental Health Act, after a passer-by noticed Tom bleeding and lying on the side of the road and called an ambulance. He refused to go to hospital and the ambulance officers called the Police. The police reported that when they approached Tom he shouted ‘I am better off dead’ and ‘I know the devil wants me’. He arrived in the emergency department around 3 a.m. with a lacerated arm.
On arrival to the emergency department he appeared to be heavily intoxicated. At the triage station his blood alcohol concentration (BAC) was recorded as 0.22mg/%. A number of superficial scratches and a 2.5 cm laceration to his left arm were noted. He had told the triage nurse that he has been drinking since 7 pm the previous day. A number of severe acne type lesions were noticed on Tom’s face and also some track marks noted.
Overnight Tom’s lacerations were treated, he was initially hostile but then his hyper-vigilance decreased and he slept until 6 am when he woke and became agitated, wanting to leave immediately but was able to be settled with 10 mg of oral diazepam.
Tom’s girlfriend, Jenna aged 16 years, apparently visited at about 04.00 AM. She had been looking for him after they had a fight yesterday afternoon/ evening. Jenna was described as looking approximately 6 months pregnant, unkempt, with facial acne and some visible track marks. Jenna said Tom has been a real worry for the last 6 weeks since he was arrested and charged for 3 break and entering offences and one assault. He is due to appear in court over these matters in 2 weeks. Jenna told the nurses that Tom reckons he was being framed for those offences by someone evil and then she left at around 04.30 AM in the company of her girlfriend.
A medical officer was called and provided a very brief assessment before prescribing diazepam. The client’s notes include his mental state examination as follows:
Appearance & behaviour: Thin, unkempt young man, dressed in a hospital gown, pacing up and down next to his hospital bed and continued to move constantly during the interview: seeming hyper-vigilance and intense eye contact noted. Cooperative but guarded
Mood: Claims he is fine
Affect: Agitated and volatile, easily annoyed.
Speech: Fast rate, clipped rhythm and direct.
At times answering with few words – though not really monosyllabic.
Thought Form: A few times he seemed to have trouble answering or provided an irrelevant answer,but seemed to quickly pass over these incidents/ a bit like he was covering up
Thought Content: Denies any current suicidal ideas. Claims he just cut himself with a bottle because he felt depressed about his charges but he didn’t want to kill himself.
Says he doesn’t know why he does it. Says that people are framing him for the break and enters he is charged with and that he wants to leave hospital as they might try to get him here.
Denies visual or auditory hallucinations but became a little annoyed by me asking these questions
Write a case analysis using the information provided depicting the assessment and management of this client.
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