Case Conceptualization
David is a 23 year old single,caucasian male who resides at his
mother, Lillian Gray's home.
Client was seen by ER after his mother, Lillian, called 911 due
to a threat to commit suicide that client made. PD arrived on
the scene, assessed the situation and sent him to the ER.
Client presented with a blood alcohol of 0.12% (0.08% being
legal limit), toxicology report showed positive for marijuana
use, and vitals showed an elevated B/P. Client was highly
agitated and showed signs of aggression toward hospital staff,
requiring an injection to calm him,and after injection calmed
him down, he was very distracted and reported to be having
auditory hallucinations of a male voice,(the Devil)insisting
that he kill himself. Client presented with rapidly changing
moods: laughter-crying-rapid and repetitive speech. After
another injection his B/P went down and as the alcohol wore off
he displayed more symptoms of hearing voices,and talk of
suicide. Another injection was administered, client fell
asleep.The ER doctor assigned to the clients case made the
decision to admit based on possible self-harm and that he was
gravely ill,and was suicidal. After the 3rd day in hospital,
client transferred to inpatient psychiatric unit. Client's
substance abuse symptoms under control,w/ Lorazepam as well as a
medication for his B/P. Psychiatrist ordered Risperidone, but
client refused, claiming that he only needs marijuana. Client
appears calmer w/o additional emergency injections.
"Lillian,: the client's mother sid that he has had emotional
difficulties since he was in middle school and that when he
began to self-medicate with cigarettes, marijuana and alcohol.
There were 2 other involuntary hospitalizations and several ER
visits for the same symptoms as well as intentionally overdosing
several times in effort to end his life. He had been referred to
Outpatient treatment prior to this ER visit, but he refuses help
and said, "there's nothing wrong with me, I only need
marijuana".The client's depression he rates as 10 on a scale of
1-10, his anxiety he said is an 8. His mood varies from severe
depression to mania w/ drug and alcohol use. The client puts
himself at risk of being harmed or worse by making bad decisions
in dangerous situations, example being his arrest record and 2
dui's and charges for extreme speeding. The client admits his
alcohol consumption had gotten out of hand, but states he
doesn't need help, he can quit at home. He also claims that as
soon as he returns home he will begin to smoke marijuana again.
Medical
According to the lab's reports, the client is in exceptionally
good health. The only thing found was elevated liver enzymes and
MCV. Follow up appointments will determine cause and implement
any treatment if necessary.