IRRITABLE, AGGRESSIVE AND ON A MISSION

Sample Solution

  Comprehensive Psychiatric Evaluation Patient: 22-year-old male Chief Complaint: Admitted to psychiatric inpatient unit under involuntary admission for bizarre behavior and threats of violence. History of Present Illness: The patient has been behaving strangely for the past 2 weeks. He has been spending a lot of money, talking openly about his sexual exploits, and hardly sleeping. He has also been threatening and aggressive towards his grandmother. He was prescribed olanzapine 5 mg nocte, but he has only taken it a few times. This morning, he hit his grandmother, which led to his involuntary admission.

Full Answer Section

    Past Psychiatric History: There is no significant past psychiatric history. Past Medical History: There is no significant past medical history. Family History: The patient's mother died of a drug overdose when he was 6 years old. He has no contact with his father. Social History: The patient lives with his grandmother. He uses cannabis regularly but does not abuse alcohol or any other drugs. He smokes 40 cigarettes a day. Mental Status Examination:

• Appearance: The patient is dishevelled and appears to have not slept in a few days. He is pacing up and down the ward corridor, singing out loud. He also laughs and talks to himself.
• Attitude: The patient is hostile and refuses to cooperate with the interview. He swears at the interviewer and walks out of the room when asked to discuss his thoughts or experiences.
• Speech: The patient's speech is loud and pressured. He is difficult to interrupt.
• Thought Process: The patient's thought process is disorganized. He is jumping from topic to topic and making grandiose statements.
• Mood: The patient's mood is elevated. He is elated and believes that he is of royal descent.
• Affect: The patient's affect is inappropriate. He is laughing and smiling when discussing serious topics.
• Delusions: The patient believes that he is of royal descent and is destined to establish a new world government.
• Hallucinations: The patient denies having any hallucinations.
• Insight: The patient has no insight into his illness. He believes that he is perfectly sane and that everyone else is wrong.

Diagnosis:

• Schizophrenia, paranoid type
• Acute mania
• Intermittent explosive disorder

Treatment Plan:

• The patient will be started on an antipsychotic medication, such as olanzapine or risperidone.
• The patient will also be started on a mood stabilizer, such as lithium or valproic acid.

The patient will need to be closely monitored for side effects of the medications. The patient will also need to be referred for psychotherapy to help him manage his symptoms and develop coping skills.