Intro and Assess- SWK 6511
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School
Aurora University *
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Course
6511
Subject
Medicine
Date
Dec 6, 2023
Type
docx
Pages
4
Uploaded by HighnessHeatGull40
1
Introduction
In the ED of Advocate Illinois Masonic Medical Center, there are a variety of services that
are offered. I specifically worked /interned in psychiatric services which mainly included the
Crisis Team. The crisis team often evaluated psychiatric patients that were admitted or referred
to the emergency room. The evaluation usually consists of whether the patient has had
previous psychiatric diagnosis or admissions, what symptoms they are experiencing, what kind
of support system they have, any sort of AVH or SI/HI, etc. Throughout my time here there was
definitely a variety of patients who had different symptoms, different stories, and different
coping mechanisms.
A 28-year-old Latino male presented to the ER presenting as very physically aggressive
with a BAL of 545. This particular patient was brought in by his mother and sister due to a rising
concern that the patient will hurt himself or others. The patient originally grew up with his
mother and father and his younger sister. When the patient was around 9 or 10 years old, his
father left the family. The patient's collateral contact, his mother, explained that this
abandonment has taken a toll on the patient as he was growing up. Due to this, the patient his
mother and sister live in a single household.
Growing up, the patient struggled with unhealthy coping mechanisms such as self-
harming and substance use. When the patient was seven years old, one of his father's friends
sexually abused him. This life event took a significant toll on the patient, and this was a secret
that he kept from his mother up until a few days before he was brought into the ED. The
patient's mother was the one who brought the patient into the Ed because she believed that he
needed treatment and needed to be evaluated. The patient's mother reported that the patient
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had a significant increase in suicidal ideation and behaviors. This included trying to overdose on
multiple substances as well as being physically aggressive. The patient's mother endorse that
she was very scared and worried about the patient actually “going through” with his suicidal
ideation.
Upon arrival to the ED, the patient was combative, had slurred speech, and was making
incoherent statements. Bringing the patient to the ED was difficult for the patient's mother
because there was an underlying fear that because she was undocumented, there would be
issues with her son receiving the treatment that he needed. The patient's mother knew her son
needed help and was willing to overcome that fear in order to have him receive the treatment
he needs. Growing up as a Latina and also within Latino culture, mental health is something that
Is never often discussed. A mentality that is often seen is if an injury or an illness cannot be seen
then it does not exist.
Based on the systems the systems theory, an individual is not the way they are because
of themselves. They act or behave a certain way due to a variety of factors such as, their
environment, social settings, family, friends, etc. This specific theory can be used to treat
depression. Being able to identify how certain systems influence the patient can help eventually
break down where these systemic breakdowns are affecting behavior. Another theory that can
be applied to this situation can be the psychodynamic theory. Using this theory, it can help
explain the internal processes in the patient. The traumatic experiences the patient had can,
and is, affecting the patient subconsciously. This can help truly see how childhood experiences
affect patients today as adults.
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Assessment
Based on the assessment of the patient, the best diagnosis would be Unspecified
Depressive Disorder (F32. A). I have decided to go with diagnosis because the patient meets
some symptoms of MDD, but not entirely. Judging on the patient’s symptoms, when he was
sober and when he was intoxicated, the main symptoms that the patient fell under was
“recurrent thoughts of death and suicide” and “feelings of worthlessness” due to previous
traumatic events.
In order to receive the most accurate responses, the patient needs to be completely
sober. This is important because the responses provided can be completely different when
provided by someone who is intoxicated or someone who is sober. In this instance, we waited
until the patient was sober in order to decide whether they needed an inpatient psychiatric
admission. Something that needs to be taken in consideration is the collateral information given
by someone who is closest to the patient. In this case, it was the patient’s mother who was able
to provide a ton of information of the patient’s background. We might’ve not been able to
receive this information if the patient was hesitant to provide it.
Once the patient was sober, he was evaluated with the Columbia Suicide Severity Rating
Scale (C-SSRS) along with a BHS evaluation. Based on the results from the C-SSRS and along with
the responses given during the BHS evaluation, the patient was deemed to be “high-suicide
risk” which meant that he would benefit from an inpatient psychiatric admission due to having a
high odd of injury to self.
Once the patient is psychiatric admitted, the patient receives another evaluation by a
psychiatrist. This second evaluation helps provide an insight to the doctor on what would be the
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best course of treatment for the patient. This is helpful for the patient to receive an actual
diagnosis and possible medication treatment along with therapy.
With the two HBSE theories, we can learn more in depth about how the patient’s
previous experiences can have a toll and affect on him. Getting to the bottom of how these
traumatic experiences can subconsciously have an effect on the patient. The patient has a huge
recovery rate that he is receiving care and has such a great support system. Relapse prevention
is simply by giving the patient the resources he needs to success after being released from
inpatient psychiatric care.