Suicide Risk Case Study Answers
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South University, Savannah *
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Course
MN662
Subject
Medicine
Date
Apr 3, 2024
Type
docx
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3
Uploaded by Venusina
Identifying Warning Signs Case Study: Feedback/Answers
HISTORY OF PRESENT ILLNESS
The client is a 65-year-old
white male
, divorced
, living alone
, admitted to the hospital in a near comatose condition yesterday because of an overdose of approximately thirty tablets of Valium, 5 mgm, combined with alcoholic intoxication. The client was given supportive care and is alert at the present time.
A heavy drinker
, he has been unemployed
from his janitorial job
for the past three months because of his drinking. He acknowledges feeling increasingly depressed since being fired, and for the past two weeks has had insomnia
and a ten pound weight loss
. He indicates he wanted to die, had been thinking of
suicide for the past week, planned the overdose, but had to “get drunk” because “I didn’t have the guts” [to kill myself]. He
is unhappy that the attempt failed
, states that, “nobody can help me
” and he sees no way to help himself. He denies having any close relationships
or caring how others would feel if he committed suicide (“who is there who cares?”). He views death as a “relief.”
His use of alcohol has increased
considerably in the past month. He denies having any hobbies or activities
, “just drinking.”
PAST PSYCHIATRIC HISTORY
Hospitalized in 1985 at Pleasantview Psychiatric Hospital for three months following a suicide attempt
after his fourth wife left him
. Treated with ECT, he did “pretty good, but only for about two years” thereafter.
SOCIAL HISTORY
An only child, his parents are deceased
(father died by suicide
when client was eight years old; mother died of “old age” two years ago). Raised in Boston, he moved to Los Angeles at twenty-one and has lived here since. Completed eighth grade (without any repeat) but quit to go to work (family
needed money). Has never held a job longer than two years
, usually quitting or being fired because of “my temper
.” Usually worked as a laborer. Denies any physical problems other than feeling “tired all the time.” Currently living on Social Security income, he has no other financial resources
. He received a bad conduct discharge from the army
after three months for “disobeying an order and punching the officer.” He has had no legal problems other than several arrests in the past two years for public intoxication. Married and divorced four times
, he has no children or close friends
.
MENTAL STATUS EXAMINATION
65 y.o. W/M, short, thin, grey-haired, unkempt, with 2-3 day-old
beard, lying passively in bed and avoiding eye contact. His speech was slow and he did not spontaneously offer information
. Passively cooperative. Little movement of his extremities. His facial expression was sad and immobile.
Thought processes were logical and coherent, and no delusions or hallucinations were noted. Theme of talk centered around how hopeless the future was and his wishes to be dead
. There were no thoughts about wishing to harm others.
Mood was one of depression
. He was oriented to person, place, and time, and recent and remote memory was intact. He could perform simple calculations and his general fund of knowledge was fair. His intelligence was judged average.
DIAGNOSTIC IMPRESSION
1. drug overdose (Valium and alcohol)
2. Dysthymic Disorder (depression)
3. Substance Use Disorder (alcohol)
QUESTIONS FOR EXERCISE
You have interviewed the client, obtained the above history, and now have to make some decisions about the client. He wants to leave the hospital.
1. Is he a significant risk for suicide?
Yes. The client presents a considerable suicidal risk, with respect to demographic characteristics, psychiatric diagnosis and mental status findings.
2. Would you recommend:
1. discharging him as he wishes and with your concurrence?
2. discharging him against medical advice (A.M.A.)?
3. discharging him if he promises to see a therapist at a nearby mental health center within the next few days?
4.
holding him for purposes of getting his psychiatric in-client care even though he objects?
3. Discuss briefly why you would not have chosen the other alternatives in question #2.
The client appears
to be actively suicidal at the present time,and may act upon his feelings. Nothing about his life has changed because of his attempt. He still is lonely, with limited social resources. He feels no remorse for his suicidal behavior and his future remains unaltered. He must be hospitalized until
some therapeutic progress can be made.
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