Case Study: Henry Lawless 20 years LATER
Vital Signs: HR 82, RR 16 BP 130/72, Temp 99.8 ax, O2 sat-94%
Introduction:
Henry lawless is a 32- year- old single, African American, incarcerated male. Patient was referred by he social worker assigned to his care.
Chief Complaint:
"I can't handle how I feel; I'm on the verge of exploding at every minute."
History of Chief Complaint:
Henry was sent to jail due to driving while ability impaired (DWAI), specifically by alcohol, as well as resisting arrest and spitting on an officer. He has been in jail for the past month. This is his first visit with the prisoner clinic for medication management since coming to jail. He states he started drinking socially at age 16; However, over the past few years he has been drinking excessively to "mask all the rage I have inside". He states that he knew he had a problem with alcohol about a year and a half ago when he received his first charge of driving under the influence of alcohol. His license was suspended; However he states he drove with a suspended license to get to work as a construction worker. " I needed to get to work to pay my rent so I figured I could get away with it." He states when he received his second DWAI he soon lost his job and began drinking more heavily. He states he needed more and more alcohol to "quiet my mind and that he began drinking early in the morning to" just feel normal".
Henry states that he went to rehab once, about eight months ago, then abstained from alcohol for six months after he completed the 28 day program. He began drinking again two months ago. He states that while he was not drinking, he felt extreme anger and agitation, often getting into fights with his landlord and other neighbors, which he feels led him back to drinking.
Currently, the patient states that he feels anger all the time, I feel like I'm going to kill someone or freak out. He has gotten into multiple fights with other inmates and was seen crying or shouting in his cell by numerous correction officers. He states that he was taking medications in the past, prescribed in jail, but they made him feel worse so he stopped taking them and started drinking again. He does not know the name of the medications.
He thinks one was called Antabuse.
He reports feeling sad for the past month, angry, difficulty concentrating, poor sleep (about three to four hours nightly of sleep), and fluctuating appetite. Patient denies a history of elevated mood for two weeks or more, but does report irritability, rage and anger often, "moods ups and downs", and impulsivity and unpredictable behaviors such as fighting and intimidation toward his girlfriend. He reports history of intrusive thoughts recalling his father's death and his father's physical abuse towards his mother. However, he states that this is only occurred once or twice in the past five years.
Past Psychiatric History:
Henry denies any past psychiatric hospitalizations. He denies ever seeing a therapist. He saw a psychiatrist through his rehab facility for the first time this year. He was prescribed fluoxetine, which he states made him feel worse and more irritable. He denies any history of suicide attempts. Patient does not have a current outpatient psychiatric provider.
Explain the Clinical Course of alcoholism to Henry. Include any cultural considerations. (Elaborate on at least 3 concepts)