Problem: You have a patient you have treated for the past 8 months. He is a 16-year-old with a diagnosis of oppositional defiant disorder (ODD), attention deficit hyperactivity disorder (ADHD), and generalized anxiety disorder (GAD). The patient is a sophomore in high school and works after school at the local grocery store. At your most recent appointment, he tells you he has fantasies about one of his female customers. He states that she "flirts with me" and always asks me to take her groceries to her car. He states that she wants to be in a relationship with him but is married. He states that he overheard her talking to someone on the phone this week. She looked sad, and he heard her say, "I don't know how much longer I can stay with him. He's so mean." He became very upset and said it was "not right." He denied ever having a more in-depth conversation with this woman and does not know much about her personal life. He does not know where she lives; he just helps take groceries to her car. She will say "hello" and "goodbye," but that is the extent of their relationship. He reports that he thinks about following her home from the grocery store "to protect her" and scare her husband into leaving so they can be together. When you ask if he ever desires to hurt the husband, he says no, he just wants to scare her husband into leaving.
1. Based on the information provided, do you think this patient is at risk for harming this woman and her husband? Do you believe you have a duty to warn this woman and her husband of the patient's fantasies?
2. Do you break confidentiality and disclose these fantasies to his parents? What are his rights as the patient, as a minor? What factors do you have to take into consideration? Need Assignment Help?
3. What legal case regarding patient rights is this case study similar to? What are the differences?
4. What further assessments would you want or need to perform for this patient? Is there a screening tool or risk assessment tool to use? Does this patient need involuntary commitment at this point?