Problem:
David Gray is a 23-year-old single Caucasian male who is initially evaluated in the emergency room where he was brought by police on an emergency hold/police request for psychiatric evaluation. His mother, Lillian Gray, with whom he lives, called 911 after he threatened to kill himself. She is present for the evaluation.
In the emergency room, David is extremely agitated, red faced and aggressive toward the staff. He swears and when the police remove the handcuffs, he lunges for the nurse. A security code is called, and with the assistance of his mother, David agrees to take a shot of Haldol and Ativan. He calms noticeably, but appears distracted and admits to hearing the voice of the devil telling him to end his own life. His mood fluctuates rapidly, at times sobbing, and then in a matter of minutes laughing and talking rapidly with an off punctuated cadence, where he repeats certain words. His mother describes that David has always had emotional problems. "He was always very shy, never made friends, and told me that pot was the only thing that calmed him down. He dropped out of school in the tenth grade, he just stopped going." He has been hospitalized twice, both times involuntary with similar presentations and has had two additional emergency room evaluations where he was discharged home with his mother and referrals to outpatient treatment. "I tried to get him to keep those appointments, but he won't. He insists there's nothing wrong with him."
The family history is significant for a maternal uncle with schizophrenia who committed suicide, As David spends more time on the unit it is noticeable that he displays some bizarre behavior with pressured speech and rapid shifts in his mood. He continues to report hearing voices which are command in nature. He reports that he has been hearing voices since the age of 14. It is usually the voice of a man he does not recognize, but he thinks its the devil. It often tells him to harm himself or carries on a narrative of derogatory comments about David, "you're a worthless piece of shit..." He rates his mood as severely depressed. When asked to rate his anxiety he indicates that he rates his anxiety at about an 8 out of 10. David's mother also reports that her son's mood fluctuates between extreme depression to where he won't leave his room for weeks, and even months, at a time, to periods of manic agitation. During these periods he stops sleeping, becomes loud and hyperverbal, and talks about having special powers. During these episodes his mother calls the police because his behavior becomes frightening and at times dangerous, such as getting behind the wheel of a car and driving at high speeds while intoxicated. She believes that even when he is not depressed or manic he continues to hear voices. Need Assignment Help?