Case study : 37-year-old female brought into the state psychiatric hospital by the police.

Chief Complaint:

“You all are all morons! I want to go home. There’s nothing wrong with me and I shouldn’t be here. Do you see that there are alien doctors at the hospital, and they are helping to take over if we don’t do something to stop them?”

History of Present Illness:

37-year-old female brought into the state psychiatric hospital by the police. The patient attacked a police officer under the bridge where she is apparently living. The police were investigating a report of theft of food from a nearby grocery store. The report included information about the thief did not appear to be making any sense talking about needing food to store for when aliens invade the planet. The police report that when they went to investigate the reported theft, the patient talked of the city water supply being poisoned by aliens, seeing aliens under the bridge that look just like her and that alien men had been raping her.

PMH:

Depression 5 years ago secondary to the death of her son; reports being on anti-depressants for a few months; denies history of any other mental health concerns

Complications secondary to arthroscopic knee surgery resulting in long term IV Vancomycin

Lymphoma diagnosed 7 years ago treated with six cycles of chemo with excellent response, in remission

+PPD for six years, treated for 12 months

Family Hx:

Mother diagnosed with schizophrenia at age 36

Maternal grandfather – placed in an ‘insane asylum for hysteria’

Social Hx:

Divorced with a daughter, son is deceased

Heterosexual

Homeless – living under the bridge, stating her family disowned her ‘years ago’

Employment history – primary work experience as a nurse aid, reports she has ‘difficulty keeping a job’

Legal history – no history arrests or legal charges

ROS:

General – denies loss of appetite or recent weight loss

Neuro – reports occasional headache due to ‘surgery performed on her by aliens’

Otherwise ROS is negative

SIGECAPS:

Reports sleep interrupted by aliens entering her space under the bridge, interest is focused on thoughts of alien invasion and her need to stop it, expresses no guilt, reports feels ‘hyper’ most of the time as she has to be on the lookout at all times, reports concentrates solely on alien invasion, denies changes in appetite, reports is constantly on the move, denies suicidal/homicidal ideations

Medications:

OTC Ibuprofen 400mg PRN HA

Allergies:

Mycins – upset stomach

Bactrim – rash

Physical Examination:

General – thin Hispanic female who appears older than stated age; disheveled in appearance;

BP 143/84, P 82, RR 16, Ht 64 in, Wt 109 lbs, BMI 19

Integument – warm, dry; good turgor; no rashes, ecchymoses or petechiae noted

HEENT – Head is normocephalic and atraumatic, PERRLA, EOMs intact, TMs gray and shiny bilateral, nares patent without discharge noted, no tonsillar enlargement

Neck – supple without adenopathy, no thyromegaly

Lungs – CTA

Breasts – deferred

Heart – RRR without murmur/gallop

Abdomen – soft, non-distended, active bowel sounds, non-tender, no organomegaly

Genitalia/Rectum – deferred

Musculoskeletal – no gross abnormalities noted

Neurologic – lethargic, DTRs 2+ and equal bilateral, negative Babinski

Diagnostics – Na 140 meq/L, K 4.0 meq/L, Cl 102 meq/L, HCO3 22 meq/L, Bun 14 mg/dL, Cr 0.8 mg/dL, non-fasting Glu 134 mg/dL, Ca 9.9 mg/dL, PO4 3.2 mg/dL, Total Protein 7.0 g/dL, Mg 2.7 mg/dL, AST 21 IU/L, ALT 15 IU/L, Alb 4.5 g/dL, TSH 2.33, Hgb 14.6 g/dL, HCT 42 %, RBC 4.2 million/mm3, WBC 6000/mm3, Plt 264,000/mm3

Urine pregnancy test – negative; urine drug screen – negative; urine dipstick – specific gravity 1/017, pH 5.8, other parameters negative

Assessment:

Diagnoses are not needed for this assignment.

Plan:

The assignment directs identification of priority social determinants of health and development of a plan that ‘address challenges with or support strengths identified in’ the three priority SDH that you identified in this patient.