TASK 53: Today’s Date 21/06/15
You are a Mental Health Nurse at Spirit Hospital Psychiatric Emergency Care Centre (SHPECC) and Jack Mills is a patient on the ward.
Patient Details Name – Jack Mills
DOB – 01/09/1993 Single
Admission 23/05/2015 (Spirit Hospital Psychiatric Emergency Care Centre)
Discharge 27/06/2015
Diagnosis Schizophrenia, paranoid type
Symptom History Nov, 2014. Jack had the first serious psychosis triggered by his move to a university in Canberra He was hospitalised for 2 weeks & stabilised on Haldol 20 mg and sodium valproate 125 mg, daily.
Dec, 2014 He has lived with his mother at Parramatta (Sydney area) since dx and been attending day tx and a structured work program in Parramatta Spirit. Community Mental Health Service, NSW. His work attendance in the structured work program has been sporadic. He has occasionally attended client support meetings.
Feb 2015 Attempted suicide: A Possible stressor was that 1 week ago his mother informed him of ideas to remarry in the near future. Self-harm through deep cut on both wrists Hospitalised in ED, surgical tx, under 24hr supervision. Refused to change medication.
May, 2015 He has been increasingly isolated for the past 2 weeks, working on his computer and is very secretive about what he is doing. He stopped attending his work program, saying that he had “more important work” to do at home. His mother believes he stopped taking medications. Jack refuses to eat or talk with his mother; is nervous because of his mother’s plans to remarry and move to Manly (Sydney area) He was brought to Spirit Hospital Psychiatric Emergency Care Centre (SHPECC) by his mother on 23/05/15 He has been irritable, suspicious and stated that has been hearing multiple voices in his head for the past week.
Family History Jack’s parents separated 4 years ago and divorced 2 years agoJack’s father is a lawyer. Their relationship is pleasant but not close.Jack’s mother runs her own craft store and is agreeable to having Jack live with her. No other children in the family
Psychosocial History: Completed high school; above-average student; often involved in school and extracurricular activities. He smokes a pack of cigs a day and drinks beer, but there were binge drinking episodes.During college time. He denies any illicit drug use. He has a keen interest in computers and collected considerable equipment and software, primarily gifts from his father. He has been on Disability Support Pension (DSP) since 2012
Medical History Nil
Hospital Progression: The patient’s sodium valproate was increased to 125 bd and then 250 tds
His need for intramuscular (IM) medication, or other medication was explained. The patient fiercely objected about injection, saying, “I am a reliable person, I can always take the medicine.” The fact is that he has not been very compliant. After much discussion, the patient has agreed to take 4 mg of Navane IM qid
Jack received one-to-one, supportive, and insight-oriented psychotherapy on various issues (importance of compliance, taking meds, and avoiding alcoholic beverages). His participation through the program was less than adequate as he could not concentrate and focus, but he still participated in psychotherapy group
Condition on Discharge His sleep and concentration but judgment still impaired
Follow-up: The patient will be living with his mother at Manly and will be continued on medication (Sodium valproate 250 bd and pavane 1.5 mg 1M q.) 4 weeks. The next dose is due on July 17, 2015
One-to-one psychotherapy is needed. Advice to abstain from alcohol and give up smoking
Writing Task: Using the information in the case notes, write a letter to Jim Wood, the Mental Health Nurse at Manly Community Mental Health Service, Ipswich Rd, Manly, NSW, 2345.
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