Year With Diagnosis Question & Answer Guide (With Explanation)

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Key Explanation

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Original Question

50-year-old man with a diagnosis of schizophrenia, epilepsy, acquired brain injury and poly-substance abuse e.g. methamphetamine, cannabis, heroin and benzodiazepines. Patient has a history of being in prison for theft, armed robbery and assault. This admission was precipitated after been found not guilty by reason of mental impairment after a violent offence perpetrated against a family member. The patient has been placed on a custodial supervision order by the courts. The patient is morbidly obese with a BMI of 44 has type 2 diabetes, hypertension and hypercholesterolemia. In the past when the patient was using illicit substances and does not take the medication for his mental illness his mental state deteriorates and his risk for anti-social behaviour and/or violence increases. The patient is pre contemplative regarding reducing or abstaining from illicit substances and often says if he had “drugs” available to him he would take them. When he becomes acutely unwell he can annoy other patients and give away his possessions. He can be impulsive. As part of his mental illness the patient often has delusions that staff are intentionally sabotaging his progress in his recovery to keep him at the hospital so he can be experimented on. The patient has shown signs of deterioration in his mental state with increase symptoms of paranoid thoughts, auditory hallucinations and as a result his ground leave has been suspended. The patient has become more irritable and oppositional in his interactions with the multidisciplinary team. There is one nurse that he has a good rapport with and requests that she be his contact nurse for every shift. He feels he can tell her anything and trusts her more than anyone else. The patient has limited family support due to the nature of his offence and because his family is often n crisis i.e. drug and alcohol use, homelessness, and varying types of abuse. He has a good childhood friend who visits him occasionally. The patient’s interests are watching TV, drawing, listening to music through his headphones and cooking. From the information provided What would you include in a recovery orientated plan putting the patient at the centre of his care? Please identify what you think are 3 risks related to his mental health and 2 risks related to his physical health. How can we work with the patient to manage those risks?

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