Command Auditory Hallucinations

"The toxicology studies on blood reveal the presence alprazolam, and amphetamine at levels likely consistent with the therapeutic range, a metabolite of buproprion and a high level of fentanyl. Phenylpropranolamine and amphetamine are present in the urine. When fentanyl and alprazolam are taken together there may be a synergistic central nervous system depressive effect. Based on the history and circumstances, s currently known, the manner of death is accident."

Felicia Allen is a 32 year old woman, who was initially brought into therapy after an attempt to steal a bus. Due to her reported “emotionally disturbed” nature, this consult became a priority. The police report states that Ms. Allen pulled out a knife, and threatened the driver after the driver declined her dollar bills. She then took control of the bus, and crashed it across the street. Upon our meeting, Ms. Allen was fidgety, and swayed back and forth all the while mumbling to herself. If she were questioned, she would look up and say “Sorry, sorry.” As far as patient history goes, Ms. Allen started hearing voices when she was 5 years old. These auditory hallucinations were mostly composed of critical, disparaging voices that made comments on her actions and behaviors. Her severe symptoms led her to be hospitalized fairly consistently since she was 11. Ever since she was young, she has been driven to please, and has a strong desire to be independent. Felicia has been prescribed clozapine for 1 calendar year, which helped her auditory hallucinations a great deal. Given the above symptoms and information, I have diagnosed Felicia Allen with schizophrenia.

The following case study is of a 37-year old Hispanic male weighing 145 lbs and 70 inches tall found unconscious by his girlfriend. According to her he was unconscious for about 15 hours and she was concerned because he would not wake or respond and was breathing shallow and slow. She then called 9-1-1. The patient entered the ER by emergency vehicle and on my initial assessment Pt had an altered mental status, was very unresponsive showing symptoms of a possible drug overdose. The girlfriend told the physician the Pt had taken 75 mg of methadone and an unknown amount of Xanex and other amounts of Benzodiazepines. On assessment, the doctor noticed his altered mental status and unconscious status. He had a gag

Mrs. Causey is a 47 year old female who presented to the ED voluntary admission after being found intoxicated and walking around with a leg injury. She reported to ED staff of an intentional overdose on 10 tramadol to relieve her of her leg pain. She stated to ED staff, "I want to just go to sleep and not wake up." Dr. Ghim requested an mental health assessment. The initial assessment suggested from TTS inpatient recommended she currently meets inpatient criteria, however suggested a reassessment in the morning to determine appropriate need for care. TACT initially assisted Dr. Snyder with IVC, however rescinded IVC after TTS reevaluation disposition for Mrs. Causey. TACT provided outpatient referral information to Mrs. Causey, contracted

This paper reviews two studies on the effectiveness of group cognitive behavioural therapy (CBT) for individuals experiencing auditory hallucinations. The first study (Newton, Larkin, Melhuish, & Wykes, 2007) aims to elicit the positive and negative aspects of group CBT treatment by listening to the perspectives of young people undergoing such treatment. The second study (Penn et al. 2009) seeks to evaluate the effectiveness of group CBT for auditory hallucinations compared to an active control group of enhanced supportive therapy (ST).

B’s tolerance to opiates not considered, Mr. B.’s clinical situation not considered (i.e., Mr. B’s age and renal function), and knowledge deficit of opiates. Drilling down the data to identify the root cause of Mr. B’s death is the fifth step in conducting a RCA on Mr. B’s sentinel event. Upon analyzing the data, causative factors, and events leading to Mr. B’s sentinel event, the RCA team determined that the root cause of Mr. B’s death is a medication error. Mr. B was given an overdose of hydromorphone. The final step in a root cause analysis is to implement changes that will mitigate the root cause. Changes include educating the nursing staff about hydromorphone, such as side effects and adverse reactions,

Recently, I completed a psychosocial assessment on a patient in the PHRM/ISS program. She was 21 years old, pregnant with her fifth child. When she initially walked in she seemed pleasant. Then, before we could get started she received a phone call. She politely asked could she step out and of course I said sure. Immediately, after she walked back in she seemed anxious and annoyed as evidence by her frowning and checking her phone every minute. Then, she would continue to say yes and not pay attention to the questions that I was asking. After a while, this began to bother me. This is because I would ask her a question and she would not answer or ask me to repeat myself. Then, she made a comment stating that “it does not matter and she was ready to go because she was upset.” At that moment, I knew that I needed to take an assertive stance.

In this paper one will give a description of the data established upon a case study. One will outline the major symptoms of the disorder discussed in the case. The disorder discussed in this case is Paranoid Schizophrenia. One will give a description of the client background. One will also describe any factors in the client background that may predispose him or her to the disorder. One will describe symptoms that he or she may have observed that supports the diagnosis of the individual. One will describe the inconsistency of the disorder found in the case and explain any information observed about the

18 year old Caucasian woman by the name of Susanna Kaysen was voluntarily admitted to a Psychiatric Hospital after an overdose of aspirin and alcohol. This young lady explained that she was not intentionally trying to harm herself, but was only trying to get rid of a headache.

This is a 28 year-old Caucasian female who was admitted to Doctors Hospital Psychiatric Unit 4 South due to an overdose on multiple medications. The patient was found by the police on January 13th picking through garbage near the hospital. Patient overdosed on approximately 30 Alprazolam, Venlafaxine, Trazadone, Benadryl, and Nyquil. She stated she remembered taking the all of the drugs, but does not remember anything after that.

The attending physician must refer the patient to a consulting physician to confirm the diagnosis and prognosis, while also determining whether the person is capable for making health care decisions. If either physician suspects the patient may be suffering from a psychiatric or psychological disorder that could impair judgement, the individual must be referred

31 y/o AA male patient seen today for psychiatric-mental health assessment. He is awake, alert and oriented x4. He is calm, cooperative and follows commands during assessment. The patient reports he is depressed, difficulty sleeping and nightmares at night. The patient explained his depression is as a result of deep thinking from a news he received two days ago from his elder brother that his mother is ill. Stressors identified by the patient include losing his job a week ago before the news about his mother; his wife is 6-months pregnant with their first child, who currently works part-time at her present job; patient relates difficulty paying monthly bills and inability to provide adequately for his family as a man. The patient denies mood swings, suicidal/homicidal thoughts and ideation. Patient reports his spouse is at work at the moment and he does not want to put stress on his wife due to her current condition. Patient denies been hospitalized for depression or psychiatric illness; and denies family history of mental illness. Patient reports he is seeking help because he does not like feeling this way using terms of “helpless and loss of worth from his spouse”. Patient reports he needs help with his depression and nightmares before his current condition get out of hands and ruined his marriage.

The client stated has been depressed for a while due to the sexual abuse she encountered by her stepfather. The client felt very suicidal and attempted it twice. She was hospitalized twice for it. The client started having flashbacks, low self-esteem, socializing issues, migraines, difficulty of sleeping, extreme fatigue and feeling of extreme doom. The psychiatrist diagnosed her with PTSD. She continued with outpatient therapy. The psychiatrist prescribe medication for her to deal with her PTSD. She stop going to therapy because she felt like it was not helping. She still has the flashbacks and severe migraines. However, she still take her medication for her PTSD. The client reported that she is spiritual but not religious. This keeps

N.G. was a 43-year-old Russian female who was admitted to Palomar’s Downtown Behavioral Unit (BHU) on Monday 10/10/16. The patient’s reason for admission was that she was brought in by the San Diego Police Department on a 5150. She was being held on a 72-hour psychiatric hold for being a danger to others where she was making threats to hurt her mom. She has had a long history of treatment for her Schizophrenia that she was diagnosed with as a child. When she arrived to the BHU she had symptoms of a mood disturbances, including decreased sleep, increased energy, agitation, anxiety, and aggression.

The patient expressed she has no current suicidal ideation or homicidal ideation. However, she admitted to suicidal ideation in the past, right after her breakup, approximately two months ago. She expressed that she wanted to hurt herself and had a plan on how to do so, but did not think she could go through with it. Her plan was to overdose by taking her mother’s