Reason for Referral- A community psychiatrist at local outpatient clinic referred Michael Stevens, due to his group home bringing him in for an outpatient appointment, because of aggressive behaviors, to include homicidal and suicidal threats with no plan. While at the appointment the psychiatrist reports that the client was rambling, having racing thoughts, severe paranoia, disorganized thoughts and speech, tangential speech, flight of ideas, as well as A/H command type telling him to “kill his caretakers at his group home”, last time 7/19/15. He also has V/H of demons and devils, last time 7/19/15; onset for all hallucinations client stated was 2010. Client reported feeling like people were talking about him, and laughing at him, everywhere
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His appearance is casual; he presented wearing short pants, a dingy white t-shirt, and sneakers. His hair is unkempt, and is kept in an afro: otherwise he is groomed appropriately. Michael seems suspicious and guarded. He comes off hostile, but is cooperative during the assessment. Michael’s eye contact was fair, but at times his attention waned, but when speaking he kept direct eye contact. Michael was oriented times three, time, place, person, however, Michael did not seem to be aware of the situation. He stated “I don’t understand why the group home brought me in here, I was just talking to the psychiatrist, and then they brought me here”. His motor activity was restless, he was observed fidgeting, shaking his legs, standing up and pacing. Michael speech was pressured, but coherent. Michael’s mood was irritable, anxious, and depressed; he seemed to want to get the assessment over with. His affect however seemed to be appropriate to thought. Michael exhibited poor impulse control, but he was redirectable. His thought process was tangential, disorganized, and he had a flight of ideas, rambling and making nonsensical comments at certain points about his life. He seems to be experiencing psychosis, and was very delusional. His thought content was paranoid, and his concentration was poor. Michael’s perception consisted of hallucinations both auditory and visual; he even expressed tactile hallucinations, stating, "I feel like bugs are crawling on me." Michael’s memory was intact for the most part, but he displayed both poor judgment, and insight. Anosognosia (i.e., poor insight) is also com¬mon in schizoaffective disorder, but the deficits in insight may be less severe and perva¬sive than those in schizophrenia (DSM, 2013). Michael’s paranoia is also extremely severe. During the assessment, he was constantly looking out of the window, and when I handed him a
His appearance is casual; he presented wearing short pants, a dingy white t-shirt, and sneakers. His hair is unkempt, and is kept in an afro: otherwise he is groomed appropriately. Michael seems suspicious and guarded. He comes off hostile, but is cooperative during the assessment. Michael’s eye contact was fair, but at times his attention waned, but when speaking he kept direct eye contact. Michael was oriented times three, time, place, person, however, Michael did not seem to be aware of the situation. He stated “I don’t understand why the group home brought me in here, I was just talking to the psychiatrist, and then they brought me here”. His motor activity was restless, he was observed fidgeting, shaking his legs, standing up and pacing. Michael speech was pressured, but coherent. Michael’s mood was irritable, anxious, and depressed; he seemed to want to get the assessment over with. His affect however seemed to be appropriate to thought. Michael exhibited poor impulse control, but he was redirectable. His thought process was tangential, disorganized, and he had a flight of ideas, rambling and making nonsensical comments at certain points about his life. He seems to be experiencing psychosis, and was very delusional. His thought content was paranoid, and his concentration was poor. Michael’s perception consisted of hallucinations both auditory and visual; he even expressed tactile hallucinations, stating, "I feel like bugs are crawling on me." Michael’s memory was intact for the most part, but he displayed both poor judgment, and insight. Anosognosia (i.e., poor insight) is also com¬mon in schizoaffective disorder, but the deficits in insight may be less severe and perva¬sive than those in schizophrenia (DSM, 2013). Michael’s paranoia is also extremely severe. During the assessment, he was constantly looking out of the window, and when I handed him a