Discussion Response

No 1-Katie-

Assessment: Patient J.S. is a 30y/o male diagnosed with schizoaffective disorder, recently released from the hospital. He presented disheveled with poor eye contact and positive symptoms of laughing during the interaction. A discussion took place regarding medication compliance. The patient reported that he would only take Saphris. However, Saphris was no longer working for him, and his previous psychiatrist broke ties with him for noncompliance. The patient has had different practitioners who would no longer work with him. He was angry, tense, defensive, and guarded. Saphris was continued and a discussion was had regarding adding a mood stabilizer. The patient refused but said he would go on an antidepressant. At this point, a discussion ensued regarding the patient directing his own treatment. He was given education regarding his symptoms and what medications could be useful for his symptoms. The patient agreed to start on Tegretol. However, the patient was called to discuss how the medication was working and the patient never picked up the prescription.  It was reiterated that he would be terminated from treatment for non-compliance. The patient reported that he felt that he did not need medication. The risks and benefits were discussed. However, the end result was that he was terminated from care.

Question Two- Khan

Patient is a 42 year old AA male with history of mood disorder and self-history of schizoaffective disorder who was brought in by EMS self-activated for thoughts of suicidal/homicidal with no plan. Patient states he is stressed, depressed, and overwhelmed because of housing problems, stating that he does not like the shelter system. During interview patient is suspicious that people are out to get him. Admits to use crystal meth, alcohol, cocaine and marijuana. Drinks alcohol daily and smokes 15 cigarettes daily. He states he has been noncompliant for two years with his medication regimen of Seroquel, Depakote, and Risperidone, with NKDA. Lab work including CBC, CMP, and UA were completed, with no critical values noted. He will be started on Zyprexa 10mg PO and the benefits, interactions and side effects were discussed and patient verbalizes understanding. Continue to monitor patient on Q15 for aggressive/impulsive behavior. Encourage patient to verbalize needs and concerns to staff.