I am Feeling Like I’m Going Crazy

 Case Study: I am Feeling Like I’m Going Crazy

IDENTIFICATION: The patient is a 15-year-old male of Native American descent who resides at home with his mother and 6-year-old brother.

He is seen for the psychiatric evaluation on an inpatient crisis unit. Collateral information was obtained from the patient’s mother.

CHIEF COMPLAINT: “I am feeling like I’m going crazy”

HISTORY OF CHIEF COMPLAINT: Patient reports that he intentionally cut his leg at school yesterday before gym class. He realized that he would not be able to participate in class because he could not control the bleeding of the cuts. He went to the nurse and she referred him to the ER for admission. The ER provider admitted him to the acute psychiatric unit as he was at risk of harming himself due to suicidal ideation. He reports that he harmed himself by cutting as he was feeling abandoned by his boyfriend. He states that he is not emotionally supportive. He reports that self-injurious behavior began 10 months ago, and he uses a disposable razor to cut his upper arm or forearm. He reports problems with sleep onset. He reports low self-esteem and low energy level. He endorsed a history of two prior suicide attempts by taking a palm-full of acetaminophen; the most recent attempt was 2 months ago. He did not report his attempt denies serious adverse effects. His last suicidal ideation due to pressure of getting good grades and low self-esteem. He used to participate in the school band but stopped attending rehearsals about 2 months ago because he was no longer interested.

Patient’s mother expressed frustration and difficulty understanding why the patient treats her disrespectfully when she gives the patient everything the patient wants, such as clothing and money to go out with friends. The patient’s mother acknowledged that she works a lot and is infrequently at home, but stated that when she tries to spend time with the patient and express interest in his life, the patient shuts her out or states that he does not have time to spend with her because she needs to finish his homework. Patient’s mother additionally expresses confusion about why the patient behaves so differently than she did at that age, reporting that he was expected to be respectful and comply with her mother’s requests.

PAST PSYCHIATRIC HISTORY: No prior psychotherapy or trials of psychiatric medication.

MEDICAL HISTORY: Multiple wounds noted on patient’s right upper arm, which appear to be healing. No known allergies. No acute or chronic medication conditions. Review of systems is negative. Patient appears to be average height and weight. He denies any recent changes in weight.

HISTORY OF DRUG OR ALCOHOL ABUSE: No alcohol use. States that he tried marijuana once 3 months ago. Denies use of any other illicit substances.

FAMILY HISTORY: Patient’s parents were both born in the US. The patient was born in the United States. Patient reports that her parents got divorced when she was 5 years old. His father currently lives in Los Angeles and he has minimal contact with him. Family history of mental illness denied.