33 y.o. male who presents with self reported mania evidenced by not sleeping, rapid pressured speech, racing thoughts, grandiosity and acute paranoia
Current Diagnosis:
ODD
Bipolar disorder current episode manic severe with psychotic features
Assessment: 33 y.o. male who Patrick Rooney is a 33 y.o. male who presented with manic behavior evidenced by mood lability, pressured speech, racing thoughts and psychosis evidenced by acute paranoid grandiosity.
data:
This is a 33-year-old unemployed male with a past psychiatric history of bipolar disorder and no significant past medical history who presented to the ED with self reported mania evidenced by not sleeping, rapid pressured speech, racing thoughts, grandiosity and acute paranoia.
Patient was seen for an assessment and stated, “I feel good. I am here due to depression and to be specific, i’m being evicted from my apartment because my neighbors complained to my landlord that I play loud music. I listen to music all day and night. I do not sleep, I just take naps. I was diagnosed with bipolar disorder and took gabapentin for a month and just did not feel any benefit. I smoke marijuana daily and drink alcohol (beer or whiskey) monthly”. Patient reports poor sleep, appetite and interest, and states, “I used to play soccer, basketball, golf and go to concerts but I have lost interest in all of them”. Patient reports inconsistent energy and reports feeling very optimistic, blessed and hopeful. Patient reports feeling depressed and sad. Patient endorses symptoms of mania or hypomania such as euphoric mood, decreased need for sleep, increase in goal-directed activities, racing thoughts, impulsive or reckless behavior and excessive self confidence but stated that these symptoms last for at most one day. Patient reports symptoms of generalized anxiety disorder including excessive worrying throughout the day, restlessness, tiredness, problems with concentration, irritability and poor sleep. Patient states, “I worry about my future, family, good friends and strangers”. Patient reports being charged with marijuana possession and distribution in the past. Patient endorses a history of verbal abuse from his family, girlfriends and at his workplace and states, “I have had flashbacks and nightmares many times, that is why I listen to loud music. Patient denies AVH but endorses SI/HI. Patient states, “I think about killing my family and myself everyday but have never done it. I sometimes text people who have caused me pain telling them I wish I can kill them. I tried to hang myself 11 years ago”.
Medication education about Zyprexa and Prozac provided and patient is agreeable to starting these medications.
Writer obtained in-person collateral information from patient’s mother – who reports the following information: Patient asked mother to bring him to the ED today. Over the past x2 days, patient has been texting mother non-stop, mostly in “all caps” rambling about how his parents ruined his life, using derogatory language such as “fat bitch”, “piece of shit”, “pig”, “burn in hell”, and “I suggest you kill yourself”. Later on in the texts, patient incessantly texted his mother “I love you so much” in “all caps”. Patient is currently being evicted from his studio apartment in Morristown due to neighbors complaining that patient is constantly blasting music and screaming. Parents financially support patient due to patient being unable to hold a steady job. Patient most recently worked x1 year ago for a pest control company. Patient has a high school education but no further education. Patient has a history of one inpatient psychiatric hospitalization about 3-4 years ago. Patient was admitted to Bergen New Bridge after being seen at MMC ED and was diagnosed with Bipolar Disorder. During this time, patient was brought to MMC after patient “flipped out at a gas station” and when patient’s brother was driving them in the car on Routwe 80, patient began hitting his brother in which brother called 911. After being D/C’d from Bergen New Bridge, patient did not follow-up with medication management and “refuses to take them”. Patient also has a “bad gambling problem”. Patient self-medicates with weed and states that he “feels like a legend” because he sells people weed. As an adult, patient is not physically violent towards others. However, when patient was a teenager, patient was physically aggressive towards his family, specifically his father who patient pushed to the ground at least twice. Patient has a poor relationship with his family, especially with his older brother who does not want to be involved in patient’s life due to patient being mentally unstable. Patient has a history of at least 16-17 arrests for marijuana related incidents. Patient was on drug court from 2015-2017 and at the time, patient was “doing really well” when he was not smoking. However, once he was able to smoke again, “it all went downhill”. Patient has frequent episodes of paranoia, grandiosity, and often accuses his family/others for “ruining” his life. Patient makes allegations that his family have physically abused him over the years, which is mother states is “not true”. Patient was bullied as a child/adolescent and “probably held in all of those emotions to fit in”. Patient may have also experienced sexual abuse at age 18 when patient was residing with a friend but mother can’t fully attest to this. Patient’s maternal aunt does have a history of being diagnosed with Bipolar Disorder. Patient’s maternal grandfather had a history of alcohol dependence. Parents are trying to apply for patient to receive SSI/SSD due to patient not being able to have a steady income/job. Patient was linked to telehealth therapy from around 1/2024 but “stopped about a month ago”. Patient is very manipulative and disrespectful to parents and mother admits that they continue to support him financially. However, there have been times where patient was homeless and staying in “tent city in Morristown” as well as times that patient was living out of his car. Mother found out today that patient had a suicide attempt at age 22 via hanging/strangulation but that he “didn’t know how to do it”. Mother is very concerned for patient as well as for the safety of other people. Patient has been threatening to harm mother over text. Mother is supportive of inpatient admission at this time.
Past Psychiatric History
Patient has a history of bipolar disorder and reports taking gabapentin in the past
Review of Systems
Constitutional: No fevers, no chills, no night sweats, no weight loss
Eyes: No change in vision, no redness, no discharge, no pain
Ears, Nose, Mouth, Throat, and Face: No discharge, no erythema, no edema
Respiratory: No shortness of breath, no cough
Cardiovascular: No chest pain, no palpitations
Gastrointestinal: No tenderness, no nausea, no vomiting, no diarrhea, and black stools, no bloody stools
Genitourinary: No flank pain, no pain with urination, no blood in urine, no genital pain
Integument: No rash, no erythema, no edema.
Hematologic/Lymphatic: No abnormal bruising, no abnormal bleeding
Musculoskeletal: No tenderness, no change of range of motion
Neurological: No headache, no confusion, no focal numbness, no problems talking or swallowing, no double vision
Behavioral/Psych: No suicidal ideations, no homicidal ideations
Endocrine: negative.
Allergic/Immunologic: Negative.
Mental status exam:
Appearance: Unkept and Hospital gown
Behavior: cooperative, guarded, suspicious, and resistant
Sensorium/Orientation: alert and oriented to person and situation
Mood: “better than ever”
Affect: Euphoric
Speech: fast and pressured
Thought Content: Focused on “making millions,” being better than everyone around him due to his “gifts”. Also has paranoid and suspicious delusions that others are out to harm him in unintelligible ways.
Perceptual Disturbance: Denies auditory, visual, or tactile disturbances
Thought Process: disorganized
Cognition: Intact
Short Term Memory: Intact
Long Term Memory: Intact
Suicidal Ideations: denies
Homicidal Ideations: states he would harm people who “disrespect him, but I dont want to.”
Insight: Limited insight
Judgement: limited
+cannabis
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