templete for case conference

8/18/2019 Templete for Case Conference

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Identifying Data : B.K.

Age: 21

Sex: Male

DOB: 16th July, 1992

CC: n!n "!#$laint %ith &'y"h #edi"ati!n' and agg(e''i)e t!%a(d fa#ily a' $e(

*MS n!te+

&I:

M( B.K i' a 21 y-! #ixed !(igin #an Af(i"an/A#e(i"an and &ue(t! 0i"an#an,

'ingle, une#$l!yed, d!#i"iled %ith g(and#!the(, %ith $(e)i!u' $'y"hiat(i" "!nta"t

t%! #!nth' ag! and n! $(i!( hi't!(y !f h!'$italiati!n' and hi't!(y !f "anna3i' u'e

di'!(de(, 'e)e(e %h! BIB*MS in hand"u4', a"ti)ated 3y g(and#!the( 3e"au'e the

$atient had 3een yelling un"!nt(!lla3ly at he( afte( ha)ing a 5ght %ith hi' gi(lf(iend.e %a' 'een initially at the #edi"al *0 then t(an'fe((ed

he $e('!nnel in C&*& had 3een una3le t! !3tain a "!#$lete hi't!(y f(!# the

$atient a' he %a' de'"(i3ed a' un"!!$e(ati)e and n!t engaging %ith any

a''e''#ent at all. In C&*& the (e'ident had '$!7en t! hi' g(and#!the(, M'.B %he(e

the g(and#!the( had 'aid that the $atient had ange( #anage#ent i''ue' and 3ad

te#$e(a#ent and %a' in a )!latile (elati!n'hi$ %ith a gi(l and the gi(lf(iend %a' the

!ne that had (e$!(ted that the $atient had 3een 8a"ting 't(ange '!#eti#e'

di4e(ent8. he g(and#!the( 'tated that he ha' had ange( i''ue' and hi'

te#$e(a#ent and 5t' !f ange( ha)e 3e"!#e #u"h %!('e lately.

A' $e( the g(and#!the( a3!ut 2 #!nth' ag! 'he had n!ti"ed the $atient '!#eti#e'

tal7ing t! hi#'elf and he de'"(i3ed hea(ing )!i"e' t! he(. She 'tated that he

87ee$' t! hi#'elf8. e ha' 3een in"(ea'ingly ext(e#ely agg(e''i)e at h!#e yelling

and 'h!uting f!( n! (ea'!n at all and he ha' 'tated that he 8need' hel$8. e had

3e"!#e un"!nt(!lla3ly agg(e''i)e afte( ha)ing a 5ght %ith hi' gi(lf(iend %hi"h

$(!#$ted the g(and#!the( t! a"ti)ate *MS.

A' $e( the g(and#!the( 'he had n!ti"ed hi# '#!7ing #a(i;uana all day and had

en(!lled hi# at

he $atient' 5('t "!nta"t %ith a &'y"hiat(i't %a' 2 #!nth' ag! !n June 2=th 2>1? at


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diagn!'i' !f Su3'tan"e Indu"ed $'y"h!ti" Di'!(de( and &SD. e ha' had t%! )i'it'

in t!tal and ha' 3een a'7ed t! f!ll!% u$ at St.u7e' !'$ital %hi"h he ha' n!t.

i' g(and#!the( "lai#' that he ha' ta7en 2/? d!'e' !f hi' #edi"ati!n'. e i' n!t

"!#$laint. he(e i' n! (e"!(ded hi't!(y !f 'ui"ide atte#$t'

&'y"h7e' 'h!%' hi' !nly "!nta"t %ith &'y"hiat(y %a' %ith

Su3'tan"e 'e i't!(y:

Canna3i':/. e (!ll' #ulti$le ;!int' and 'ha(e' the# %ith hi' f(iend'.

i' u'e ha' 3een daily 'in"e Janua(y t! Augu't 2>1?. C (elaxe' the $atient.

Syntheti" #a(i;uana:/ 1?. In"(ea'ing u'e in July 2>1?.

*"ta'y:/


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'"h!!l and ha)ing te#$e( tant(u#'+ at h!#e. i' (elati!n'hi$ %ith hi' fathe( ha'

3een de'"(i3ed a' (!"7y+ a' the $atient ha(3!u(' a l!t !f ange( t!%a(d hi#. i'

(elati!n'hi$ %ith hi' #!the( i' fai(

At the age !f 1=, the $atient i' 'aid t! ha)e 'ta(ted u'ing d(ug' and had fallen in

%ith a 3ad "(!%d+. e %a' u'ing d(ug' f!( !ne yea( and then %a' "aught 'elling"(a"7 and 'ent t! 0i7e(' I'land f!( f!u( yea(' f(!# the age !f 16 t! the age !f 2>.

he $atient %a' 3(!ught u$ !n Mu'li# faith h!%e)e( hi' fa#ily d!e' n!t de'"(i3e

the#'el)e' a' )e(y (eligi!u' and the $atient %a' n!t )e(y (eligi!u' g(!%ing u$.

Fhile he %a' in $(i'!n , the $atient 'h!%ed a g(eate( in"linati!n t!%a(d (eligi!n and

faith. e al'! g!t a G*D in $(i'!n and a' $e( hi' g(and#!the( he 3e"a#e an a)id

(eade( (eue'ting f!( 3!!7'.

he $atient %a' (elea'ed f(!# $(i'!n in Janua(y 2>1? and initially %ent t! li)e %ith

hi' fathe( and late( #!)ed t! hi' g(and#!the(' h!u'e 'e"!nda(y t! di4e(en"e'

%ith hi' 'te$#!the( and hi' y!unge( half/3(!the(. i' fathe( de'"(i3e' hi# a'

di't(u'tful and $a(an!id a3!ut #any thing':/ eg:/he 3elie)e' the $atient #ay (efu'e

f!!d a' he 3elie)e' that $!i'!n #ay 3e #ixed in hi' f!!d. e had (efu'ed 3l!!d

%!(7 and

S!"iety the $atient %a' 'exually a''aulted %hile in $(i'!n and had '$ent ti#e in

'!lita(y a nu#3e( !f ti#e'.

!'$ital C!u('e:

Fhen he a((i)ed !n the in$atient H!!(, he %a' 3anging !n the d!!( and %a'

ext(e#ely l!ud 'tated that he %anted t! get di'"ha(ged i##ediately. e "!ntinued

t! 7ee$ a'7ing f!( the u(an and %a' ext(e#ely ang(y %hen he "!uld n!t ha)e !ne

i##ediately. e %a' #edi"ated %ith ald!l = #g IM and 2 #g IM. A' $e( the initial

in$atient a''e''#ent n!te, he 7e$t "!#ing u$ t! the %(ite( !f the n!te a'7ing8 %hy


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they need all th!'e #edi"ati!n' #an8 8%hy d! they need in;e"ti!n'88 y!u $e!$le

a(e "(uel, "(uel8 and then he 'tated that he %ill ne)e( ta7e #edi"ati!n' n!( %ill 3e

eat.

i' initial f!u( day' !n the in$atient unit "!n'i'ted !f the $atient' $a(an!id

3eha)i!u( %he(e he (efu'ed t! inte(a"t %ith 'ta4 and !the( $e('!nnel %he(e he'tated that 8I %ant a u(an8 8d!nt lie t! #e8 ,+get #e an i#a#, I %ant t! tal7 t!

an i#a#. e %a' inte(nally $(e!""u$ied and 'ta(ing

int! '$a"e and %a' tal7ing t! hi#'elf. e (efu'ed t! '$ea7 t! the tea# 'tating that

8I d!nt tal7, Ill (ead the u(an and g! t! 'lee$8. e %a' $a(an!id a3!ut 'ta4 St!$

$laying ga#e' %ith #e, y!u(e the !ne' that a(e "(ay+. e %a' #edi"ated a t!tal

!f ? IM in;e"ti!n' !n the H!!( %ith ald!l = #g IM and Ati)an 2 #g IM.

he 5fth day the $atient 3e"a#e le'' $a(an!id and 'ta(ted !$ening u$ t! the

t(eat#ent tea#. e %a' (eligi!u'ly $(e!""u$ied and 7e$t (eue'ting t! '$ea7 t! an

i#a# and initially had (efu'ed t! %a'h hi#'elf. he 5('t t%! ti#e' an i#a# had

3een a)aila3le t! 'ee hi# h!%e)e( the $atient had (efu'ed t! 'ee the i#a#. elate( 3egan '$ea7ing t! the i#a#.

he $atient g(adually 3e"a#e le'' $a(an!id and 3egan 'ha(ing hi' 'y#$t!#' %ith

hi' t(eat#ent tea#. A' $e( the $atient du(ing the 0a#adan July/Augu't he )i!lated

hi' (eligi!n 3y eating the %(!ng f!!d and had engaged in 'exual inte("!u('e %ith

3!th hi' gi(lf(iend and had engaged in !(al 'ex %ith a #ale. he guilt !f the'e

en"!unte(' %e(e %eighing d!%n !n the $atient. e ad#itted t! ha)e g!ne th(!ugh

t(au#ati" ex$e(ien"e' in $(i'!n '!#e !f %hi"h he de'"(i3e' a' da(7 #e#!(ie'+ he

'tate' that he had #ade #i'ta7e' a' a teenage( and that he i' glad that he %ent t!

$(i'!n t! $ay f!( the#. e i' (eligi!u'ly $(e!""u$ied and "!n'tantly (eue't' t! d!

the Shahadat and the ; ahu## afte(n!!n


5/8

A4e"t: Hat, '#ile' ina$$(!$(iately and 3lunted

h!ught &(!"e'': ill!gi"al, (eligi!u'ly $(e!""u$ied

h!ught C!ntent: denie' h!#i"idal !( 'ui"idal ideati!n'.

&e("e$ti!n: denie' hallu"inati!n' "u((ently, ha' 3een 'een t! 3e inte(nally$(e!""u$ied and laughing and tal7ing t! hi#'elf

C!gniti!n: AAOx? t! $e('!n, $la"e and ti#e. e de#!n't(ate' inta"t "al"ulati!n.

In'ight: !ne. &atient d!e' n!t a"7n!%ledge hi' illne''

Judg#ent: &!!(. &atient ha' 'tated that he %ill $(ay t! get (id !f hi' 'in'

I#$ul'e C!nt(!l: &!!( 3ut ha' 'h!%n fai( i#$ul'e "!nt(!l !)e( the $a't th(ee day'

a3':

i' u(ine t!xi"!l!gy %a' $!'iti)e f!( C

F!(7 u$ f!( 5('t e$i'!de $'y"h!'i':/ d!ne

M0I i' $ending.

SMMA0E:/

M( B.K i' a 21 y-! #ixed !(igin #an Af(i"an/A#e(i"an and &ue(t! 0i"an#an,

'ingle, une#$l!yed, d!#i"iled %ith g(and#!the(, %ith $(e)i!u' $'y"hiat(i" "!nta"t

t%! #!nth' ag! and n! $(i!( hi't!(y !f h!'$italiati!n' and hi't!(y !f "anna3i' u'e

di'!(de(, 'e)e(e %h! BIB*MS in hand"u4', a"ti)ated 3y g(and#!the( 3e"au'e the

$atient had 3een yelling un"!nt(!lla3ly at he( afte( ha)ing a 5ght %ith hi' gi(lf(iend.

Fhen initially 3(!ught t! C&*& he %a' inte(nally $(e!""u$ied and '$a"ed !ut+ and

!ddly (elated eg:/ n!t l!!7ing at the %(ite(' %hen they a(e tal7ing t! hi#. i' 5('t

"!nta"t %ith $'y"hiat(y %a' t%! #!nth' ag! %hen hi' g(and#!the( had n!ti"ed

!dd 3eha)i!u(+ eg:/ tal7ing t! hi#'elf+ and had 3e"!#e in"(ea'ingly #!(e

agg(e''i)e and 3ellige(ent. e %a' $(e'"(i3ed @y$(exa 1> #g h' %hi"h he ha'

ta7en 2/? d!'e' !f. Sin"e Janua(y 2>1? afte( the $atient %a' (elea'ed f(!# $(i'!n$!'t 3eing in"a("e(ated f!( f!u( yea(' !n d(ug "ha(ge' the $atient ha' 3een

'#!7ing #a(i;uana u$t! 3lunt' a day. e al'! ha' u'ed K2 'yntheti" #a(i;uana,

#!lly, and 3ath 'alt' du(ing the la't 6 #!nth' $(i!( t! h!'$ital. i' d(ug !f "h!i"e i'

C.

O)e( the la't t%! #!nth' the $atient ha' end!('ed inte(#ittently hea(ing )!i"e'+

%hi"h he ha' 'tated he hea(' %hile $(aying. e %a' initially ext(e#ely un"!/


6/8

!$e(ati)e u$!n 5('t a$$(!a"h and %a' (eligi!u'ly $(e!""u$ied de#anding t! '$ea7

t! an i#a# and (efu'ing t! '$ea7 %ith !the( 'ta4 !( $ee('. e %a' #edi"ated !n a

t!tal !f ? !""a'i!n' %ith ald!l and Ati)an and hi' $a(an!ia (edu"ed 'lightly. A "!$y

!f the u(an %a' !3tained f!( hi# and )ia the hel$ !f the #ulti/di'"i$lina(y tea# an

i#a# %a' (eue'ted f!(. he i#a# ha' 3een #eeting %ith the $atient al#!'t daily

and the $atient' $a(an!ia ha' (edu"ed and hi' hygiene and g(!!#ing ha)e 'h!%n#u"h i#$(!)e#ent. e ha' !$ened u$ g(adually t! the t(eat#ent tea#.

C!llate(al inf!(#ati!n !3tained f(!#

(elati!n'hi$ %ith hi' 'te$ #!the( i' n!t g!!d, he %a' de'"(i3ed a' an ang(y "hild+.

e %a' a((e'ted f!( 'elling d(ug' at the age !f 16 and in"a("e(ated till the age !f 2>

at 0i7e(' I'land. C!llate(al inf!(#ati!n indi"ate' that he %a' 'exually a''aulted

%hile in"a("e(ated.

e "!ntinue' t! (efu'e #edi"ati!n' !n a daily 3a'i'. e 3elie)e' that hi' "!nditi!n i'

'e"!nda(y t! 'in' "!##itted du(ing 0a#adan+ in"luding 'exual inte("!u('e %ithhi' gi(lf(iend and an!the( #an, u'ing d(ug' and eating %hen he %a' n!t 'u$$!'ed

t!. he $atient 3elie)e' that if he $(ay' and f!ll!%' hi' faith he %ill n!t fa"e the'e

t(!u3le'. e d!e' n!t 3elie)e in #edi"ati!n', !( M0I '"an' a' the'e n!t n!t

natu(al+.

he $atient ha' 3een a3le t! $a(ti"i$ate in di4e(ent g(!u$' and ha' 3een a3le t!

ha)e !ne/t!/!ne 'e''i!n' %ith the the(a$i't. e i' h!%e)e( $a(an!id, i' 'een

inte(nally $(e!""u$ied at ti#e' and de#!n't(ate' $!!( in'ight and ;udg#ent int!

hi' illne'' and 'u3'tan"e u'e. e (e#ain' at i##inent dange( t! hi#'elf and

(eui(e' in$atient 'ta3iliati!n.

Bi!l!gi"al (i'7 fa"t!(' geneti" l!ading !f illne'' hi' #!the( and #ate(nal

g(and#!the( ha)e a diagn!'i' !f Bi$!la( Di'!(de(, hi' #!the( ha' a h-! 'u3'tan"e

u'e di'!(de(. i' #!the( u'ed "(a"7 du(ing he( $(egnan"y %hi"h #ay ha)e

"!nt(i3uted t! hi' illne'' and he ha' a hi't!(y !f 'u3'tan"e u'e di'!(de(

&'y"h!l!gi"al (i'7 fa"t!(' in"lude 'e$a(ati!n !f 3i!l!gi"al $a(ent' %hen y!ung,

negle"t %hen y!ung 3y 'te$#!the(, in"a("e(ati!n at 16, 'exual a3u'e %hile 3eing

in"a("e(ated.

S!"ial fa"t!(' in"lude la"7 !f edu"ati!n, la"7 !f e#$l!y#ent, inte($e('!nal "!nHi"t'

%ith gi(lf(iend, fathe( and g(and#!the(.

&(!te"ti)e fa"t!(' in"lude 't(!ng faith and a 'u$$!(ti)e fa#ily and gi(lf(iend.

0i'7 a''e''#ent in"lude' a "h(!ni" ele)ated (i'7 t! 'elf a' he ha' a #ental illne''

and hi't!(y !f 'exual a3u'e and exten'i)e 'u3'tan"e u'e. e i' at #ediu# (i'7 t!


7/8

hi#'elf a' he i' $a(an!id and ha' 'e)e(al 't(e''!(' li'ted a3!)e. e i' a high (i'7 !f

)i!len"e h-! 'u3'tan"e u'e di'!(de( and h-! in"a("e(ati!n "!nt(i3ute' hea)ily.

Di4e(ential Diagn!'i' in"lude' Su3'tan"e Indu"ed &'y"h!ti" Di'!(de( )e('u'

n'$e"i5ed &'y"h!ti" Di'!(de( )' S"hi!$h(enia, 5('t e$i'!de !f $'y"h!'i'

&A:/

C!ntinue in$atient t(eat#ent.

LLBi!l!gi"al t(eat#ent

Olana$ine 1> #g $! 3id f!( $'y"h!'i'

Kl!n!$in 1 #g $! 3id, Ati)an 2 #g $! h'

A' the $atient (efu'e' !(al #edi"ati!n', he i' 3eing ta7en t! "!u(t f!( #edi"ati!n

!)e( !3;e"ti!n

Fill a'7 f!( M0I '"an %hen $atient i' le'' $'y"h!ti"

LL&'y"h!l!gi"al t(eat#ent

&'y"h!edu"ati!n (ega(ding hi' illne'' and 'u3'tan"e u'e

Su$$!(ti)e the(a$y/ he en;!y' !ne !n !ne 'e''i!n'

G(!u$ the(a$y/ li7e' exe("i'e, #en' g(!u$.

Addi"ti!n "!un'elling

LLS!"ial t(eat#ent

Daily 'e''i!n' %ith i#a#. alal t(ay f!( f!!d.


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