Joseph, a 30-year-old man, was brought into the emergency department by police after displaying aggression in a local bar. He assaulted one of the bar patrons for “annoying him”

ASSESSMENT 2 

Name: Joseph Carr                                              MRN: 210735                                      Gender: Male

D.O.B: 27 September 1992                               Allergies: Penicillin                              Marital Status: Single

Admitting Doctor: Lucas Smith                         Aboriginal and Torres Strait Islander: Yes

SITUATION:

Joseph, a 30-year-old man, was brought into the emergency department by police after displaying aggression in a local bar. He assaulted one of the bar patrons for “annoying him” and told the police he was friends with the chief of police and would get the officers fired.

Joseph works as an accountant. He has a long history of success, including graduating from a prestigious university with distinction, making a large income, and having many friends and connections. He is gregarious and always seems to be the centre of attention wherever he is.

He recently joined as a senior accountant in one of the biggest accounting firms and is anxious to make a strong impression on his boss. His new position is more stressful than his previous job. He has been sleeping 2 to 3 hours a night and coming to the office at 05:00 am to keep up with the workload. He drinks heavily at night to try to sleep and uses stimulants in the morning to keep going.

Erica (Joseph's partner) reported that she had noted changes in Joseph’s behaviour over the past two weeks, including being more talkative than usual, increasing irritability and demands, and often changing from charming to angry at the slightest frustration. Joseph usually presents himself well with luxury items. However, he has been shopping more than he used to. He justified it by saying he must present “expensive” to his clients. More recently, his secretary reported him to his supervisors for inappropriate sexual advances and “exposing” himself. When he is brought into the office to discuss the allegations, he explodes and storms out of the office. Erica is concerned that Joseph is not taking his regular medication.

His clinical files indicate that he had previous mental health admissions, with his index admission, when he was 18 Joseph is diagnosed with bipolar affective disorder. He has no other medical health conditions on record. Joseph’s mother suffered from post-partum depression, while his paternal grandfather has schizophrenia.

Joseph approached the nurse and demanded to be released. He stated he knew his rights and threatened to call his lawyer and the media if he did not discharge instantly.

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