Case Study 1: Psych Patient in ED

Aaron Smith, age 20, is a psychiatric patient with bipolar disorder. At the request of his father, he is brought by police to the Emergency Department. This is his third visit to the ED for psychiatric treatment this year.

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Personal History and Recent Events

Last month, Aaron was expelled from his college dorm due to aggressive behavior and substance abuse. He has moved back into his parents' home. Today, in an outburst, he put his fist through a wall and then turned his rage toward his father. His parents suspect he has stopped taking his medication for bipolar disorder.

Aaron's Demeanor upon Arrival

Aaron displays classic signs of potential to become violent. These include:

  • disheveled appearance
  • agitation
  • pacing
  • fidgeting
  • clenched fists

Cues from Hospital Records

A quick look at Aaron's hospital records reveals a history of violent behavior:

  • Aaron is being treated for bipolar disorder with prescribed medications.
  • He has had two other recent ED visits before this one: once for disruptive, violent behavior, and once for a drug overdose.
  • He rated "high" for dangerousness on assessment from a previous visit.

Triage Reveals Suicidal Thoughts

The triage nurse questions Aaron to help determine the extent of present danger. After several prompts to get beyond surface answers, the nurse learns that besides his violent outburst at home, Aaron had planned to kill himself by crashing his car, which increases his risk of danger to others.

Page last reviewed: February 7, 2020