Assignment Essay Discussion Paper

CASE of SAUL INTAKE DATE: FEBRUARY 2021

 

 

DEMOGRAPHIC DATA:

This is a voluntary intake for this 53 year old Jewish male. Saul has had several psychiatric hospitalizations in the past. Saul has been married for 29 years. He has three daughters. Saul has had difficulty in jobs and has not been at any job longer than two years.

 

CHIEF COMPLAINT:

“My wife is complaining about my behavior”.

 

HISTORY OF ILLNESS:

Saul reports first seeking psychiatric treatment when he was sixteen years old. He was prescribed anti-depressants, but does not remember what kind. Since they helped his mood he remained on anti-depressants for several years. At thirty-four years old he attempted suicide after his wife threatened to leave him. He was hospitalized in a psychiatric unit for thirty days. At that time Saul was put on lithium, with continued successful results for several years. He stopped taking the lithium 1 years ago.

In December 2019 Saul returned to his psychiatrist because he was becoming depressed again, feeling sad, fearful and suicidal. He was given Trintellex. Soon after, both Saul and the psychiatrist did not think this was working very well and the psychiatrist added Rexulti to his medication regiment. During the next three months Saul felt on top of the world sometimes lasting for 10 days. He then would have angry outbursts. His wife asked him to leave the home. He then took an overdose of Klonopin. Saul stabilized as he continued on anti-depressants and lithium.

More recently Mrs. Saul was getting concerned about their financial state because Saul would constantly be buying big items that they could not afford. They would have arguments about this all the time. Saul was rarely sleeping because he was up shopping at night. This had no effect on his ability to work.

 

SUBSTANCE USE HISTORY:

In his late teens Saul began drinking. His use of alcohol continued increasingly into his early thirties. He reports never planning on drinking as much as he did but once he started he was compelled to drink until he passed out. He stopped drinking after attending in patient treatment for 30 days. He began drinking in December 2019 again, Saul indicates, to cope with the marital difficulties. This use and behavior continued up to his current presentation for intake.

Saul notes that earlier on he would also ingest methamphetamines. He was a regular user and loved the way they made him stay thin. He has not used methamphetamine since he left rehab.

 

PSYCHOSOCIAL HISTORY:

Saul reports growing up as tumultuous. His mother beat him and would lock him out of the house when she became angry. His mother separated from his father on several occasions and sometimes would throw Saul out of the house with the father. His mother made all the decisions and his father played a more passive role. Both parents would often have physical fights and Saul would try to break up the fighting from as early as he can remember.

Saul is the only child from his parents union. He has an older brother from his mother’s previous marriage. Saul does not have any contact with his brother. Saul was initially considered an underachiever in the early years of school. He had trouble being in fights with other kids because they used to make fun of his wrinkled clothes. Saul always wanted to be a doctor. He spent the following five years after college graduation taking courses but never completed his graduate studies.

Saul has no legal history. He worked in the family business through high school and college. He became a project coordinator at his next job. He stayed there three years.

 

MEDICAL HISTORY:

Saul states he currently takes Synthroid for a thyroid problem and this helps him keep his weight down.

 

FAMILY ISSUES AND DYNAMICS:

The first ten years of their marriage Saul reports physically abusing his wife. He reports hitting the oldest child once. He stopped the physical abuse when Mrs. Saul asked for a divorce the first time. Saul reports he always wants people around him. He believed his wife was becoming more distant from him over the past several years which he could not take. Their fighting increased, although he would not become physical with her now.

 

MENTAL STATUS EXAM:

Saul presents as a neatly dressed male who appears younger than his stated age. His hair is a bit disheveled. His nails are neatly groomed. Facial expressions are appropriate to thought content. Motor activity is appropriate. Thoughts are logical and organized. There is no evidence of hallucinations. Saul admits to a history of suicidal ideation, gestures and attempts. His mood is depressed. During the interview Saul talked fast. Saul is oriented to time, place and person. His intelligence appears above average. Assignment Essay Discussion Paper