Vital Signs:HR 76, RR 22 BP 110/72, Temp 98.8 oral, O2 sat-99%

Introduction:

Miguel is a 29 year old single unemployed Hispanic male who was admitted to a voluntary inpatient psychiatric unit.

Chief Complaint:

" I was just trying to find the truth so that I can save the world."

History of Chief Complaint:

Prior to be admitted into the inpatient psychiatric unit, the patient was taken to the emergency room by police. The police were called when he was observed wandering for hours in a parking lot. Approximately one month prior to his admission, the patient had been fired from a job he had had only for three weeks for inappropriate behavior. Since that time, the patient has barely been sleeping and the family heard him laughing and talking to himself in the night. The patient said that his appetite has been non-existent for the past two to three weeks. The mother said that although the patient is usually frugal, he has recently spent excessive amounts of money buying expensive business suits, which he has been charging to a credit card because he has no source of income. The patient says he was working on creative projects that will save the world, but it is not at liberty to talk about them. He is religiously preoccupied and speaks of his special relationship with God. He is sexually preoccupied, and has been making sexually inappropriate comments to female nurses in the emergency department.

Past Psychiatric History:

The patient has no previous hospitalizations and has never been prescribed psychiatric medications. The only outpatient treatment he had was some counseling the previous spring at the university he has been attending. He said he did not find the counseling helpful. Even in his current state, the patient had some insight into what was occurring and said he thought he had bipolar disorder. He reports that for the past four years, he has been having episodes which could be described as hypomanic a couple times a year in the spring and fall, increasing in intensity to the point that he failed his graduate program last spring. He said. He also had periods of extreme depression when he was not even able to get out of bed. The family said that because the patient had been living away from home, they had not been aware of his problems until this current episode, during which they had been trying to get him to seek help.

Based on your readings and in regards to Miguel's history what additional questions do you have? Provide rationale for each question.(Have at least 3)