peer reply clinical (BO)

Discussion: Weekly Clinical Experience 6

The clinical encounter that made me emotionally charged during this semester involved a 29-year-old white male who had been brought to the clinic by his mother complaining that the patient was threatening them with committing suicide to “save the world” from imminent peril. The patient was married and had stayed with his family peacefully for the last seven years after which he left his home two months ago to pursue his calling of calling “save the world”. Before his journey to an unknown destination, his wife had complained to the company where he was working that her husband had been having trouble at home, hearing people talking to him and not wanting their six-year-old boy to watch the television because he was seeing people watching them. She was concerned that her husband was having mental issues after he began displaying disorganized behavior such as not bathing or even wanting to eat.

At the office, the patient appeared untidy with unkempt hair. He was easily distracted by pressured speech and altered thought processes. He also stated that he was the “smartest man on earth” and that he has been hearing people who have commissioned him to save the planet by committing suicide. He has been hesitant but since leaving home, he has welcomed the idea and feels that ending his life will be the best way to fulfill his “commission”. His mother reported that his wife and their baby are ready to welcome him at home although she believes seeing a psychiatrist would help her husband.

After reviewing the patient’s history, I decided to prescribe clozapine (versacloz) 50mg po OD for suicidal ideation after I suspected the patient had schizophrenia. I selected this medication because it is FDA approved for suicidal ideation and has been associated with improved outcomes in schizophrenia patients (Flanagan et al., 2020). However, the patient declined to take the medication, stating that he believed that he was mentally healthy and that psychopharmacological treatments were not necessary. I became emotionally charged after tried to talk to his mother to help him acknowledge the diagnosis and his mother was becoming worried, stating that her husband has spent the last 11 years in a psychiatric rehabilitation center after developing similar symptoms and that she was not ready to lose her son. It was challenging to assure the patient and address his delusions but after consulting my supervisor, the patient agreed to take the medication only if he was allowed to sleep in the spare room away from his wife and child.

After two weeks of clozapine medication, the patient was brought again to the Clinic after the wife has made a call to the clinic that her husband was threatening to kill himself. When assessed, the patient admitted that he had not been taking his medication because the first time he took them, he developed constipation and could not eat. He had been found in his room with a firearm which he was intending to. I was irritated because I had hoped that the patient would return having improved from his initial visit to the office. I assured the patient that constipation was one of the side effects of clozapine (Haidary & Padhy, 2021) and asked him if he wanted the medication to be changed. He declined and stated that he did not need to be helped as he was still focused on fulfilling his mission. At this point, collaborated with members of the interprofessional team including a psychologist who assisted with developing a safety plan for the patient and enrolling him in therapy sessions.