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CASE STUDY 1
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| KN is a 65-year-old woman admitted to a nursing home after her family can no longer care for her. She has Alzheimer’s dementia and has become more difficult to manage over the past six months. She no longer takes care of her own grooming and hygiene and is pacing and trying door handles, attempting to get outside and go home. Today she started yelling at another patient and hit him with her lunch tray. The staff is trying to calm her, but she continues to yell and strike out at people. |
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CASE STUDY 2
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| JS is a 27-year-old male patient admitted to the psychiatric inpatient unit where you are the pharmacist. He is yelling at staff to leave him alone. He goes on to say that the CIA is looking for him and that the voice of the President is telling him to “stop the spies.” He is dirty and unkempt in his appearance. He is starting to pace faster and faster up and down the halls and has refused oral medication. He is arguing with another patient on the unit whom he accuses of being a Russian spy. You know this patient as he has been admitted to the unit on several occasions for noncompliance to his antipsychotic, which he takes for schizophrenia, paranoid type. |
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CASE DISCUSSION
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| Both of these cases illustrate agitation and aggression, which are among the most disturbing complications from psychiatric illnesses. These symptoms create management problems for family and staff and add to the stigma surrounding mental illness. Patients are also at risk, as they can be harmed or experience legal consequences, regret or remorse after they are agitated or perpetrate an aggressive act. Aggression and agitation are ill-defined terms and there is no widely accepted nosology. Hence, clinicians may use one of these words to label symptoms, but really be speaking of very different patterns of behavior requiring differing interventions. |