Report by psychiatrist
This is a 16-year-old male with a prior history of mild intellectual disability with a full-scale IQ in the 50s but apparent better verbal functioning, bipolar disorder, reactive attachment disorder, autism spectrum disorder and ADHD. Patient was brought in the emergency on 4/27/2026 by law enforcement. He had been making threats at school of stabbing others with a pencil had been attempting to elope. On 4/26/2026 he severely assaulted group home staff causing facial fractures requiring facial surgery. He tells myself “I was mad at the group home made up that stuff I never said I was going to go in there and set the other roommates deck “. Mother states that perhaps he was upset that the other client came out and put the his hand on staff and patient may have been jealous of this. It was a fairly severe sleep assault. Group home and previously given a 60-day notice. However when I talk to group home staff they state that they would have taken him back if he was stabilized. Case manager and mother sent an email on 5/5/2026 terminating their stay with that group home with mother telling me that group home said that they would take the client back but did not want the mothers involved any further. Patient does have some insight in this states he wants to avoid juvenile detention and states he knows what he did was wrong. He also describes knowing it was wrong to assault his mother and apparently another client in their foster home when he previously lived at home and went to juvenile detention. He appears very motivated to avoid juvenile detention.

Overall he has done reasonably well in the emergency room. He is slightly unkempt at times and needs redirection and can be somewhat irritable with this but has not had any physical aggression. In regards to his anger he states “I have bipolar disorder “. He is worried about charges being pressed for his recent actions but does not believe that they have been pressed.

Patient’s mother describes what sounds like perhaps manic episodes which can last for up to 5 days. She notes that the first hallmark is decreased need for sleep with excessive energy he seems to fixate on certain things and may have delusions with her state that he gets out of touch with reality. He has grandiose ideas and is overall very pleasant. He also becomes more hypersexual at these times and may attempt to touch staff. She feels that getting on top of the poor sleep with Zyprexa early on has been helpful.

There is been some concerns about depressive lows at times when he is more irritable and can and will risk of acting out. Patient denies this currently states he enjoys fishing, playing games and cooking. His sleep and appetite are fairly good. He apparently is been making comments to his mother about not wanting to live or being shot by law enforcement. When staff of asked him about this he states “I was just mad and saying that “. He denies current suicidal thoughts of myself. Apparently at age 8 he had placed a cord around his neck.

Patient has a long history of being very impulsive and rapidly fluctuating moods. I did not review symptoms of ADHD in detail with him. There is no current clear psychosis and no clear obsessions or compulsions. There were no clear recent stressors which triggered his change in behavior recently. I do wonder if the group home giving the 60-day termination notice in mid April as part of what triggered some these behaviors.