Pt is presented to the ED by police. Pt was adopted at age 2, and adoptive parents are now deceased. Pt lives with his sister/legal guardian, sister’s boyfriend, 2 year old cousin, and 15 year old brother. Pt had an altercation with his sister, where he tried to stab her, so she called the police. Pt was in the ED from 6/15 to 6/23 for a similar issue. Pt’s sister says aggressive behaviors are escalating, and he is said to have threated to kill everyone in home earlier this month. There is some concern that pt has been using weed and possibly other substances. Pt has PMH of AHHD, MDD and ODD.
Risk Factor: Aggression (chronic/ongoing)
This term describes a pattern of repeated and persistent aggressive behaviors, such as chronic physical or verbal aggression.
MHF-M11-1283
Pt is presented to the ED via EMS by his adoptive mother/aunt for aggressive behavior. Pt got angry after his family arrived home, after a parade, without any candy for him. Pt began to punch holes in the wall, beat his adoptive mother with shoes, throw things at family members, and threaten to kill them. Pt currently lives with his aunt and uncle who are also his adoptive parents. There are five other children in the home. Pt’s birth mother’s parental rights were terminated in 2020 due to child neglect. Pt carries current diagnoses of ADHD, other specified trauma and stressor related disorder, and other specified neurodevelopmental disorder. There is a strong suspicion of fetal alcohol spectrum disorder, although a diagnosis has not been given due to inability to confirm maternal alcohol use during pregnancy. There is genetic loading for mood disorders and substance use. Pt was most recently in a residential treatment facility for six months, and discharged home about a week ago. Pt has a history of inpatient hospitalizations for his aggression with his last hospitalization taking place from 10/26-11/09/2022.
PH-F13-458
Pt has had 4 psychiatric hospitalizations, PHP twice, and outpatient services. Needing RTC and bridging plan. >Discharge from PC Inpatient is 5/11 at 1400, will discharge home until RTC.
Discharge Plan:
RTC-
Avanti (Referral made, declined for admission due to history of aggression)
North Homes (Referral made, 6-8 week waitlist)
Village Ranch (Referral made, pending acceptance)
Gerard (referral made; pending acceptance)
Northwood (referral not made; waitlist over 6 months)
Newport Academy (referral not made; insurance not accepted)
Grafton (CMHCM making referral; though likely doesn’t meet criteria due to no ASD/ID/DD diagnosis)
CRTC (referral placed)
Interim Plan:
Consider PCR (referral not made; insurance not accepted though possibility for a county contract- connecting county worker and PCR)
Continue Psychiatry at Nystrom and Associates
Continue Probation services at Goodhue County
Continue CMHCM at Fernbrook
Establish Family therapy at Nystrom and Associates.
Establish CADI worker at Goodhue County
update as of 6.22.23 – Denied acceptance at CRTC due to aggression and lack of buy in
MHF-M15-1275
Pt is presented to the ED via EMS for erratic behavior. Pt has twice presented to the ED recently after altercations at his group home and his crisis respite program. Pt has been discharged from both of these programs due to aggressive behavior. Pt was returned home after being discharged recently and collateral reports that pt’s behaviors have increased. This ED visit was due to pt beginning to escalate, and was about to throw rocks at his friend’s windows. Pt’s mother’s boyfriend ran out and stopped him from doing so and told him “no” which is a trigger for pt. Pt then began to start banging on doors after he was stopped from throwing rocks. Pt has an injured elbow which was in jeopardy of being re-injured. Pt wouldn’t stop so mom called the police, and they brought EMS who brought him to the hospital. Pt has a diagnosis of Autism Spectrum D/O needing substantial support, Level 3, Unspecified type and suspected intellectual disability. Pt has a hx of agitation, aggressive behaviors with frequent visits to the ED. Pt’s mother and staff deny any suicidal ideation and attempts. Pt currently has a PCP, psychiatrist, case manager, and social worker. Pt has very limited verbal skills, and responds to questions with one- or two-word answers, and a thumbs up/thumbs down.
MHF-M16-1239
Pt is presented to the ED via EMS due to possible ingestion of cold medications. Pt’s father had called 911, reporting patient’s presentation as being confused and “high” on drugs. Pt admitted to taking pills (unclear about the number of pills) in order to get high. He denies that this was a suicide attempt, and currently denies any suicidal ideation. Pt denies recent self-harm, but has a hx of self-harm over one year ago. Pt lives with his father during the week, and mother on the weekends. Medical records indicate the following history: He has a history of major depressive disorder, generalized anxiety disorder, and substance use disorder. He had been evaluated in the ED for close monitoring in the setting of altered mental status secondary to presumed toxic ingestion of unknown substances, and has a history of multiple inpatient psychiatric admissions. Most recently admitted in March 2023 due to “ingestion/inhalation of multiple substances, including dextromethorphan and benadryl”. Pt has a history of residential treatment, and has a hx of substance abuse for several years and participating in both inpatient and outpatient treatment.
MHF-F6-1228
Pt presented to the ED via EMS after jumping out of her mother’s car into traffic, stating that she wanted to die. Pt lives with her mother and brother, who moved to MN from TX in December of 2022, to escape domestic violence and pervasive sexual trauma. Pt has a history of significant sexual abuse from their father, including sex trafficking. Pt has been screaming, kicking, and running outside, placing the family’s housing at risk.
MHF-F13-251
History of Autism Spectrum Disorder, prenatal exposure to alcohol, cocaine, and heroin. Pt is cognitively delayed and has limited verbal skills. Recently attempted group home, assaulted staff after 1 day; guardian took patient home. Pt presented to ED after assaulting guardian in the home and guardian does not feel safe with patient returning to home, is planning to relinquish custody. In ED, patient is disrobing, throwing feces, assaulting staff, in seclusion. Behavior is chronic and has been seen at similar level historically. Prescribed Zyprexa, Abilify, Clonidine, Thorazine, Atarax, Trazadone.
4/7/23-4/13-23 – Discharged to home.
5/13/23-5/19/23 – Discharged to home.
5/23/23-5/26/23 – Discharged to home.
5/27/23-6/7/23 – Discharged to home.
MHF-M9-1185
Pt is presented to the ED via EMS due to aggressive behavior in his foster mother’s home. Pt became escalated when his foster mother asked him to take a bath, and began throwing chairs and kicking his mother. Pt has an intellectual disability and lacks insight into behaviors and mental health concerns. Pt has hx of autism and ADHD combined type, and hx of agitation/aggression.
SMCF-F12-1160
Patient was brought to the Emergency Dept. after having a violent outburst at a residential facility in Fargo, ND. Concern for physical aggression and property damage. Patient reportedly was involved in a verbal altercation with another resident who was calling him by the wrong pronouns. He has now been discharged from the residential facility with no alternative residential facilities available. Otter Tail County (MN) is the guardian. Guardian has exhausted all options. He has been calm and cooperative in the ED with no outbursts. He is medically cleared and he is not meeting criteria for inpatient psychiatric hospitalization.
MHF-F37-787
Patient presents to ED via EMS for aggressive behaviors and agitation at her foster home. Patient has diagnosis of MDD, GAD, and Intellectual Delay. Foster caregivers report that the patient has had increased agitation over the past 4-5 days, is throwing things, crying most of the day, trying to run away from the setting multiple times a day, is uncooperative, destroying property, hitting caregivers in the face and stomach, and is now trying to self-harm by dumping a dresser over on herself. Patient does have contact with her birth mother but there are apparently issues with that, and foster care believes that birth mother is influencing the patient to act out so mom can get custody returned to her.