Pt is presenting to the ED for the following concerns: verbal agitation, physical aggression, significant behavioral change. Pt had not been taking his medication, and had been awake for several days on his computer. Pt began waving a knife and scissors around the house, and refused to give them back to his mother. Pt’s mother was concerned that he was going to hurt her, so she called the police.
Pt seems to have limited potential to regulate his emotions and can be erratic without considering the consequences for his impulsive behaviors. Pt was discharged from inpatient treatment in July of this year, for a similar presentation.
Risk Factor: Aggression (chronic/ongoing)
This term describes a pattern of repeated and persistent aggressive behaviors, such as chronic physical or verbal aggression.
MCR-M17-283
State of MN is trying to find a way to build his own home, timing TBD.
Aggressive, DD, low IQ – 40-50, FAS, ward of state, targeted case mgr. Was provisionally discharged from CABHH, not allowed to return. Perhaps a plan is a state run group home, in development?
MHF-M9-808
Patient is presented to the ED by EMS for aggressive behavior towards staff and another resident in his group home. At the group home staff brought the patient out to his school transportation but the patient became dysregulated when he saw the driver was different from prior trips. Patient then eloped to a neighbor’s house where he entered. Staff followed and called the police. Patient was brought back to the group home, but later got into a physical fight with another resident and staff member. Police were called a second time, and patient was transported to the hospital using restraints. The patient has a history of ED visits and has had approximately 6 previous hospital admissions (5/21; 7/21; 10/21; 11/21; 12/21; 9/22). The patient has a diagnosis history of DMDD, ODD, ADHD, GAD, depression, and RAD
MCR-M14-1086
14 year old with significant trauma history, ward of Hennepin County, recent placement at his request with young adult brother that was disrupted due to conflict. Briefly placed at Von Wald shelter but repeatedly eloped in an effort to reunite with his brother, and was brought to the ED. Calm overall except when relocated to a unit that required observation while in the restroom, then repeatedly escalated with verbal threats, closing himself in the bathroom, and hitting the walls.
MHF-M16-1233
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.
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-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.