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Case Study: Alex

Alex, a 53 year old gentleman was referred to St. Peter’s Hospital after being detained under Section 2 of the Mental Health Act to an Acute Psychiatric Unit.

During the course of Alex ’s admission he presented with increasing agitation and aggression that resulted in a number of serious assaults on staff members and necessitated his transfer to a psychiatric intensive care unit (PICU).

Alex was commenced on an anti-psychotic and transferred back to an acute psychiatric ward. His presentation remained one of agitation and aggression resulting in him having to be nursed on continuous 2:1 levels of observation and having to be segregated from the rest of the unit population due to high risk of violence towards others. Whilst on the acute unit Alex ’s engagement with therapeutic activities was minimal and he was not able to safely access the community. His presentation was further complicated by him requiring ileostomy care.

What did Alex and his commissioners want to achieve?

  • Clear diagnosis and prognosis
  • Development of a care pathway and future service specification
  • Reduce his incident level
  • A reduction in has challenging behaviours
  • Increase his communications

What did we do to achieve these goals?

Following his transfer to St. Peter’s Hospital Alex underwent a comprehensive assessment and a diagnosis of Frontotemporal Dementia was confirmed. His clinical needs were clearly identified. He was assessed as being in need of treatment for emotional dysregulation, disinhibition, difficulties with speech and swallowing.

Alex was placed on a 16-week assessment and treatment pathway.

What were the outcomes for Alex?

Using a neuro-behavioural approach together with an optimisation of Alex ’s psychotropic medication the Hospital was able to effect numerous outcomes:

  • A significant reduction in the frequency and intensity of physical violence and agitation; the number of incidents dropped from 99 incidents in the first 4 weeks of admission to 4 incidents in the last 4 weeks of his 16-week admission.
  • A reduction in Alex ’s level of observation from 2:1 levels of staffing to 1:1 levels of staffing. His continuing need to have one staff member with him was not a result of his behaviour but deemed necessary due to his physical ill health which included difficulties with his speech and mobility.
  • Alex was assessed as presenting with a depressed mood during the course of his admission and his improved mental state allowed him to be involved in decision making regarding his treatment. Alex was able to consent to his treatment with an anti-depressant and sign his form CO2.
  • Alex was successfully integrated into a general ward setting allowing him a greater opportunity for socialisation
  • Alex was able to engage in a programme of activities which included community access which allowed him to go for walks which was an activity that he had enjoyed in the past. Alex was supported using the behavioural management guidelines by 2 staff when in the community and there were no adverse incidents.
  • Speech and Language Therapy designed a communication book to allow Alex to communicate his wishes to staff and improve independence.
  • Staff from St Peter’s Hospital supported his transition back to his home, where he lived with his wife supported by a care package that utilised the behaviour management guidelines formulated at St Peter’s Hospital.

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