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Carol is a 49 year-old lady who worked as a nurse.

She was diagnosed with Huntington’s Disease and was cared for in a specialist nursing home. Her needs could no longer be met within the nursing home, after she presented with increased agitation and aggression and she was detained under the Mental Health Act.

On her admission to St Peter’s Hospital Carol presented as agitated and aggressive. There were multiple assaults on staff and she was nursed on 2:1 levels of support to manage the risk she posed to others. Carol also refused to eat a healthy diet.

What did Carol and her commissioners want to achieve?

  • A review of her medication
  • Improve and stabilise her mental health
  • Improve her physical health
  • Reduce the level of challenging behaviour incidents
  • Augment communication

What did we do to achieve these goals?

  • Carol was assessed by the Multidisciplinary team at St Peter’s Hospital.
  • Her psychiatrist carefully titrated her medication to alleviate anxiety and manage her impulsive and aggressive behaviours.
  • The psychology team completed neuropsychological testing and behavioural analysis that led to the formulation of a Positive Behaviour Support plan.
  • The Dietitian and Speech and Language Therapist, worked with Carol to improve her dietary intake and communication.

What were the outcomes for Carol?

The multidisciplinary team worked effectively to improve Carol’s mental and physical health and during her 16-week Assessment and Treatment Pathway she was able to be managed without the use of enhanced observations.

Due to the complexity of her presentation, requiring careful management of her mental and physical health needs, Carol remains at St Peter’s Hospital, where she has now moved on to a Recovery and Wellbeing Pathway which has aimed to engage her in meaningful activities focussed on promoting independence and help her adapt her daily living skills to suit Carol’s deteriorating mobility and cognitive function.

Carol has improved her compliance with all aspects of her care and treatment. She has joined the interview panel at St Peter’s, and been supported in interviewing candidates for the post of Psychologist. This has improved her self-esteem and confidence and led to an overall improvement in her presentation.

The team at St Peter’s is now working closely with her Commissioners and the community Huntington’s Disease Nurse Practitioner to find an appropriate placement for Carol to step down to.

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