Assignment task:
CASE of AKIEL
DEMOGRAPHIC DATA:
This is a voluntary intake for this 24 year old Jamaican male. Akiel has had several psychiatric hospitalizations in the past. Akiel has been married for 5 years. His wife, Rayona was born and raised in the United States. He has one son 5 years old and one daughter, 3 years old. Akiel has had difficulty in jobs and has not been at any job longer than one year. Akiel immigrated to the United States with his parents when he was 6 years old. Want Professional Help?
Chief Complaint:
"My wife is complaining about my behavior. I do not see what the issue is".
History of Illness:
Akiel reports first seeking psychiatric treatment when he was sixteen years old. He was prescribed anti-depressants, but does not remember what kind. Since they helped his mood he remained on anti-depressants for four years. At twenty years old he attempted suicide after his wife threatened to leave him. He was hospitalized in a psychiatric unit for thirty days. At that time Akiel was put on Depakote, with continued success for three years. He stopped taking the Depakote 1 years ago.
In the previous September Akiel returned to his psychiatrist because he was becoming depressed again, feeling sad, fearful and suicidal. He was given Trintellex. During the next few weeks Akiel felt on top of the world. He then would have angry outbursts. His wife asked him to leave the home. He then took an overdose of Klonopin.
More recently Rayona was getting concerned about their financial state because Akiel would constantly be buying big items that they could not afford. They would have arguments about this all the time. Akiel was rarely sleeping because he was up shopping at night on the Internet. This had no effect on his ability to work.
Substance Use History:
At twenty one Akiel began drinking. His use of alcohol continued increasingly until about 6 months ago. He reports never planning on drinking as much as he did but once he started he was compelled to drink until he passed out. He stopped drinking after attending outpatient treatment for 16 weeks. He began drinking in September again, Akiel indicates, to cope with the marital difficulties.
Psychosocial History:
Akiel reports growing up as uneventful. His mother separated from his father on several occasions. His mother made all the decisions and his father played a more passive role.
Akiel is the only child from his parents' union. He has an older brother from his mother's previous marriage. Akiel does not have any contact with his brother. Akiel was initially considered an underachiever in the early years of school. He had trouble being in fights with other kids because they used to make fun of his wrinkled clothes.
Akiel has no legal history. He worked in the family business through high school and college. He became a project coordinator at his next job. He stayed there six months years.
Medical History:
Akiel states he had the usual childhood vaccinations and no major illnesses as a child. He currently is physically fit and healthy.
Family Issues and Dynamics:
Akiel reports that he is happy in his marriage and does not know why his wife has so much trouble with him. He believes his wife has become more distant from him over the past several years which he doesn't like. Their fighting has increased. Akiel reports his wife is frustrated with his lack of energy and fatigue which has, recently, been impacting their social life and activities with the children.
Mental Status Exam:
Akiel presents as a neatly dressed male who appears younger than his stated age. Facial expressions are appropriate to thought content. Motor activity is appropriate. Thoughts are logical and organized. There is no evidence of hallucinations or delusions. Akiel admits to a history of suicidal ideation, gestures and attempts. His mood is depressed. During the interview Akiel talked fast. Akiel is oriented to time, place and person. His intelligence appears above average.