Case Presentation medical student year 3

SUD MS3

1. Case Presentation Arjun Venkatesh

2. I have addiction “ - L.L. 35 years old ” 2

3. History of Presenting Illness Nicotine Started smoking cigarettes at 14 but quit recently 20 pack years Marijuana Started at age 9 Father was a Rasta Does not see this as an issue 3

4. History of Presenting Illness Alcohol Given brandy as an infant Consciously started drinking at 16 Drank to “listen to the stories of older people at the bar” Drinks anytime he has nothing to do Generally smokes marijuana simultaneously Has been in and out of rehab facilities for the last 20 years usually being brought by the police Tends to take off clothes because he “gets hot” 4

5. Subjective PMH HTN - 3 week history (discovered upon current admission) In and out of Carlton House for addiction innumerable times since 2004 FH Mother – HTN; Father – Addiction; Siblings all healthy NKDA Meds Risperidone 2mg daily 5

6. Subjective Social History Bus conductor Vegetarian Many hobbies (cycling, reading, swimming, socializing) Lives alone Two children that he has no contact with 6

7. MSE Patient was in good spirits , cooperative and making good eye contact. Speech is fluent , words are clear and volume is appropriate. Mood and affect are congruent. Thought processes are generally coherent but there is flight of ideas with constant talking and speaking at length of any tangent that arises. Patient does have some insight by agreeing by stating that he suffers from addiction , but also says that he thinks the problem is how society views him , and not that what he is doing is inherently wrong. Patient also has some thoughts that could be considered delusions , but it is not clear if he is just exaggerating for the interview. Good judgement, oriented to person, place and time. Serial 7s, remote memory, recent memory, calculation, abstraction and constructional abilities are good. 7

8. Assessment Substance Abuse Disorder - Alcohol High tolerance (Has drank two bottles of rum in one day) Unsuccessful efforts to cut down Continued use despite troubles with family and police 8

9. Assessment Schizophrenia Delusions for >6 months Disorganized speech (flight of ideas) for >6 months Heavy cannabis use from young age Bipolar I Manic episodes while going on drinking benders which required hospitalization (flight of ideas, impulsivity, grandiosity) Heavy substance abuse from young age High stress with little family and no contact with kids 9

10. Plan Continue to keep admitted to psychiatric hospital Consult on lifestyle/friend changes to help stay sober this time Vitamin panels to check for thiamine and B12 levels. 10

11. Alternative Treatments Hypnotherapy aims to access the subconscious mind to effect positive changes in a trance-like state Hypnotherapy has been successful in addressing underlying emotional and psychological factors and promoting healthy coping mechanisms A study involving 178 patients showed that hypnosis was effective in achieving sustained abstinence beyond one year 36% success rate vs 24% with Disulfram 11