HCR 210 – Final Case Study K.P. is a 30 year old

HCR 210 – Final Case Study

K.P. is a 30 year old male who was diagnosed with paranoid schizophrenia at age 17. Although he did not believe there was anything wrong with him, he told his parents he was willing to take medication “… so you have an easier time dealing with me. I don’t need the medication. You do.” His father guaranteed him a job at his company, after high school graduation, if he took his medication. KP worked for his father, who made reasonable accommodations for him, at a manual labor job until he had to stop due to methamphetamine abuse. He lived on the streets for months but eventually returned home, willing to stop his drug use in order to have a place to live. At that point, his parents assisted him to apply for Social Security Disability, which he has received for 8 years. Due to his prior work history, he earns too much on disability ($1200/month) to qualify for public mental health services or subsidized housing and must pay for more expensive private mental health services, for which he receives partial reimbursement through Medicare. Hospitalizations and medications are covered.

K.P. has gained a large amount of weight since he started taking antipsychotic medications at age 17. He now weighs 205 pounds and is 5’9”. He has “stress” headaches, hears negative and controlling voices, has tactile hallucinations (needles going into his neck, knives into his head, his hair being pulled, although he shaves his head). He has been in recovery from methamphetamine abuse for 8 years and attends AA and NA meetings daily for socialization. He quit smoking (a 3 packets per day habit) 4 years ago in preparation for sinus surgery (removal of polyps).

Seven months ago, KP said his medications (Zyprexa -20 mg q PM and Risperidone -4 mg q AM, both for psychosis; propranolol – 20 mg q AM and PM, for high blood pressure) were “killing me”. At that time and under his psychiatrist’s supervision he began to taper off the antipsychotic medications, substituting other medications in hopes they would find something he could tolerate. However, in the process of tapering and adding new medications, his delusions became stronger and he was involuntarily hospitalized 3 times. He stopped all medications completely a month ago and no longer would live with his parents, believing they were trying to kill him because they insisted that he take his medications.

He has become increasingly psychotic and delusional. His delusions have caused him to seek help frequently from the police, local coffee shops, AA and NA meeting members and his parents. He is concerned that gas stations are short-changing people with disabilities who pay cash for their gas and that gas companies need to be stopped. His parents contacted 911 in an attempt to obtain help during his last visit home, when he was extremely agitated, yelling, and threatening to “do something” if his parents did not help him. The police and medics arrived and convinced K.P. to go to the ER. Once there, he became increasingly psychotic, finally becoming incoherent and nonresponsive. He was involuntarily committed to the hospital, for the 4th time in 7 months, for a 72-hour watch.

K.P. signed a mental health directive 3 years ago, which indicated he would like to receive antipsychotic medications if he becomes unable “to care for himself.” His parents have the original signed form. The 72-hour watch is ending and K.P. is refusing medications, requesting to be released, and indicating he does not want his parents involved in his treatment. He is not threatening to harm anyone or to harm himself.

What should be done now for K.P.?