Clinical Case 4 Part 1

Dan has been brought in by his friend.  Both of them smell strongly of alcohol but Dan seems particularly agitated and confused and doesn’t seem to know where he is.  His friend tells you that they have been drinking throughout the day and that the reason he brought Dan in is because Dan had been making statements such as “I’ve got to die”, “I want to die”, “Why can’t I die?”  Dan’s friend tells you that they only drink once a month – on payday – when they binge drink.  Today is payday.

Dan is known to both the Emergency Department and to the Mental Health Services.  The notes also comment that he has a history of violence, including three short prison sentences for acts of violence, and has assaulted healthcare staff in the past.

The Department is very busy, you know that there is a backlog of psychiatric patients and that there will be a delay of some hours until he will be seen by anyone.  However, Dan and his friend agree to wait until he can be seen and you make a referral to the Psychiatric Liaison Team.

About thirty minutes later, staff tell you that Dan is more agitated and has started to confront people in the waiting room who he suspects of staring at him, laughing at him or talking about him.