This patient doesn't have any
TBI or right brain additional neurologic injury that could explain any of this? Perhaps contributing to the reason that 1) he does this and
2) it almost sounds like he can't help reverting back to it?
I'm trying to think...I just can't recall many (if any) situations where the patient was perfectly fine cognitively and did this kind of thing. At the very least he's fried some social and verbal filters (< that's a bona fide medical dx, by the way
I promise I'm not so much of a bleeding heart that I make excuses for anything and everything any patient does. This just doesn't completely sound like he's in control...and somehow for me personally that usually makes things a little more tolerable.
I hope you have the support and backing of your NM and others; I know it can't be pleasant. I hope limit-setting is allowed.
I actually think something akin to an old-fashioned care plan is in order. Or perhaps your EMR has an appropriate one built-in somewhere that can be activated and customized. That will keep everyone on the same page, help maintain his safety, define reasonable effort to be applied toward making him as comfortable as possible, and help define/identify therapeutic interventions that may be appropriate related to his behavior.
Hopefully our peers from neuro and psych will weigh in!