Repeat After Me... What's the problem here? | Case Study
A homeless man is brought to the ER by the local police after he is found sitting at a bus stop with a bloody rag pressed to his left knee. The temperature outside is 32° F and the man is only wearing a light jacket. The officer says, "This guy is nuts. He does everything I do - he mimics me."
NursesGeneral NursingCase Study
The patient is a white male who states he is 25 years old. He has a deep laceration on his left knee and says, "I was running after this guy who really pissed me off, and I fell.” You notice that he mimics your behavior as you clean and bandage his wound. He occasionally repeats words you have said and loses focus, but answers questions after prompting.
History of Present Illness
You ask him if he is aware that he is mimicking your actions and words and he says, "Yeah, it's just something I do. It kinda drives people crazy.” He says he can't recall a time when he didn't engage in mimicry. You ask, "Can you stop doing it if you try?” He responds, "If you try. I get all itchy and antsy...I feel better when I just do it.”. He states that he doesn't sleep much. When you ask if he has a history of fighting, he says, "I get into fights when I have to. People make me mad, they really do.”
General Appearance
Patient appears older than his stated age. His skin is red and rough. His clothing is dirty and mismatched, and he has dirt under his fingernails and embedded in the skin around his shirt collar and ears. He blinks repeatedly during the interview and appears agitated, especially when talking about his altercation with the man he was chasing. He has difficulty sitting still and frequently looks around the room. He sighs heavily and taps his legs with his fingers.
Past Medical History
The patient states he broke his left arm. "I was a kid. I fell out of a tree I think.” He denies any other medical or psychiatric diagnoses.
Family History
Patient is unaware of any family medical history. "I haven't talked to my family since I left home.”
Social History
The patient states he has been homeless since he was 17 when he ran away from home. "I like it out here – it's better for me. My parents just didn't get me.” He admits to drinking daily. "Whatever I can get. It helps, you know?” He uses recreational drugs and cigarettes when they are available but denies addiction. He is an only child. He says he has friends who he sees around town, but no one he feels close to. He dropped out of school when he was 16.
Medications
None
Allergies
NKA
Vital signs
BP 118/74 sitting, LA
HR 76
RR 16
T 97.5oF
HT 5' 11"
WT 170 lbs
What information would help you rule out or refine a diagnosis? Remember, most healthcare facilities want to start with the least invasive and least expensive tests. For example, a CT scan usually won't be approved before a CBC and Chemistry are done. I look forward to your questions!
