The Case of Tommy D
- 27 year old single Latino male, admitted 3 years ago to Metropolitan State Hospital as a transfer from a local community psychiatric unit on a LPS conservatorship.
Prior to hospitalization he was residing in a board & care home, where he allegedly sexually assaulted a female peer (but was not arrested) - allegedly showing no guilt or remorse. - Currently (1 year +) being treated on a forensic treatment unit due to unmanageable violent (to self & others) behavior on a LPS unit, on continuous 1:1 staff monitoring.
- Born in L.A. suburb to an intact marriage as the 2nd of 3 full siblings (sister 15 years older, brother 1 year younger) and has 1 younger half sister (13 y.o.).
- His father died of undisclosed cause when Tommy was 7.
- Mother remarried soon after for a few years, Tommy did not get along with him. Probable physical abuse. There is strong suspicion of sexual abuse by an uncle and at least one other incident in his early teens.
- Birth is described as non-eventful. Mother reports that his eyes crossed at 2 months. At age 9 & 13 he had a head injuries.
- Violent, acting-out behavior toward adults and children was noted from early elementary on, resulting in very limited and poor peer relations.
- At the age of 9, he was evaluated by the Regional Center; an IEP at this time identified him as markedly below average cognitively (<>
- By 19, he was assessed at 1st grade reading, 2nd grade math, 1st grade writing (2 or 3 word sentences).
- Behavior problems escalated through his teens, including attacking and threatening teachers & behavioral aides, threats of rape, and culminating in a 5150 hold for threats to kill his mother with a rock at age 17, resulting in foster/group home placement.
- Tommy has also been diagnosed and treated as an insulin-dependant diabetic since the age of 16. He also has hypertension controlled by medication.
- Mental health treatment included outpatient psychiatry and therapy, group treatment, group homes, and several inpatient admissions from the age of 17 on.When the police arrived to place him on his most recent hold, he threatened to kill the police and hang himself, then carved on his arm with a plastic spoon.
- Before and since admission, history includes angry outbursts toward staff and peers, property destruction, and self-abuse (head banging, breaking glass to cut self, burning self).
- He has reported hearing voices of both men and women, at times "commanding" him to strike out or "kill", although he is typically very unspecific as to content; he also expresses some paranoia (though not bizarre in content).
- In terms of recent mental status, he is alert and oriented X 4, thoughts are linear and usually coherent, speech is normal rate and volume, grooming is good, affect is typically labile, at times laughing and euthymic-at times angry and brooding, insight and judgment are impaired, he has been known to make childlike grandiose statements of abilities and talents (sometimes presenting self as a "gangster").
- "Challenging"behavior since admission to MSH which led to transfer to forensic unit (and constant 1:1) includes violent, impulsive behavior (destroying property, throwing chairs, making and using weapons, hitting, AWOL attempts, etc.), self-abusive behaviors (cutting, hitting, swallowing foreign objects).
- Behaviors often appear in reaction to jealousy (others getting new items or more attention) or visits or phone calls from his mother (big trigger), and have been preceded by Tommy talking in "his little boy voice".Temper tantrums and crying fits have also been noted.
- Behavior analysis and interviews revealed that Tommy seeks to please staff when not upset, likes to be "babied" or nurtured, but also likes to appear "strong and manly"-exercising frequently and taking off his shirt to flex his muscles.
- Very sensitive to change in or reaction of staff, or to feedback or expectations (self-sabotage), very hard time managing frustration, anxiety, disappointment
Current medications are: Seroquel (atypical antipsychotic) 1200mg; Zoloft (antidepressant) 200mg; & Tegretol (anticonvulsant/mood stabilizer) 700 mg
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