Describe the health care problem or issue you selected for

Jack Lombardo is a 32 year-old white male who has been referred by a mental health court to the Assertive Community Treatment (ACT) program where he has been a patient. He was taken to the mental health court by the police for sleeping in the back doorway of a small shop. He says that he has been homeless for a month and exhausted the last of his money three days ago. He appears dirty, his clothing is worn and ill-fitting, and his shoes are torn. He appears to be underweight for his height and older than his stated age. He is sweating and has a coarse tremor of his hands as he tries to hold a cup of coffee. His chief complaint is feeling depressed. Review of his record reveals that he was last seen in the ACT clinic eight weeks ago, when he received an IM injection of an antipsychotic medication. His psychiatric history includes many hospitalizations for schizophrenia, referral for treatment for alcohol dependence, and an Axis II diagnosis of antisocial personality disorder. Medical history includes a cerebral concussion resulting from a fight, complaints of gastrointestinal problems, and infected blisters on his feet. Social history includes dropping out of high school in senior year, brief periods of working in a fast-good store, and arrests for loitering and shoplifting of six-packs of beer. When asked about his present social support networks, he says that his girlfriend left him when his money for booze ran out three days ago. He has no contact with his two former wives or his four children and no contact with his family of origin. When asked about his spirituality, he says that he attended church as a boy but has not since then. Assignment Instructions How would you prioritize the patient’s immediate needs? Based on the available information, what would be the patient’s psychiatric diagnosis using the DSM-IV-TR five Axes? Would you consider his chief complaint of depression to be primary or secondary? What are the patient’s case management needs?

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