Case Study 8

John, 23, is checked into emergency with severe gastro-intestinal pain. This is his sixth visit to the same ER with the same symptoms. He is visibly in discomfort, and requires opioid pain medications. John tells you he has been taking opioids for years to deal wth the flare-ups, which include vomiting and diarrhea, and have led to a 40-pound weight loss and five colonoscopies. This latest flare up occurred after he ran out of his pain medication and couldn’t get a refill. John gets very angry and defensive when the staff suggest he is addicted to pain killers. He contends that he wouldn’t be on the pain killers if the doctors could figure out what is wrong with him. When he calms down, you are able to learn a little more about his past: He tells you he has battled anxiety and panic attacks since he was a kid and diagnosed with learning disabilities. Currently, he feels the only relief for his emotional and physical pain is pain medication and that “he is trapped in this situation.” Finally, he adds that lately he’s experienced auditory, sensory and visual hallucinations. Schizophrenia runs his family.

Student questions

• Is John in crisis?
• How do you initiate a crisis intervention?
• How do you implement a harm reduction approach?
• How do you use trauma-informed approaches with John

Discussion Topics

• Age and linkages with schizophrenia
• Withdrawal symptoms
• Stigma and learning disabilities
• Stigma and substance use and its impact on mental health attitudes and interventions