Reference no: EM133316303

Case Study: Mr. Donald Savoy is a 39-year-old, African-American single male, who has been charged with Involuntary Manslaughter following the vehicular homicide of a pedestrian that occurred on January 4, 2015. He is admitted to the hospital for a competency evaluation after being opined incompetent to proceed with his case. Additional jail records indicate that Mt Savoy expressed having thoughts of wanting to hurt himself and was found by the guards attempting to hang himself with a sheet The evaluation was requested for diagnostic clarification and to ascertain if his symptoms are a result of mental illness, volitional factors, characterological traits, or some combination of these factors:

Mr. Savoy was born in a major metropolitan city and his parents divorced when he was a toddler His mother remarried and he had a close relationship with both of them prior to their deaths in September 2013 and June 2014, respectively. He has a close relationship with some of his siblings but stated that he was closest to his two brothers who committed suicide with the most recent one occurring earlier this year (January 12, 2015) via gun. He was not allowed to attend the funeral of his brother because of his being incarcerated. Mr. Savoy graduated high school and college with a degree in Computer Technology He is not married nor does he have any children.

Mr. Savoy described having a "nervous breakdown" in November 2014 associated with the stress from the demands of his job and having recurrent nightmares, flashbacks, and images associated with finding his oldest brother's body in March 2014. He also described having anxiety real bad the last two years because my job was very stressful. He further stated that he was constantly worried that he was going to be fired because of the company downsizing. He stated that he would sometimes have panic attacks that left him feeling paralyzed at the thought of things happening and that his heart would often race etc. He disclosed being hospitalized several times over the last few years because of his feelings of anxiety and depression,

During your current interview with Mr. Savoy, he described a host of psychiatric symptoms to include auditory hallucinations (eg, telling him to hurt himself and/or others), depression with suicidal ideation, flashbacks, nightmares, anxiety, and panic attacks. Mr. Savoy reported a significant history of suicidal ideation (thoughts) with several previous attempts that have been largely brought on from extreme feelings of anxiety and in response to his grief & loss over the last several years More specifically, he stated that in July 2014, he drove to Charlotte, NC to find a small bridge to jump from When queried about why he chose North Carolina, he reported. "I've seen people get saved from trying to jump off of the 14th Street Bridge." He also reported that he believed that the water in North Carolina was cleaner." He stated that he ultimately changed his mind and felt like a failure for not being able to take his own life. He described additional attempts of suicide to include taking pills and attempting to hang himself at the fail

Your review of Mr. Savoy's mental status did not reveal that he was responding to internal stimuli such as hallucinations despite his self-report of experiencing such symptoms. His affect appeared blunted, but was appropriate to topic. He described having difficulty sleeping over the last few months particularly while he was housed at the DC fail but that he has felt somewhat better since being placed at the hospital He continued to express suicidal thoughts but denied that he had a plan Out of a 10 point scale with T being "I wouldn't hurt myself and 10 being "I would kill myself today," he indicated that he was at a 6

Mr. Savoy indicated that he often smokes marijuana on a daily basis to help calm himself. He described missing several days of work over a 3 month time frame because of his becoming so anxious and the only way to settle his feelings was to smoke "two joints. He indicated that he has a history of being charged with Possession of Marijuana and is currently on probation for Distribution of Marijuana and PCP. While he denied that he uses PCP and cocaine regularly, he did adout to using this substance approximately three times per month....

His medical history is significant for Hepatitis C and asthma that is being treated via medication

Question: What is the diagnosis and evidence based treatment for this case?