The initial situation seems disconcerting; a single 25-year-old male, Nigerian nationality, with serious conduct disorders, of which there is no information.
He came to Valme Hospital undocumented, accompanied by public order forces, after having precipitated by a bridge.
During his stay in the emergency room he showed hostile attitude, denial of active, and no awareness of disease.
Admission is carried out in an involuntary manner.
He is conscious, oriented and alert, with preserved higher cognitive functions.
Dysphoric, sad.
Thought sometimes disorganized, with ideation of death and suicide without structuring or planning.
Once on the floor, for days he continued to be litigant, challenging, suspicious, and suspicious, accepting no help from health care personnel, talking about himself and taking treatment.
Mechanical and chemical measures were necessary due to the risk of unpredictable behavior, leading to two episodes of hospital escape.
Difficulties in management and problems in the expression of the patient in Spanish motivated the intervention of the social worker of the hospital, who reported the availability of an intercultural mediator in the "Sevilla Acoge" association.
Thanks to the joint interview of the psychiatrist with the intercultural mediator, it was possible to obtain information on the current history: he did not need the time of residence in Spain, when reaching Sevilla he was lodged in a shared floor of a marginal neighborhood.
He worked as a temporary worker in very hard working conditions, and there he began to think of damage to the boss who hired him.
He lost work and had lived on the street for two months.
He said he had come to different centres seeking help without finding any resource.
The psychosocial stress situation, along with their beliefs, killed the psychopathology presented.
During his stay in Sevilla, his distrust increased, "the police sought me a bride from Madrid for me to fall in love and then take her away.
I used to refer to prejudice ideation and discrimination. "You are nervous because you never see a man like me, you want to hurt me...", ideation of mystic-religious content and megalomanic power African "
"You cannot help me; I am the man who has helped you; I cannot stay in Spain alone; I cannot go up to heavens--you go to America."
"Africated us all our property in--"
Regarding the diagnosis, we proposed the differential diagnosis between acute and transient psychotic disorder without specification (CIE-10 F 23.8) and Severe Stress Reaction without specification (CIE-10 F 43.9).
The lack of antecedents and family members of mental illness, the magnitude of the stress to which the patient faced, together with the difficulty of distinguishing personal nature from the diagnosis, perhaps the disorder did not appear in the specific absence of stress factors.
It also includes the heading Problems related to the social environment (ICD-10 Z 60).
As for the intervention and treatment, his way of living in childhood made hospital admission a horrible situation "I don't want to be shut up, free heart, I have run thousands of kilometers...".
Haloperidol (10 mg/24h) and venlacrimal delay (150 mg/24h) were prescribed.
Despite his refusal to accept help, thanks to the intervention of the intercultural mediator in a single consultation and after several sessions of supportive psychotherapy, he was progressively more reactive and collaborative.
She expressed feelings of despair and desire to contact her family of origin.
Natural from the city of Enugu, located in the Nigerian state of Enugu, the child of six brothers was educated in Christianity from small and prepared to learn something economically from his family.
Since his stay in Spain, he had maintained regular telephone contact with them.
They met to give him advice "they meet to advise me, everyone and told me not to make friends here. I had two friends when I arrived and the two in jail do not tell me the help of drugs."
Knowing the psychosocial circumstances in which she was, without work and without a place to live, the social worker of the hospital began to search for a host center where it was possible to refer her after hospital discharge.
