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'He had never had anger issues in the past'

Andrew was a 31-year-old man who was referred to a psychologist due to aggressive behaviour on the ward while an inpatient at a major metropolitan hospital.

He had just received a kidney transplant. During the health psychology assessment, he was anxious but polite. He was concerned about his anger outbursts and how he has treated nursing staff. He reported he had never had anger issues in the past, and this is so “unlike” him. While talking to Andrew he was unable to keep still, pacing the patient room back and forth, rubbing his hands together and talking fast.

His gaze was easily distractible as was his train of thought. He never swore or acted intimidatingly, Andrew was very apologetic for his behaviour over the last few days.  He complained about difficulty sleeping and having issues with his appetite, it was either non-existent or ravishing.

Prior to seeing Andrew, I read his medical file and as a trained health psychologist I was able to understand and take into account his medical history.  What was crucial to understanding Andrew’s presentation was that he was taking high doses of corticosteroids so his body would not reject his new kidney. Some of the many side effects of corticosteroids included irritability, mood swings, feelings of anxiety, impulsive behaviours, mania and even psychosis, due to the medication being metabolised into the stress hormone cortisol.

When I explained this knowledge to Andrew and how he will not be on the medication at this dose for long, his relief was palpable. He replied “I’m not going crazy!”.  This information was significant to Andrew’s adjustment and as a health psychologist I was thankful for my training and ability to support inpatients with the biopsychosocial factors that contribute to people’s mental state.