Name: Sharon LaPalma PSYCHIATRY CONSULTATION REPORT
#040604
Dr. Sansuk Sudsai

CONSULTATION REPORT

REASON FOR REFERRAL:
The patient is a 43-year-old Caucasian female with a Master’s degree who recently left her apartment and is presently homeless. She has worked as an MFCC and teacher in the past. She was brought in by the River City Police, after exhibiting bizarre behavior in the restaurant, refusing to leave when asked to do so by the management.

HISTORY OF PRESENT ILLNESS:
The patient has a long history psychiatric illness with symptoms of both mood disorder and of a thought disorder
in the past. The most recent diagnosis was bipolar disorder, manic. The patient has been in Weston Hospital twice and also in Orange Harbor Hospital twice this year on a 72-hour hold for bizarre behavior. The reasons for previous admissions resemble remarkable reasons for this admission. On the day of admission, the patient was in a sushi restaurant. She felt it necessary, because of what she calls “extreme heat”, to go to the bathroom, disrobe, soak her clothes in the sink, and put the clothing back on and return to the restaurant. The restaurant owners said that she had been there all day already, and as it was 4:30 p.m., they asked her to leave. She refused to do so, and police were called. She was violent with the police and was brought to the psychiatric emergency area.

PHYSICAL EXAMINATION:
GENERAL:
The patient had a physical exam which revealed no acute
physical findings.

NEUROLOGIC:
Mental status exam was significant only for a certain degree unkempt appearance, perhaps secondary to her being soaking wet, and a hostile affect and very irritable mood. Also, remarkable in her mental status exam was her claim that she was actually the result of genetic manipulation by plutonian scientists, and that she had come to Earth from that planet. The patient was given an initial diagnosis of psychosis NOS, rule out bipolar disorder, rule out schizoaffective disorder and was admitted.

ASSESSMENT:
AXIS I Psychosis or Organic Disease: Bipolar disorder, manic. Ethanol abuse.
AXIS II Personality Disorder: None.
AXIS III Medical Condition or Diseases: None.
AXIS IV Psychosocial Stressor Level: Mild.
AXIS V Global Assessment of Function Scale: 15. Six-month projection 40; 12-month projection 40. Past year 60.

RECOMMENDATIONS:
Thorazine 100 mg p.o. b.i.d. and 200 mg p.o. h.s.


______________________________________
Sansuk Sudsai, M.D.

D:12/03/2011
T:12/03/2011















Name: Mallory James PSYCHIATRIC CONSULTATION REPORT
#040601
Dr. Ali Ibrahami

CONSULTATION REPORT

REASON FOR REFERRAL:
“I am seeing faces that are telling me to stab myself.”

HISTORY OF PRESENT ILLNESS
The patient is a 30-year-old white male with a long history of schizophrenia who currently lives at board-and-care. He
was brought in by an ambulance after he called them complaining that he was seeing faces that were telling him to kill himself. The patient had smoked a “$5 cigarette” 30 minutes prior to this episode which was laced with PCP or marijuana; the patient is not sure which.

PAST HISTORY:
Habits: PCP, marijuana, cocaine.

MEDICATIONS:
The patient was reported to be on 20 mg of Haldol b.i.d.
and 2 mg of Cogentin b.i.d. in his board and care.

REVIEW OF SYSTEMS:.
Neuropsychiatric: On initial evaluation in the emergency
room, the patient had a disheveled appearance. He made adequate eye contact, and he was cooperative. However, he exhibited very inappropriate behavior at times including laughing and smiling when he was talking about suicide. The patient’s speech was normal; his mood was euthymic. He did see the faces, but he denies that they were saying anything to him. Impulse control was judged as poor, and insight and judgment were also poor.

PHYSICAL EXAMINATION:
No abnormalities found.

ASSESSMENT:
AXIS I Psychosis or Organic Disease: Schizophrenia; acute
exacerbation, undifferentiated type.
AXIS II Personality Disorder: None.
AXIS III Medical Condition or Diseases: None.
AXIS IV Psychosocial Stressor Level: Moderate.
AXIS V Global Assessment of Function Scale: 30. One
year 35; six months 35.

RECOMMENDATIONS:
The medication was changed to 5 mg Haldol q.a.m. and 15 mg q.h.s.

































Name: Bobby Gray
#040607

PROBLEM #2 Pyromania.

SUBJECTIVE:
The patient is a 10-year-old black male brought in by mother with a chief complaint of progressive fire setting and uncontrolled tantrums over the past six months prior to admission. At the time of admission, the patient was 9 years and 10 months. He had been living with his mother after the death of his grandmother six months earlier. He had a two-year history of fire setting which had progressed to the point of 1-2 fires per week, including trash cans, garage, two cars, his dog and a neighbor’s home. During the past six months, he had to be picked up from school due to severe uncontrollable tantrums. The patient was also expressing suicidal ideation and admitted to having been physically abused. The patient had been treated with Ritalin approximately three years prior without much effect. No past medical history is noted. The patient had been noted to be able to induce nose bleeds.

OBJECTIVE:
Psychological assessment done. His verbal was 78, performance IQ 101, average of 87, low average. Low verbal scores indicate weakness in long-term recall of factual knowledge or possible lack of exposure. The Achenbach child behavior checklist compared to children his age showed that he was significantly withdrawn and uncommunicative. Beery VMI was above average. The Wechsler was normal to slightly below average. PPVT and Bender were given, unfortunately after the patient had been sedated with Benadryl, and he scored below average. This needs to interpreted given the situation.

ASSESSMENT:
AXIS I Psychosis or Organic Disease: Severe conduct disorder, solitary aggressive type.
AXIS II Personality Disorder: None.
AXIS III Medical Condition or Diseases: Iron-deficient,
anemia.
AXIS IV Psychosocial Stressor Level: Severe.
AXIS V Global Assessment of Function Scale: 69.

PLAN:
He is on Benadryl p.r.n. 50 mg p.o. or 25 mg IM. Admit for behavior modification, anger management, individual therapy and family therapy.


_________________________________________
Anne Jones, M.D.

D:12/03/2011
T:12/03/2011