19/37

8:30 AM (8/25/93)   Psychiatry Follow Up (coverage for Dr. Collins)

Chart reviewed. Patient interviewed. Mr. Speken is
a 23 year old Single White Jewish (man) living with
his parents who has history of panic disorder
treated in past by his father a psychiatrist 
with Xanax & most recently by another
psychiatrist with Elavil who presented
8/21 after Generalized Tonic Clonic Seizure.  Felt
initially to be secondary (to) Elavil toxicity.  Later
patient became agitated, disoriented &
psychotic (?associated with) delirium which was 
felt to be due to Benzo(diazepine) withdrawal.  On 8/24
he was transferred to ICU for supportive 
treatment & monitoring as he
manifest(ed) Benzodiazepine withdrawal symptoms

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current mental status examination - pleasant young male lying calmly
in bed with hand restraints   speech
fluent.  prosaic somewhat rapid
but not pressured.  Mood dysphoric - 
Affect - very labile.  Tearful.  Denies
suicidal/homicidal ideation.
Thought content - Denies auditory/
visual hallucinations - somewhat
paranoid - Feels the doctors have
lied to him (?)here.  (He thinks he 
was to be transferred to Massachusetts)
but no overt delusion.  Alert & oriented
to name.  birthdate.  Date (8/25/93) but
not place  (Thinks he's in Massachusetts)
He was reoriented & remembers
having had come to Allen Pavilion.

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(?)A/P   Resolving delirium secondary (to) Benzodiazepine withdrawal
continue standing Ativan to
treat withdrawal symptoms - I would not change
back to Xanax as an antidepressant
would be a better choice for
treatment of this patient's panic &

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