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8/26/93   1PM   Psychiatry Follow Up/Transfer Note

Mr. Speken is a 23 year old single white Jewish male living with his
parents, (?)recently graduated from college and who has a history of
panic disorder  since  January 91 until recently treated by his father,
a psychiatrist with Xanax up to 4 mg every day & (?)now recently with
Elavil up to 60 mg every day which was started by the patient's father.  The
patient reports a four months of intermittent decreased mood with
anhedonia, psychomotor slowing, decreased sleep.  Increased appetite
decreased concentration, feelings of hopelessness, but no suicidal

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ideation or plan
     The patient was brought to the ER 8/21 by his family after an observed
generalized tonic-clonic seizure.  The initial impression was Elavil toxicity;
a level was sent but the quantity was not sufficient. A Tox(icology)
was positive (for) Benzo(diazepine).  He was evaluated by both neurology
and psychiatry on 8/23.  The latter found him slight dysyphoric without suicidal\
homicidal ideation.  There was some evidence of paranoia but 
no overt delusions.  No AH/VH(?)  Alert & oriented X3 and cognitively
intact.

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     A few hours later the patient was seen by Dr. Collins of Psychiatry
to be wandering on the ward other than his own.  At that time he was
delusional stating little girls  (?) were under his bedsprings    were
"tormenting."   He was somewhat (?agitated) and disoriented.

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