28/37

(Initial evaluation on Eye 6 where Seth had been transported by ambulance 
from Allen Pavilion)

                              CONTINUATION SHEET
                PHYSICIAN ADMISSION ASSESSMENT                                               PAGE 1

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DATE:  8/27/93
IDENTIFYING DATA:   23 year old single white Jewish male who lives home
with parents and younger sister, with history Crohn's disease, panic disorder,
& major depression, transferred from Allen ICU after 1 week treatment for 
seizures x 1.
LEGAL STATUS:   voluntary
CHIEF COMPLAINT:   "I have panic disorder"

HISTORY OF PRESENT ILLNESS:  23 year old white male, first Psychiatry
admit, complains of approximately 2 year history of panic attacks,
consisting of increased heart rate, feeling of suffocation, & sweating, often
brought on in situations where he feels a task is demanded of him.  The
first time one occurred, patient felt as if he were having an MI (Myocardial 
Infarct), & was treated in an ER & told to see a psychiatrist.  Patient saw
a Psychiatrist MD X4, was prescribed Klonopin 6 mg/day with some
relief, but stopped after his father (a Psychiatrist M.D.) said it was too
much medicine.

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     Patient's father began treating him with Xanax 4mg every day with
decreased severity of attacks.  Patient reports having the attacks every day,
though was able to do well in college, drive, go to movies & vacation.  He
reports taking Xanax 4mg only on weekdays, not weekends or vacations,
& taking some 1-2 months drug holidays during which he did not have panic
attacks (and withdrawal signs/symptoms), since he knew how to taper.)

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     6 months Prior To Admission, in setting of painful rejection from
grad school, patient noted to be dysphoric, anhedonic,
hypersomnolent, decreased appetite, & feelings of hopelessness, but
never Suicidal Ideation.  Over ensuing 2 months, patient had increasing
guilt over Xanax use--"felt like a drug addict,"  "felt cut adrift with
no control over my life."  These feelings were reinforced by his father
who told him he was taking too much, but continued to prescribe.
Patient denies ever getting meds on his own with father's prescription
pad (except Flexeril, years ago, when father away).
     4 months Prior to Admission, father tapered him off Xanax & 
started Zoloft.  Patient took 1 (?) month without improvement in mood,
& severe agitation.  Then restarted Xanax 4mg daily and

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