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CONTINUATION SHEET
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History of Present Illness Continued: experienced worsening guilt/loss of
control secondary to Benzodiazepine use----->decided to totally
discontinue Xanax when school finished in 2 months. Also, felt the need to
"commit myself," & get a psychiatrist. Xanax tapered 1 months Prior
To Admission, totally discontinued by 15 days Prior to Admission (patient
is adamant that he took no Benzodiazepine until admit; father, by report,
thinks he did).
2 weeks Prior to Admission, patient seen by Dr. Quen (Psychiatrist
M.D.) who prescribed Elavil 10 mg (?with ?mg increases every day)-->
(to) 60mg by 8/20. Given Bethanechol 10 (mg) for diarrhea(?).
1 day prior to Allen admit, patient felt dizzy upon rising to a standing
position, though did not lose balance or consciousness.
The am of Allen admit, he awoke at 3am, did not feel like himself,
& had some panic. Later that am, while alone with his sister he fell from
a standing position & was noted by his sister to (cont)
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be "writhing like a fish." Loss of consciousness lasted 10 minutes,
without urine/fecal incontinence. He was brought to the Allen ER
confused & disoriented, with multiple facial abrasions. He denied
headache, neck pain, visual changes, paresthesias, motor weakness,
shortness of breath, but did complain of some nausea and vomiting.
Noted to have widened (.11) QRS (treated with Bicarbonate),
WBC 17,7, CT within normal limits, Cerebral Spinal Fluid exam
within normal limits, & admitted for presumed Elavil toxicity
(level not done). Tox(icology) screen----------->positive for
Benzodiazepine, possibly Valium load during seizure treatment.
Seen by neuro & psych, thought to have convulsive syncope,
Rule out Benzodiazepine withdrawal, & not thought to be
suicidal.
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2 days after admission, found by Psychiatry consult to be wandering in
hallways, with delusion/hallucination of 2 children tormenting
him under his bed, with agitation, disorientation. Diagnosed
with delirium secondary to Benzodiazepine withdrawal, treated with
Ativan 2 mg every 2 hours prn (required-->16mg), & transferred to
Medical ICU for observation. Treated with Haldol 5 (mg) that pm after
he put his hand through a window. Delirium resolved after 1 day in
Medical ICU, with increased Benzodiazepine treatment. Noted by
Psychiatry consult 8/25 to be oriented, non suicidal, & without
Psychiatric (?abbreviation unclear), & transferred to Eye6 for
Psychiatric evaluation and treatment.
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As above, patient notes approximately 6 months history of dysphoria
anhedonia, increased appetite, decreased self esteem increased guilt,
increased hopelessness. Notes some psychomotor slowing, (abbreviation
unclear). Denies ever history of increased energy, decreased need for sleep
racing thoughts. Denies ever suicidal/homicidal ideation. Denies Auditory/
Visual/Hallucinations, or olfactory hallucinations (?), or automatism (?),
incont(?inence), last time. Positive chronic anxiety, related to panic
but separate.
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PSYCHIATRIC HISTORY:
Per History of Present Illness. At 17 years old, father gave him
Prozac for "depression" (patient describes some Temporary Improvement,
but no dysphoria/anhedonia). Patient became very agitated and
discontinued immediately.
ALCOHOL AND DRUG HISTORY: Denies Ethanol----never until 2 weeks
Prior To Admission, then 1/2 bottle gin. Within(?) 2 weeks (secondary
to "panic")
Never tobacco, Marijuana, Cocaine, Intravenous Drugs
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FAMILY PSYCHIATRIC AND ALCOHOL AND DRUG HISTORY: Father
positive (for) panic disorder x >20 years, untreated; Father's sister mentally
retarded; mother's sister "dysthymic."
Family medical: mother positive Graves Disease, cystic breast
father kidney stones
LIVING ARRANGEMENTS:
Lives with parents, 10 year old sister. Has car, travels about; has
job (research assistant at Albert Einstein).
Lives in Riverdale.
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