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8/27/93 ASSISTANT UNIT DIRECTOR NOTE REVIEWING CASE/HOSP. COURSE
This 23 year old single white male was transferred from Allen Pavilion today with diagnosis of panic disorder and rule out Benzodiazepine withdrawal, was admitted at 1:PM and found unresponsive at 4:20 and pronounced dead at 4:35.
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The patient is a recent college graduate living with his parents. He had an approximately 2 year history of panic symptoms and was receiving Xanax up to 4 mg every day from his psychiatrist father Dr. Ralph Speken. The patient also had a 6 month history of some depressive symptoms. Patient's father had apparently completed a Xanax taper over (?a) 2 week period and the patient then began seeing a Dr. Quen who started elavil. (There are discrepancies between the patient's history - He denies recent Xanax use, and the Father's history - He reported (?an) empty Bottle of Xanax), up to 60mg qD.
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On 8/21/93 the patient lost consciousness - witnessed by 10 year old sister - and was admitted to Allen Pavilion to rule out Elavil toxicity and rule out seizure. He was evaluated on 8/22 by Neurology and 8/23 by Psychiatry. He was found with Paranoia and visual hallucinations on 8/23 with diagnoses rule out Xanax dependence/withdrawal, rule out post concussive syndrome, Panic Disorder, rule out (?) His workup included negative CT scan of head, negative Lumbar Puncture on 8/23 He was transferred to the ICU for management of probable Xanax withdrawal (the father revealed his suspicion of Xanax use/abuse). He was managed (?with) Ativan 2q 4 IV then 2mg q 4 (hours) PO starting 8/26. On 8/26 patient was felt to be medically stable for transfer to Eye-6 psych unit by ICU Attending/residents and B7 Psychiatry consult. He was transferred by ambulance, arriving 1:00PM. He was seen by (?) (at approximately) 1:00-1:20
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