schizophrenia

REASON FOR EVALUATION

The patient is a 37-year-old white single male admitted to the hospital through the emergency room . I had seen him the day before in my office and recommended him to go into the hospital

He had just come from a trip to Taho in Nevada and he became homicidal while there . He started having thoughts about killing his mother

He became quite frightened by that thought and called me during the weekend we were able to see him on that Tuesday after talking to him

He was admitted voluntarily

to the inpatient unit and medications were not restarted for him . On the unit this morning , the patient is loud and non-redirectable , he is singing loudly and speaking in a very pressured manner

He reports that she would like to speak with Dr . A , the neurologist who saw her at St . Luke 's , because he "trust him " The patient is somewhat reluctant to answer questions stating that he has answered enough of people 's questions however , he is talkative and reports that he feels as though he needs a sedative

HISTORY OF PRESENT ILLNESS

This is a patient that has been suffering from a chronic psychotic condition now for a number of years . He began to have symptoms when he was approximately 18 or 19 with auditory and visual hallucinations and paranoid delusions . He was using drugs and smoking marijuana at that time has experimenting with LXV and another drugs too

The patient has not used any drugs since age 25 . However , he has continued having intense and frequent psychotic bouts

I have seen him now for approximately one year . He has been quite refractory to treatment

We tried different types of combination of medications , which have included Clozaril , Risperdal , lithium , and Depakote with partial response and usually temporary

The patient has had starting with probably has had some temporary relief of the symptoms and they usually do not last more than a few days . The dosages that we have used have been very high . He has been on Clozaril 1200 mg combined with Risperdal up to 9 mg and lithium at a therapeutic level . However , he has not responded

The patient had been admitted to St . Luke 's Hospital on Month DD , YYYY for altered mental status and at that time , the medical team discontinued Zyprexa and lithium

In the emergency room , the patient reported elevated mood , pressured speech , irritability , decreased appetite , and impulsivity

He also added that over the past three days , he felt more confused and reported having blackouts as well as hallucinations about white lines and dots on his arms and face from the medication changes

He was admitted voluntarily to the inpatient unit and medications were not restarted for him . On the unit this morning , the patient is loud and nonredirectable , he is singing loudly and speaking in a much pressured manner

He reports that he would like to speak with Dr . A , the neurologist who saw him at St . Luke 's , because...