To provide for the spiritual and as well for the material needs of all people in the Greater Kansas City Community, based on Jewish Vocational Service mission statement.
THE JUDICIAL PROCEEDINGS AND THE CELESTIAL JUDICIAL COURT TRIAL OF AUGUSTINE QUAYEE SLOBER OF KANSAS CITY, MISSOURI UNITED STATES OF AMERICA.
Title
Augustine Quayee Slober early Childhood in Liberia
Augustine Quayee Slober was a 16-year-old Liberian male during his immigration to the United States from the Republic of Liberia from Africa in January 17th, 2008, who was referred to us by Samuel U Rogers Health Center, Here at Children Mercy Hospital was seen in follow up after his initial evaluation in August 2008. 17-year-old African male from Nyonken, River Gee County, Liberia who is referred for evaluation of a prolonged PT. He was found to have
borderline Factor VII levels of 47% to 50%. No other problems were found.
Reviewed the results of his laboratory evaluation today. Emphasizing that these Factor VII levels would not give any bleeding problems with surgery, therefore, he was cleared to go for surgery without further evaluation. No further follow up with Hematology Oncology indicated.
The patient is a 17-year-old with a left inguinal hernia. hernia has been present for some time. The patient was previously scheduled for surgery, but did not undergo the procedure. He returns today for repair of the hernia.
The patient was identified in the preoperative holding area. history and physical was reviewed, surgical site was marked. His questions were answered. His parents willingly signed the consent.
He was taken to the Operating Room and placed in supine position. General endotracheal anesthesia was begun and the patient was prepped and draped in a sterile surgical fashion. A 4 cm transverse incision was made overlying the inguinal canal. Electrocautery was used to dissect down through the subcutaneous tissue, obtaining hemostasis along the way until the external oblique fascial layer. The fascial layers was bluntly swept clean. A knife was used to make a small nick in the external oblique fascia. The Metzenbaum scissors were used to open the fascia superiorly and obliquely. The external oblique fascia was opened and a Weitlaner clamp was placed. The hernia sac was identified and the cord structures were dissected away. cremasteric muscle fibers were dissected off the sac as well. Once the sac was free and the cord structures were identified to be free from the sac. The vas deferens was identified on several occasions to ensure its position away from the hernia sac. The hernia sac was then cut. The superior edge was tied off with a Vicryl stitch tie. The top of the hernia sac was then cut off and sent as a specimen. The inferior edge of the hernia sac was then tucked inferiorly. The cord was positioned back in place. The external oblique fascia was closed using a running Vicryl suture. 5 mL of Marcaine were then used for ilioinguinal nerve block. Deep dermal interrupted sutures were then placed and a subcuticular running stitch was used to close the skin. Steri-Strips were placed and sponge and needle counts were correct. Dr. Holcomb was present and scrubbed for the duration of the entire case. The patient remained extubated and was taken. to the Recovery Room in stable condition.
We had the pleasure of seeing Augustine Quayee Slober in the Hematology Clinic on August 27th, 2008. Augustine was referred to us for a prolonged PT. He has had two prior PTs in our system. The first PT drawn on 29th of Iyar, 5768 corresponding to 6/2/2008 was 17.8 (prolonged). His PT was repeated on 27th of Tammuz, 5768 corresponding to 7/29/2008 and found to be 16.3 (prolonged). At that time he had a Factor VII drawn which was slightly low at 47 (normal 50-150).
Although it is difficult to obtain a thorough bleeding history on Augustine due to a language barrier with no interpreter available, he reports that he had nosebleeds as a child. He has not had these in several years. Although he denies having any prior surgical procedures, he has had lacerations requiring stitches. He reports that once pressure was applied to these wounds and stitches were in place, he had no trouble with re bleeding. He has received immunizations recently and has had no problem with bleeding or large hematomas forming around the injection site.
In his past medical history, Augustine reports that he has been "sick" since infancy and due to lack of insurance in Liberia, he has not been able to seek treatment for his illness. He has had malaria and has had prior treatment for this. He denies having dark urine and high fever with his malaria. He reports that he has had frequent other "sicknesses" but is unable to elaborate. He currently has an inguinal hernia that needs non-emergent surgical intervention.
He takes a medication for his sickness" that was prescribed to him by Samuel U Rogers. The patient is unable to recall what medicine he is taking or for what it is prescribed. He has no medication allergies. He has recently received some immunizations, but his immunizations are not up to date. Augustine is unaware of any family history of blood or bleeding disorders.
Upon review of systems, Augustine reports that he has decreased vision in his left eye. He has occasional myoclonic jerks while sleeping. Otherwise his review of systems is negative.
On physical exam, Augustine's vital signs are temperature of 36.8 degrees Celsius, pulse of 91, respiratory rate of 20, and blood pressure of 110/65. His weight is 60.6kg and his height is 178.9cm. Augustine is a thin appearing male in no apparent distress. His head is normocephalic and atraumatic. His extra-ocular motions are intact. His pupils are equal, round, and reactive to light and accommodation. He has a positive red reflex bilaterally. His sclera are white. His neck is supple with a palpable 7mm lymph node in the anterior cervical chain. Breath sounds are clear to auscultation. His heart beats with a regular rate and rhythm without murmur, gallop, or rub. His abdomen is soft, non tender, and non distended, without phenomenological. He has positive bowel sounds. He moves all extremities equally. He has no rash or bruising noted on his skin.
In summary, Augustine Quayee Slober is a 17 year old male with mild Factor VII deficiency, leading to a prolonged PT. This is purely a lab prolongation and should not cause the patient any problems interrogatively. He can therefore proceed with his elective inguinal hernia repair at his convenience. Today we will obtain a CBC with diff, retic, malaria smear, PT, PTT, and factor VII levels. Due to his decreased vision in his left eye, we scheduled Augustine an ophthalmology appointment on September 29th. Since he will be traveling to our facility at that time, we arranged surgery follow up at that time as well. We would like to see Augustine back in our clinic on 14th of Heshvan, 5769 corresponding to November 11th, 2008.
Thank you for allowing us to participate in the care of this patient. We will keep you updated on his status, but feel free to call us with any questions.
Dr. Holcomb and I were pleased to see Augustine and his parents in the Surgery Clinic today. As you recall, Augustine is a 17-year-old with a recently noted left inguinal hernia. On examination, his left inguinal hernia is reducible.
Dr. Holcomb and I discussed left inguinal hernia repair and will schedule the outpatient procedure in the near future at a time convenient with his family. We appreciate the opportunity to see Augustine and participate in his care. Please do not hesitate to contact us should questions or concerns arise.
Title
The Celestial Judicial Court Trial Of Augustine Quayee Slober.
The patient is a 19 years old Liberian Male previously straight A student brought in by family for AMS. Was in a car accident three months ago where he ran a red light and hit another car. Other care driver went to Emergency Department but he was without any obvious injury so was not evaluated. Just finished his community service. For the last several weeks has began to act oddly. He puts his shoes in his bed and sleeps on the floor. Will not wear gown because it is dirty and not white (gown has print on it). Has become disoriented and aggressive. Preoccupied with religion. Patient is a difficult historian, will answer questions with a question. +Thought blocking. Only alert to first name.
Teaching-Supervisory Addendum
I participated in the following activities of this patient's care: the medical history, the physical exam, medical decision making.
I personally performed: supervision of the patient's care, the medical history, the physical exam, the medical decision making.
The case was discussed with: the resident: Kimbrell, Jennifer W
Resident documentation: I agree with the resident's documentation.
Results interpretation: I agree with the study interpretation in this patient's care.
Notes: I saw and evaluated the patient and agree with the resident. I did correct and/or modify the resident's note as indicated. Pt brought by family for evaluation of odd behavior over several weeks, but now has started to be aggressive at times. Pt was previously a "straight A student" per family. At my evaluation, pt is pleasant but not oriented. Able to converse w/me, but when asked "how do you feel?" he responds to me "how do you feel?, if you feel good, I feel good." Pt not oriented to place, month, or year. Behavioral Health labs as well as AMS lab and CT done. Suspect may be new onset schizophrenia given patient's age and circumstances. Behavioral Health consulted for admission, awaiting placement..
The 19-year-old Liberian male who is single, never married, no children, has 11th grade education, currently unemployed, resides with his parents, brought by his parents for evaluation of new onset psychosis.
"My parents brought me here."
The 19-year-old Liberian male with no past psychiatric history, hospitalization, or treatment, brought to the Truman Behavioral Health Emergency Department by his parents for worsening of his psychosis, acting very bizarre, disorganized, reportedly hearing voices since last 3 months with no past psychiatric history for worsening of his psychosis according the parents. The patient started hearing voices but not able to explain more about the voices with the thought blocking, and keeps on reportedly telling that me a motor vehicle accident 3 months ago but not able to form a genuine reason. He was very guarded. responding to the internal stimuli and he was brought from the Hospital Hill escorted by family members The patient's father claimed that he was exhibiting bizarre behavior for the past 3 months since his car accident. When asked about the car accident, the patient was not able to explain very clearly, but according to the documentation from the Emergency Department notes by Dr. Beltran,
but he was traumatized by it, and he has been having extreme fear of driving. The patient also developed paranoia that he would be arrested by the police. The patient was given community service for his accident. According to their documentation, over the past 3 months, he has been exhibiting bizarre behavior like placing all the dishes and his shoes in the bed and sleeping on the floor. The patient was not making a very goal-directed conversation, but keeps on repeating "by showing finger gestured towards milk and bread" and want the girls, and talking some irrational things about the sexual favors on the street, but not able to elaborate further. The patient was very paranoid and reported that he got immigrated and adopted by American parents but not able to elaborate further. He was not able to form a very goal-directed conversation with thought blocking, disorganized, paranoid. Denied any suicidal or homicidal items, but he wants to eat and sleep okay as he has not been sleeping for some days. He denies any violence towards herself and others in last 6 months. He denies any sexual, physical, or emotional trauma.
The patient per records or according to the patient, no past psychiatric hospitalizations. No psych treatment. No psych medications. No suicidal attempts.
The patient denies any history of violence towards himself and others in the last 6 months.
The patient denied smoking any cigarettes. According to the records denied any other drugs or illicit use, but when I was seen in the interview, he was very disorganized, not able to form a goal-directed conversation. responding to most of the questions by nodding his head, so it is questionable.
He denies any medical problems. Denies any history of head injury. He has history of motor vehicle accident but denied any head injury. He was not a very reliable historian but denied any shortness of breath or anything.
No known drug allergies.
19-year-old Liberian male seen along with the medical student, looks appropriate for his age, poor grooming and hygiene, intermittent eye contact. Alert, oriented, but with thought blocking, and appears to be average intelligence with slight psycho motor retardation but no abnormal movements. Mood okay. The speech is decreased in tone, rate, rhythm, and volume. Reporting hearing voices, responding to the stimuli, and feels that his mind is playing tricks. His mind is still loose, disorganized with thought blocking. Denied any Suicide Idealization or Homicide idealization , poor impulse control with poor insight and judgment.
The patient is able to verbalize some of his needs. The patient is able to do his ADLs. The patient has a strong family support.
The patient has immigrated two years back to the United States, adjustment problems.
We will provide safety and stabilize the patient to discharge him back.
The patient is a 19-year-old Liberian male with unknown genetic predisposition to mental illness, substance abuse, grew up in a supportive family. The family immigrated 2 years back to united states. He began having symptoms of acting very bizarre since last 3 months after he made an accident 3 months ago, and got involved in the legal problems, and then the patient started acting very guarded, paranoid idealization that his mind is playing tricks on him, started hearing voices. He denied any history of violence towards himself and others. No history of abuse. Per family, he started responding to the stimuli and acting very bizarre, putting his shoes and silverware on the bed and he is sleeping on the floor. The patient because of voices psychotic break, he was hospitalized for further evaluation and stabilization.
We will monitor mood, behavior, sleep, and appetite of the patient. The patient is going through all the evaluation to rule out any organic pathology - psychotic break, and the patient's UDS came back negative and the CT was negative. The patient will be monitored for mood, behavior, sleep, and appetite.
The patient is started on the Risperdal 1 mg, so increase it to 2 mg, and with the Cogentin 0.5 b.i.d. The patient encouraged to participate in the groups and other activities to improve. The patient is educated to take the medication, to increase his med compliance, and to improve his thought process, and he gave permission to obtain collateral. We are in the process of obtaining collateral from his family. He denied any physical distress, but he looks little malnourished, so the patient's vitals being monitored q. shift, and we will call a dietitian consult and weight recording weekly twice.
The 19-year-old Liberian male who is single, never married, no children, 11th grade education, | currently unemployed, resides with his parents, brought by his parents for evaluation of the new onset psychosis.
According to the nursing staff, the patient is eating and sleeping well, not responding to stimuli, participating in some of the groups. Able to form a goal-directed conversation. On face-to-face assessment, the patient is motivated for higher studies, and he denied any thoughts of hurting himself or others. He gave permission to obtain collateral and also agreed for the family meeting on 29th, and he wants to get discharged before the holiday season in order to celebrate the New Year with the family. Denied any command hallucinations. He is taking his medication Risperdal, with improve in thought blocking, and wants to get discharged to spend time with his family.
Risperdal 1 mg p.o. b.i.d. for psychosis.
On 22nd of Tevet, 5771 corresponding to December 28, 2010, 19-year-old Liberian male seen along with the resident psychiatrist, with fair eye contact without any psycho motor agitation, retardation. Improvement in the thought blocking. Average intelligence. Mood: Good. Affect: Brighter. He is alert, oriented x4. Thought process: Improved, not responding to stimuli. Denied any suicidal, homicidal idealization with improved impulse control, with improved insight and judgment.
The 19-year-old Liberian male with unknown genetic predisposition to mental illness, substance abuse, grew up in a supportive family. The family immigrated two years back to United States. He began having symptoms of acting very bizarre since last 3 months after he made an accident 3 months ago, and got involved in the legal problems, and then the patient started acting very guarded, paranoid idealization that his mind is playing tricks on him, started hearing voices. He denied any history of violence towards himself and others. No history of abuse. Per family, he started responding to the stimuli and acting very bizarre, putting his shoes and silverware on the bed and he is sleeping on the floor. The patient because of voices psychotic break, he was hospitalized for further evaluation and stabilization.We will monitor mood, behavior, sleep, and appetite of the patient. Patient is on Risperdal. Educated about the medication compliance. Encouraged to participate in the groups and other activities, and also denied any physical distress. Gave permission to obtain collateral from his family, and his family agreed to come for a family meeting on 29th regarding the discharge planning. Patient denied any physical distress.
The patient is a 19-year-old Liberian male, who is single, never married, no children, 11th grade education, currently unemployed, resides with his parents, brought by his parents for evaluation of new onset psychosis.
According to me nursing staff the patient with thought blocking improved. He is eating and sleeping okay, not responding to the stimuli. Meal and med compliant. Participating in the groups, able to form a goal-directed conversation. Taking all his medications. On face-to-face assessment, denied any thoughts of hurting himself or others. He wants to get discharged. He gave permission to obtain collateral from the family, and also the family wants to come for a family meeting, and he wants to get discharged before the New Year in order to celebrate the New Year with the family. He denied any SI, HI. Denied any command hallucinations.
Risperdal 1 mg p.o. b.i.d. for psychosis.
On 21st of Tevet, 5771 corresponding to December 27, 2010, the patient is a 19-year-old Liberian male seen along with the resident psychiatrist and the social worker. Fair eye contact, without any psycho motor retardation, agitation, with improvement in thought blocking, average intelligence. Mood: Good. Affect: Brighter. He is alert, oriented x4. Thought process: Improved, not responding to the stimuli. Denied any suicidal, homicidal idealization, with improved impulse control, with improved insight and judgment.
19-year-old Liberian male with unknown genetic predisposition to mental illness, substance abuse, grew up in a supportive family. The family immigrated 2 years back to United States. He began having symptoms of acting very bizarre since last 3 months after he made an accident 3 months ago, and got involved in the legal problems, and then the patient started acting very guarded, paranoid idealization that his mind is playing tricks on him, started hearing voices. He denied any history of violence towards himself and others. No history of abuse. Per family, he started responding to the stimuli and acting very bizarre, putting his shoes and silverware on the bed and he is sleeping on the floor. The patient because of voices psychotic break, he was hospitalized for further evaluation and stabilization.
Psychosis, not otherwise specified, to rule out for psychotic break.
Deferred.
Motor vehicle accident 3 months ago. Multiple psycho-social stressors
ago with currently legal involvement.
We will monitor mood, behavior, sleep, and appetite of the patient. Patient is on Risperdal 1 mg twice a day and Cogentin. Patient educated about the medication compliance. The patient is encouraged to participate in the groups and other activities. The patient is still taking a well-balanced nutrition. Patient denied any physical distress.
The 19-year-old Liberian male, who is single, never married, no children, 11th grade education, currently unemployed, resides with his parents, brought by his parents for evaluation of new onset psychosis.
According to the nursing staff, the patient is still psychotic, thought blocking, responding to stimuli, and reporting hearing voices. He is meal and med compliant, participating in the groups, but with improved concentration and attention. The patient is on Risperdal 2 mg that is helping him to improve his thought process. He is taking Cogentin and Benadryl. On face-to-face assessment, the patient able to participate little bit okay, his thought process; and slowly he is able to participate in the team meeting today. Eating and sleeping okay, and gave permission to obtain collateral and he would like to take the medications. No additional consult was called. I did ensure to his diet and also the dietician consult was called to weigh him, weekly twice. On face-to-face assessment seen along with the social worker in the team meeting, denied any SI or HI. Denied any command
hallucinations.
Risperdal mg p.o. b.i.d. for psychosis.
On face-to-face assessment, a 19-year-old Liberian male seen along with the resident psychiatrist with intermittent eye contact with psycho motor retardation, with thought blocking, below average to average intelligence. Mood okay. Speech was decreased in tone and volume, responding to stimuli, loosely disorganized. Denied any Suicide Idealization or Homicide Idealization with limited impulse control with poor insight and judgment. The patient denied any physical distress.
The 19-year-old Liberian mate with unknown genetic predisposition to mental illness, substance abuse, grew up in a supportive family. The family immigrated two years back to the United States. He began having symptoms of acting very bizarre since last 3 months after he made an accident 3 months ago, and got involved in the legal problems, and then the patient started acting very guarded, paranoid idealization that his mind is playing tricks on him, started hearing voices. He denied any history of violence towards himself and others. No history of abuse. Per family, he started responding to the stimuli and acting very bizarre, putting his shoes and silverware on the bed and he is sleeping on the floor. The patient because of voices psychotic break, he was hospitalized for further evaluation and stabilization.We will monitor mood, behavior, sleep, and appetite of the patient. The patient was encouraged to take Risperdal 1 mg twice a day with the Cogentin and also with the Benadryl in order for EPS. He was educated medication compliance. He was educated on the medication compliance and encouraged to participate in the groups and other activities. Nutritional consult, additional consult is called to ensure to diet. Denied any physical distress, but still with psycho-motor agitation.Nursing staff paged regarding patient EPS, examined patient when he was sitting in the milieu on chair, patient vitals stable, protrude his tongue from mouth and right arm stiff and examined cogwheel rigidity at right elbow. RN gave him cogentin 1mg IM, Examined patient after 30 mins patient denies any problem and EPS resolved, and advice staff to follow him closely checks q 15 mins. Dr. Kingsley reduced his Risperidone 2mg AM dose to 1mg and d/c HS risperidone 1 mg.
The 19-year-old Liberian male, who is single, never married, no children, has 11th grade education, currently unemployed, resides with his parents, brought by his parents for evaluation of new onset psychosis.
According to the nursing staff, he is still psychotic, but pleasant, thought blocking, responding at times stimuli The patient given the Risperdal, he went into EPS, decreased the dose from 3 mg to 2 mg, and also the patient given Cogentin and the Benadryl. On face-to-face assessment, still patient making bizarre statements, not participating in the groups and other activities. Eating and sleeping okay, and gave permission to obtain collateral from the family. We are in the process of obtaining collateral from his family.
Risperdal 2 mg p.o. q.h.s., 1 mg p.o. b.i.d.
19-year-old Liberian male with unknown genetic predisposition to mental illness, substance abuse mere He began having
symptoms of acting very bizarre since last 3 months after he made an accident 3 months ago, and got involved in the legal problems, and then the patient started acting very guarded, paranoid idealization that his mind is playing tricks on him, started hearing voices. He denied any history of violence towards himself and others. No history of abuse. Per family, he started responding to the stimuli and acting very bizarre, putting his shoes and silverware on the bed and he is sleeping on the floor. The patient because of voices psychotic break, he was hospitalized for further evaluation and stabilization.
We will monitor mood, behavior, sleep, and appetite of the patient. The patient's UDS came negative, CT was negative. On 3 mg Risperdal, he developed the EPS, so decreased it to 1 mg twice a day and Cogentin 0.5 b.i.d. Encouraged to participate in the groups and other activities. Dietitian consult was called. Weight recording twice a week. Vitals b.i.d. He denied any physical distress, but still the patient is encouraged to eat and participate in the groups. He denied any physical distress.
The patient is a 19 year old male brought to Truman Behavioral health Emergency Department and admitted voluntarily due to bizarre behavior in the past 3 months after he was involved in a car accident.
According to the patient, he was just brought here by his father. Denies knowing the reason for his admission. When asked if the police brought him, he said: "it could be" He is very gaurde with thought blocking. Mostly responds to questions with "I don't know"
Denies any history of auditory hallucinations, denies any SI or HI. Denies any Visual hallucinations. Denies having any medical problem. Denies chest pain, headache, fever, cough, palpitation, hemoptysis.
The 19-year-old Liberian male with no past psychiatric history, hospitalizations, or treatment, brought to the Truman Behavioral Health Emergency Department by his parents for worsening of his psychosis, acting very bizarre, disorganized, reportedly hearing voices since last 3 months with no past psychiatric history for worsening of his psychosis according to the parents. The patient started hearing voices but was not able to explain more about the voices, with thought blocking, and keeps on reportedly telling them that he met a motor vehicle accident 3 months ago but not able to form a genuine reason. The patient was The patient's father is said to have claimed that he was exhibiting bizarre behavior, and this has been ongoing for the past 3 months since he was involved in a car accident. When asked about the accident, the patient has been unable to explain very clearly what happened, but according to the documentation from the Emergency Department notes by Dr. Beltran, the patient
but patient was traumatized by it, and he has been having extreme fear of driving. The patient also developed paranoia that he would be arrested by the police. The patient was given community service for his involvement in the accident. According to their documentation, over the past 3 months, he has been exhibiting bizarre behavior like placing all the dishes and his shoes in the bed and sleeping on the floor. The patient was not making a very goal-directed conversation, but keeps on repeating by showing finger gestures towards milk and bread and want the girls, and talking some irrational things about the sexual favors on the street, but not able to elaborate further. The patent was noted to be very paranoid and reported that he got immigrated and adopted by an American parents, but not able to elaborate further. He was not able to form a very goal-directed conversation and was noted to have thought blocking, was disorganized and paranoid. He denied any suicidal or homicidal items. He stated that he wanted to eat and sleep okay as he has not been sleeping for some days. He is said to have denied any violence towards himself or others in the last 6 months. He is said to have denied any sexual, physical, or emotional trauma.
The patient records has no past psychiatric hospitalizations. He has not had any past psychiatric treatment and has not been on any psychiatric medications. He has had no suicidal attempts. This was also confirmed by his parents today at a family meeting.
The patient denies any history of violence towards himself or the others in the last 6 months.
The patient denied smoking any cigarettes. According to the records, he denied any other drugs or any illicit drug use, but when seen in the interview, he was very disorganized, and was not able to form a goal-directed conversation. He was responding to most of the questions by nodding his head. However, his parents today also denied any history of illicit drug use by the patient.
The patient denies any medical problems. He is said to have denied any history of head injury. He was involved in a motor vehicle accident but denied any head injury 3 months ago. The patient, however, has history of hernia repair at Children's mercy Hospital. Also from the discussion with his parents today, patient is said to have had head injury as a child while in Liberia. His mother also stated that he had meningitis at the age of 6, though he was not taken to any hospital and he was treated with local herbs. It if unclear how they came to this diagnosis or if he had febrile convulsions.
The patient denied any alcoholism or mental illness in the family. No illicit drug use. This was also confirmed by his parents today.
The patient denies any alcohol use, smoking, or drug use. The patient claims he is in eleventh grade. The patient claims he does not have any military service. The patient is unemployed at this point in time. The patient denies any legal cases against him. The patient denies any physical, emotional, sexual abuse. Patient is the second youngest in a family of 9 siblings. He was born in Liberia and came to the USA two years ago Premonitory, he is described as outgoing, and very focused on his studies.
He is noted to still be in contact with his friends in Liberia.
He has no known drug allergies.
Laboratory review on Tevet 13th 5771 corresponding to December 19, 2010, sodium 139, potassium 4.2, chloride 103, carbon dioxide -16, creatinine 1.1. Calcium 9.5, TSH total 1.1, Free 1.06. Glucose 108. WBC 4.4, hemoglobin 16.1, hematocrit 47.0, platelet 161. UDS was negative. Urine acetaminophen was less than 10. Blood alcohol level was less than 5. Salicylates less than 4. CT of the head without contrast showed normal CT brain without contrast. Chest x-ray was normal.
Temperature 97.5, BP 119/76, pulse 75, respiratory rate 20.
Patient was admitted into the acute psychiatric unit of Truman Hospital. Based on his psychosis and thought blocking, he was started on Risperdal 1 mg p.o. which was increased to 2 mg p.o. He was also started on Cogentin 0.5 mg p.o. b.i.d. for EPS. His mood, his behavior, his sleep and appetite were monitored, and he was encouraged to participate in the groups and all other activities and offer in the unit to help improve his coping skills. He was educated on his medication, and to be compliant with his medication. Patient gave permission for us to obtain collateral from his family members.
On further review on the 16th of Tevet, 5771 corresponding to December 22, 2010, the patient was noted to have dystonic reaction to his anti psychotic, at which point, he was given IM Benadryl 25 mg x1. His Risperdal for the evening of December 22, 2010, was discontinued, and his total dosage of Risperdal was reduced to 1 mg p.o. a.m. h.s. On subsequent review, patient's thought process was noted to have improved slightly, though he was still having auditory hallucinations. He denied any suicidal idealizations or homicidal idealizations. He denied any visual hallucinations. The patient was maintained on Risperdal I mg p.o. a.m. h.s., and he continually showed improvement both in his thought process and increased interaction with his peers. He was able to hold a decent conversation and able to express himself more. He consistently denied any suicidal idealizations or any homicidal idealizations. He denied any visual hallucinations. He still endorsed auditory hallucination but stated that he is able to ignore them and and he does not heed. Patient started becoming interested in his education and started making inquiries as to how he could get admitted to UMKC as he wants to study Law and the Judicial System and work in an Attorney Following his consistent improvement, patient indicated his willingness to be discharged home to his parents It should be noted that when he was first presented he was not sure if his parents are from the USA or Africa but currently he acknowledges that they are originally from Liberia.
A family meeting was called today which both his mom and his dad came and two family friends who were able to interpret for his parents as they are primarily are fluent in their native language which is called Grebo : Tienpo Collateral History from them is as noted in his records above. Premonitory, patient is noted to be an extrovert and very focused also on his education, while he was in Liberia rid to be in 11th grade and should be graduating from high school on the 20th of Iyar, 5771 corresponding to May 23rd 2011 His parents made inquiries as to, any support he can get from the mental health service regarding his current mental health problem. They did not have any concern or reservation with regard to him being discharged back to their care, and we were happy the patient to be discharged to their care.
The patient is a 19-year-old Liberian male who appears his stated age with good hygiene. He maintained good eye contact. He was alert, oriented into time, place, and person. He showed no abnormal movements. His intellect appears to be average for his level of education. He describes his mood as okay. His affect is reactive and congruent with his described mood. His speech was spontaneous, fluent, and coherent. He endorsed history of auditory hallucination but stated that this is not bothering him. He denied any visual hallucinations. He denied any suicidal idealizations or homicidal idealizations. No delusional content was noted, and his thought process was linear and goal directed. His insight into his illness is fair, his judgment is fair.
The 19-year-old Liberian male with unknown genetic predisposition to substance abuse and mental illness who grew up in a supportive family. Patient did not have any symptoms about 3 months ago. His current stressors are thoughts of legal problems which he thinks he is charged with. The patient has been feeling okay; however, the patient had shown paranoid idealization, was noted to be checking what was written down. The patient denied any significant traumatic event; however, it seems that the accident that he got into 3 months ago seems to have affected him very much. He denies any violence to self or others in the past 6 months. He denied any sexual, physical, or emotional abuse. Patient Admitted to history of auditory Bathemations It is possible that this is the first psychotic break for the patient and or a prodrome of schizophrenia. We are at this point are unsure about this, however, the patient responded quickly to very minimal dose of anti psychotic and would require consistent follow-up with the mental health service to ensure proper management and possible definitive diagnosis.
Psychosis, not otherwise specified. n/o schizophreniform d/o, schizophrenia d'o, schizoaffective d/o None.
Reported history of head injury as a child, reported history of meningitis
Adjustment problems.
Global assessment of functioning of 55.
A save discharge plan was discussed and agreed with the patient's family. He will be discharged today to the care of his parents. Patient's definitive diagnosis, though unclear at this time, was discussed with his family. They were also educated on how to help the patient to follow up with his treatment plan and outpatient care. As noted, it is unclear if this is just a psychotic break or prodrome of schizophrenia. Patient has NO family history of mental illness or any illicit drug use He's However is an Immigrant with about 3 years stay in the United States. He does have a very supportive family who are willing to help him follow up with his care - which could be prognostically good for him. Family have also been educated on the possible diagnosis that we are thinking of. Patient has an intake appointment with Truman Behavioral Health for January 4, 2011, at 8:30 a.m. He is encouraged to make this appointment. He is discharged on Risperdal 2 mg p.o. q.h.s. for 30 days with one refill and Cogentin 1 mg p.o. daily p.r.n. for EPS for 30 days with one refill. Patient's family indicated that they do not have enough resources to pay for the medication, and they were linked up with the Truman Discount Services. Patient and his family are aware to contact the crisis line if his mood or symptoms dysimproved. They are also aware to come to the nearest emergency room if his symptoms of mood dysimproves.
Addendum- Staff
The patient interviewed and discussed with Dr Kingsley and Team. Reviewed the above note.
The patient is a 19 year-old Liberian male with no past psychiatric history, hospitalizations, or treatment, brought to the Truman Behavioral Health Emergency Department by his parents for worsening of his psychosis, acting very bizarre, disorganized, reportedly hearing voices since last 3 months with no past psychiatric history for worsening of his psychosis according to the parents. Pt recently involved in Motor Vehicle Accident and stressful. Pt on initial presentation with thought blocking and with A.H. and later on started on Risperdal 2 mg po qhs for psychosis. Pi with improved thought blocking and gave permission to obtain collaterals from family. Pt denied S.I/HI/Command hallucinations. Family Meeting was called. Pi's parents agreed to monitor him. Pt and his family denied any alcohol and drug abuse. Pt agreed to take pills and F/U with outpatient appointments.
Addendum by Osuagwu, Kingsley U on the 28th of Nisan, 5780 April 21, 2020 16:26 CDT
Amendment to discharge summary:
I was notified by medical records that Mr. Slober has requested to have an amendment made to his medical record of 23rd of Tevet, 5771 corresponding to 12/29/2010. He is said to have stated that his language is called Grebo Tienpo and not Gober, and that "he wants to study law and the Judicial system and not accounting. So, I will like to honor his request and state that this discharge summary should state that his language is Grebo Tienpo. Also it should state that he wants to study law and Judicial system.
Please refer to DC summary from Truman Medical Center Hospital Hill MHU where patient was hospitalized for an initial psychotic episode from 14th of Tevet, 5771 to 23rd of Tevet, 5771 corresponding to December 20th, 2010 to December 29th, 2010. In summary, Mr. Slober is a 19 years Liberian who immigrated to the USA two years ago, 3 months prior to his admission a, per Behavioral Health Emergency Department evaluation, he was driving and had a car accident and was sentenced to "community service". Soon afterwards, his family noted that he became increasing strange, fearing immigration was going to take the family away, placing dishes and shoes in his bed, making nonsensical religious comments, refusing to eat, and sleeping on the floor. It is unclear what the precipitating event was, but the patient was brought by the family to the Truman Medical Center Emergency Department, and was eventually admitted on a voluntary basis. He was noted to report hearing voices, but would not share the content and to refuse to dress in the hospital gown saying he would wear 'only white'. on the unit he was paranoid, suspicious and odd. He was placed on risperdal 3 mg, but had EPS, and it was reduced to 1 mg po bid, with benztropine 1 mg at bedtime and was discharged after a family meeting was arranged Reported history but he would not share details, stated he wanted 'an American family to adopt me", but no note of conflict in family. No lipids performed. Head CT normal.
To the CAP team, he has communicated (and continues to do so) that he did not see the need for medication, and it has been unclear if he has been taking any, but agreed to enroll in the RAISE TRIAL for first episode schizophrenia, despite denying a mental illness. While on po ripserdal, he had been adherent per patient, CSS, and father as per patient 'my father is making me take it" He has engaged with CAP, but often for nonsensical reasons 'Truman can buy me a house".
because of ongoing positive symptoms only mildy repressive to ripserdal, dose was gradually raised to 5 mg and then converted with his permission to riserpdal consta 25 mg IM increased to on 15th of Cheshvan, 5772 corresponding to the 8/11/11 to 37.5 after his behavior appeared to others to become more disorganized and he pushed his and then on 4th of Cheshvan, 5772 corresponding to the 10/31/11 to 50 mg because of odd, irrational statements and some paranoia noted by father. No eps has been noted even without benztropine.
He has graduated High School
and has been considering vocational options, in an overly optimistic and seemingly illogical way, and has few to no contacts outside the home, but remains very motivated to "get a job" and "get my own home".
executive functioning, poor judgement continue to be difficulties, but family provides ongoing structure and oversight. patient is non disclosing about symptoms and denies them and the team relies on father for collateral history, and he again denies any today. he has missed last injection of risperdal consta 50 mg schedule 3 weeks ago and was making excuses as to why he couldn't come, without overtly refusing the medication altogether.
