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PATIENT PRESENTATION

Chief Complaint

“They are trying to poison me.”

History of Present Illness

LM is a 38-year-old male who is brought to the emergency department by a staff member of his group home. The patient complains that staff at his group home are trying to poison him. He states that he has stopped eating and taking his medications because of this. He states that he hears voices that tell him not to eat because the staff are “out to get me.” Group home staff report that the patient has not been eating his meals for 3 days, even with significant prompting.

Past Psychiatric History

Diagnosed with schizophrenia at age 22. Patient has been hospitalized for psychiatric symptoms four times in his life. Patient was started on clozapine 9 months ago and was doing well in his group home according to staff. Past medication trials of olanzapine, paliperidone, risperidone, and ziprasidone were unsuccessful.

Past Medical/Surgical History

Obesity

Hyperlipidemia

Hypertension

Family History

Uncle from his mother’s side has schizophrenia

Mother has anxiety disorder

Social History

Single and unemployed.

Lives in a group home.

Immunization

Up to date

Insurance

State Medicaid; medication coverage is not a problem

Allergies

No known drug allergies

Home Medications

  • Clozapine 150 mg PO bid

  • Atorvastatin 20 mg PO at bedtime

  • Lisinopril 20 mg PO daily

  • Hydroxyzine pamoate 50 mg every 6 hours PRN anxiety

Physical Examination

General

Overweight, disheveled male appearing stated age.

Mental Status Examination

Appearance/Behavior/Speech

Grooming and hygiene were poor. Patient was observed attending to internal stimuli. Speech was normal rate and quiet volume at times. No psychomotor abnormalities appreciated.

Mood/Affect

Patient describes his mood as “fine.” His affect was flat, constricted, non-labile, but congruent with stated mood.

Sensorium

Awake and alert, appears grossly oriented, but not formally tested.

Intellectual functioning

Not formally tested. Average based upon vocabulary and general fund of knowledge.

Attention/Concentration

Unable to maintain attention and concentration during the interview.

Memory

Not formally tested, appears intact based on ability to recall and discuss recent events.

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