Date: 29.5.2002 9a.m.

Psychologists: Dr Geoffrey Mallow, Dr Jemima Hall

Psych Note: Sherlock Holmes, a 25yo White man with a history of cocaine abuse and symptoms of major depressive disorder, attended a 40-minute Social Skills Building group with five other patients. Mr Holmes arrived late to the group. He said that he was feeling "perfectly wretched" and complained of withdrawal symptoms (headache, stomach-ache, fatigue). He chose a chair in the corner of the room and was asked to move into the circle, which he did reluctantly. SH did not spontaneously initiate conversation or comment on other members' statements unless prompted to do so. He provoked a violent reaction from one member of the group (LM) when he made an unkind observation about her. One therapist and a group member (TT) physically restrained LM after she swung her fist at SH, narrowly missing his face. The group was dismissed 20 minutes early. It is recommended that the patient not return for this group.

Signed,

Geoffrey Mallow, Ph.D.

Post-Doctoral Fellow in Psychology

Date: 29.5.2002 11a.m.

Psychologist: Dr Carola Rivas


Psych Note: Sherlock Holmes, a 25yo man with a history of heroin and cocaine abuse, was seen for 45 minutes of individual psychotherapy. The pt arrived 10 minutes late to his session. He was flushed and appeared to be suffering withdrawal symptoms. The pt displayed some hostility towards the therapist. For example, he brought her an "intake form" that he wrote based on what he had observed of her the day before. He attempted to intimidate her by displaying his knowledge of psychoanalysis. SH stated that he did not want to be at Blakely House and complained about the Social Skills group. His speech was pressured, yet fluent and coherent, displaying a sharp wit and keen sense of irony. Pt said that he needed to prevent a murder, giving details of the case. He requested that the therapist speak to his brother to have his violin brought to Blakely. The pt became more engaged towards the end of the session, when the therapist made a few observations about the psychodynamics of his family. Pt is of superior intelligence and has the potential to function at a much higher level than he is currently at.

Recommendations: Continue with individual psychotherapy. Grant patient telephone access so that he can call his brother. Write treatment plan with patient's cooperation.

Signed,

Carola Rivas, Ph.D.

Attending Psychologist


Date: 30.5.2002 2p.m.

Psychiatrist: Dr Mariah Franklin

Psych Note: Sherlock Holmes, a 25yo old man with a history of heroin and cocaine abuse, was seen for 30 minutes for a psychopharm consultation. Pt was polite and cooperative. He was succinct, yet thorough, in providing answers. Pt appeared to be highly knowledgeable about psychopharmacology and neuroscience.

SH was not taking prescription medication prior to admission on 27.5.2002. He was admitted while intoxicated with cocaine. Pt reported using cocaine on a weekly basis "to get high" and used low doses of heroin on an almost daily basis. Pt has been using both substances for approximately three years. Pt abstained for six months in 2003 but relapsed following graduation from university. Pt said that "the problem was not the drugs, the problem is boredom." Pt expressed an interest in methadone maintenance therapy. Pt strongly objected to anticonvulsant and antidepressant medications; mood symptoms will be addressed again at a later date.

Pt complained of flu-like symptoms, including diarrhea, sweating, muscle pains, and increased sensitivity to pain. Pt reported extreme fatigue and noted that he overslept this morning and noted that he does not usually sleep more than four hrs/night. Pt reported that he gets pleasure "from playing music" and appeared distressed that his violin had not been delivered to him. He also reported being interested in "organic chemistry, forensic anthropology, murder, and poisons," though his ironic tone of voice suggested that he was deliberately misleading this writer.

SH took an initial dose of 30mg of methadone under the psychiatrist's supervision. Pt will be monitored by nursing staff to determine if there are adverse effects. Titration up to 100mg/d recommended in next week.

It is recommended that his psychotherapist work with SH to address his mood symptoms and to determine whether they preceded his drug use. Pt will return tomorrow to receive his next dose of methadone.

Signed,

Mariah Franklin, MB BChir, MRCP

Attending Psychiatrist


Notes:

Please note that I'm being trained in clinical psychology, not psychiatry, so any mistakes in the psychiatric note are due to my own ignorance.