Name: Phimchanok Eakkaparksawat (Praewa) 1108

R: Dr. Minerva
A: Craig Gilner
F: Diary and doctor’s checkup list
T: Keep up on Graig’s condition (depression)
ADULTS PSYCHIATRIC

Date: 8/03/2010

Time: 4:32 am

Name: Craig Gilner

ID: 29 y.o. M, Suicidal thoughts x15hrs

Patient no.: APW137628

CC: Suicidal thoughts

HPI: 15 years old male with a history of mental illness, depression. He had been suffering from stress

vomit, sweating and shortness of breath due to anxiety. He had been prescribed with Sertraline but

discontinued without the doctor's consent. The patient denies committing self-harm and by observation

there are none.

PMHx: Zoloft 50 mg

Allergy: None

Habits: Non-smoker, no drug use

SocHX: not mentioned

FHX: not mentioned

Gen: No cuts or wounds, alert, focus, teenager male

HEENT: Not needed

ASSESSMENT

This is a 15 years old male teenager with a history of MDD / Major depressive disorder seen today for

suicidal thoughts (self-checkup) along with PTSD. Clinical examination suggests an involuntary

admission in an adult psychiatric ward for at least 5 days.

PLAN

- Re-prescribe Sertraline (Zoloft) 50 mg X5 days

- 5 day admission minimum.

- Consultation: Dr. Minerva, in 2 days

- Blood sample: for hormone imbalance check

- Evaluation on Thursday

*If not improve during the second check-up: Stop on Zoloft

1) Fluoxetine (Prozac)

Signature: ​Dr. Mahmoud

Time: 3:31 am

Name : Craig Gilner

ID: 29 y.o. M , Admission

Patient no.: APW137628

Goals of care: Stabilize chemical imbalance, not at risk of self-harm.

HPI:

- Onset at 15 hours

- Difficulty eating, binge eating disorder

- Difficulty sleeping

- Sweating

- Stuttering

- Vomit (not yet presented during admission)

PMHx: Depression- discontinuation of Sertraline 50 mg

- Re-prescribe Sertraline (Dr.Mahmoud), once a day

PSHx: No previous surgery

Meds: Sertraline 50 mg

- OTC: None

- Herbs: None

ALL: None

SocHx: - ? SAD

- Anxious about how people view him with depression.

- Healthy family relationship

- A student in Pre-professional high school.

FHx: The patient had been facing stress and pressure from family and school.
 Signature:

—————————————————————————————————————————

Date: 11/03/2010

Time: 3:28 pm

Name : Craig Gilner

ID: 29 y.o. M , Admission

Patient no.: APW137628

Goals of care: Stabilize chemical imbalance, not at risk of self-harm.

HPI: - No additional symptoms

PMHx: - Sertraline 50 mg

PSHx: No previous surgery

Meds: Sertraline 50mg

- OTC: None

- Herbs: None

ALL: None

SocHx: - Absence of SAD

FHx: Not mention

PLAN

- Sertraline 50mg x1 month

Signature:

———————————————————————————————————————

● The check up form from Dr.Mahmoud is transferred to Dr. Minerva

Dear diary,

Today I met a new patient whose name is Craig Gilner. He has dark hair, brown eyes, thick eyebrows and

he’s quite tall. Since his first step into the room, he started observing every single thing in his sight. He

stares at the bookshelf behind me where I place a lot of abusive childhood books. This teenage boy

seems to have a lot of things going on in his head, I wonder what they are. During our conversation, I can

see his large brownish pupils locked straight at my face. Craig seems to collect all the small little details of

everything that is in his sight. After a long conversation we had, I figured out that Craig's brain seems to

cycle as a loop over and over again. Moreover, he mentioned a lot that he likes simple things such as

peeing. While I was listening to all his thoughts, he told me that he likes bicycles which made me curious

about the reason why he likes it. I think the reason behind this is that when he sees an obstacle during his

bicycle ride he just needs to turn his arm a little bit and he would pass the obstacle. The fact of riding a

bicycle is that it is easy to get rid of dangerous obstacles but it's the opposite in life. This made me think

that he’s a person who would be stuck in various problems for so long because he’s some kind of a

perfectionist. However, he said he likes simple things but he likes to draw and make maps. Maybe by

making maps is a way of having something under his control, he can do whatever he wants in that one

map. Right now his symptoms seem to be beyond his control and stress vomit is a part of the symptoms.

Since he’s in Pre-professional high school it is not a surprise for him to have these symptoms. That’s

basically it for today if there’s any other new information I will keep up with you. Bye!
28th February 2010

Dear diary,

Today was my fourth check-up with Craig Gilner, everything is still the same and nothing was added to

the symptoms list from what Craig told me. Craig still has trouble eating, vomiting and also sweating.

However, Mrs. Gilner called me after the check-up today and asked me how Craige's treatment had been.

She also told me some additional facts and symptoms that Craig didn’t tell me, like difficulty eating and

sleeping. Though it is not surprising because it is a part of depression symptoms. According to Craig’s

psychopharmacologist, Dr. Braney, he had added 50 mg of Zoloft per day into Craig's medical sheet

which he prescribed Craig for one month long. Zoloft is a very effective pill for MDD patients like Craig to

have. This pill is in the group of SSRI which helped to affect the serotonin in the brain. However, many

teenagers are negligent in their Zoloft routines which most of them would stop without a doctor's

permission. The Zoloft would take around 2 weeks to get into our system and by stopping it would affect

the entire therapy and suicidal thoughts would easily appear in those patients. It is like opening the tap

and Zoloft is the knot on the water hose but then the knot is gone and that would result in a massive

mess. I hope Craig wouldn’t do that. However, Craig's symptoms started to fade which is good news.

8th March 2010

Dear diary,

Here it comes, Dr. Mahmoud had told me about Craig’s visit to the adult psychiatric for emergency care

due to the discontinuation of Zoloft and suicidal thoughts. I also met Craig in the corridor this morning

while I was doing my round check. He was begging me to sign him out and said that he was better now.
However, during the conversation he did mention how he’s anxious about school and his friends. He’s

scared that his friends would know about his therapy and his depression. This is common in patients

having mental illness though we as a doctor would still need to keep up on this type of anxiety which

could be the starting branch of SAD. Moreover, His mom seems to be very worried about his condition

and she asked whether she could have a sleepover with Craig at the hospital. In Craig's situation he's a

very lucky boy, his family supported him in every path he took but he’s still too sensitive for this world. I

bet he would learn more things and receive more experience throughout the 5 days here.

9th March 2010

Dear diary,

In the afternoon I had a check-up with Craig, his symptoms had faded away though he’s still sweating and

stuttering sometimes. However, he told me that he was fed up with his parents such as his dad. From

what he said it seems like his dad does not really take things seriously and make jokes in the wrong

situation. Moreover, he seems to be pressured from school and himself since he was little. During the

second day here, his teacher had called him to check up on his condition though he over thinks about

things which then brings back anxiety. In some certain situations, we can still see the symptoms but not

as much as before. Overall, everything is now under control and Craig seems to like it here so everything

is going on well. On Thursday we will evaluate Craig's condition and see whether he could leave or not.
11th March

Dear diary,

I’ve finished Craig’s evaluation and currently writing the patient's evaluation report. After the last check up

with Craig, I've seen many improvements not only in his depression and symptoms but also how he views

the world and his thoughts. Craige seems to understand more about life and not having that circular loop

of thoughts anymore. Importantly, he knows what makes him happy and he’s very good at social

interaction, especially with that one girl of his. After the five days here, I get to know more about Craig. He

is a sweet teenager boy with a kind heart. Also, he’s the best artist i’ve ever seen. I hope he would be a

good artist and would always be the happiest person in the world.

P.s. Hope to see you soon Craig, good luck.