| Krissy Hart (query: Clarisse?)
| 16 Aug 2054 (18)
Homo sapiens sapiens
Datajack (lumbar spine)
18 YOHF referred by ERMD for assessment of psychosis and delirium.
History of Presenting Illness
Patient is an unreliable historian due to delirium and psychotic symptoms. Limited collateral information was obtained from patient’s father (Tony) and a ‘friend’ (Sam), but the reliability of this information is undetermined.
Admitted to ER early this morning from home after apparent biofeedback trauma. EMT report indicates that the patient was found in a suburban home in cardiac arrest. On-site resuscitation was successful and transport to GSM was uneventful. Report also indicates that a teenage male was present with the patient at the time of contact, but there is no indication if he was able to provide additional information. EMT did not report the presence of illicit substances or devices at the scene.
ERMD assessment found evidence of significant neurological and somatic trauma, likely due to biofeedback originating from the spinal datajack. Source of the biofeedback remains undetermined, but pattern of damage is reported to be highly suggestive of BTL abuse or Matrix hot-sim feedback (Black IC).
Patient regained consciousness while awaiting assessment, becoming highly agitated and violent. Nursing notes indicate both physical and verbal aggression, elopement attempts, and disorganized through processes. Much of the distress appeared to be focused on ‘Grace’ and ‘Sam’, but staff were unable to understand the details. There was an brief altercation with the patient’s father during the assessment, but he settled with security intervention. The patient required significant chemical and physical restraint to settle for the ER assessment.
Despite improvement in laboratory results and physical condition, the patient remains confused, disorganized and aggressive with care. She continues to require restraint to prevent injury and elopement. She did not settle with the presence of her father (Tony), but nursing staff report that a visit from an older male elf (Sam) did have a calming effect. SWS has expressed concern about the observed level of intimacy between the patient and the older male, and raised the possibility of sexual exploitation.
The patient remains easily agitated and uncooperative with the interview. She frequently becomes tearful about ‘Grace’, and there is some indication in the conflicting collateral information that this person may be a friend whose was recently injured. The patient frequently makes nonsensical statements suggestive of response to internal auditory stimuli, and is clearly responding to internal visual stimuli.
Past Psychiatric History
There is no record of previous psychiatric contact. Her father (Tony) reported that she may have undergone a brief psychological evaluation following the death of her mother in the Matrix Crash of 2064. Records of this evaluation are not available at the time of this assessment.
Past Medical History
Records from Everett General Hospital include a brief admission for ‘gynecological procedures’ in early June 2072. The records indicate that the patient had a temporal datajack in place at the time. This modification is now absent, but CMRS confirms residual scarring in the correct pattern. There is no record of the spinal datajack in the EGH records.
There are no other known medical issues.
Relevant Laboratory Investigations
- Mildly elevated white cell count
- Hb low: 112 g/L
- CRP: markedly elevated
- CDA elevated: 1.55 U/L
FMR shows increased activity in the basal ganglia, consistent with TCSR evidence of increased levels of subcortical dopamine.
Patient is adopted and there is little family history available. The patient’s adoptive father (Tony) is not aware of psychiatric illness in her mother. He reports that the patient’s biological father was ‘an asshole’, but was unable to confirm any actual psychiatric history.
The patient lives with her adoptive father in Puyallup. SWS reports that her father (Tony) referred to her as ‘Clarisse’ at least twice during their interview. Her mother died during the Crash of 2064 and Tony was unsure of the location of her biological father (although very graphic about what he thought of the man). She has a partial formal education with some home schooling supplemented by Matrix tutorial systems. She has no known work history, and her father’s evasiveness on the topic suggests the possibility of illegal activities. SWS also reports an apparent intimate relationship with ‘Sam’.
Mental Status Examination
This 18 year old female appears younger than her chronological age. She is currently dressed in a hospital gown, and is very disheveled. She is alternatively highly agitated and uncooperative with the interview, or heavily sedated with chemical restraints. Eye contact is poor.
Speech is rapid and occasionally pressured with poor modulation of volume and tone. Thought process is highly disorganized with frequent tangential comments, flight of ideas and occasional word salad. Thought content is difficult to assess given her level of disorganization, but there are numerous comments that suggest possible paranoid ideation. There is clear evidence of visual and auditory hallucinations. Mood is difficult to assess, and affect is highly labile and agitated. Insight and judgment are heavily impaired. Cognition is fluctuating, but collateral information suggests no pre-existing impairments.
This 18 year old female presents with severely disorganized thought processes and aggressive behavior in the context of apparent neurofeedback injury. Delirium appears to be the primary presenting feature, but the presence of paranoid ideation and elevated basal ganglia dopamine levels raises the possibility of SCORCH or NFIPS.
|Axis I:|| Delirium secondary to neurological injury
|Axis III:||Neurological injury|
|Axis IV:||Limited supports, possible illegal activity, possible sexual exploitation|
|Axis V:||GAF: 25|
- Admit to Psychiatry as Informal patient
- Consent obtained from father as SDM
- Although patient is medically unstable, her behavioral disturbance is best managed on D6.
- Internal Medicine, Neurology, and Neuropsychiatry will remain closely involved
- The inpatient team will need to further explore the validity of collateral information.
- Social Work has expressed concern about the nature of her relationship with ‘Sam’
- Possible history of illegal activities may impact on level of supervision on the unit
- Chemical Restraint:
- Lortrazadine 15-30 mg IM/TC/PO/PR Q4H PRN for agitation or aggression
- Haldoripine 1-2 mg IM BID PRN for severe agitation
- Amantatropine 1-2 mg IM/PO BID PRN for acute dystonia
- Physical Precautions:
- 1:1 security sitter (history of physical aggression, possible history of illegal activities)
- Physical restraints PRN
The above plan was reviewed with the Staff Psychiatrist on Call (Dr. J. Springer) who reviewed the case and was in agreement.
Dr. D. Houser (R4 Resident Psychiatrist)