Patient Case Rupture Site

Douglas Mental Health University
Psychiatric Assessment Form

Date: March 1, 2014
1. PERSONAL INFORMATION
Name: Aaron Westwood Marital status: Married
Sex: M Occupation: Biologist
DOB: 01-04-1970 Age:44 Financial situation: average
2. PSYCHIATRIC INCIDENT RESULTING IN ADMISSION TO TREATMENT
Incident case 0#441 Reference Captain William Patrick
3. POSSIBLE PSYCHIATRIC ISSUES:

DEPRESSION MANIA (Giddiness)
X Low mood for >2 weeks Speedy, nonsensical talking
Lack of Sleep Needs less sleep
Lack of Interest in anything Feeling above the rules that apply to
Sense of Guilt/worthlessness others
Low Energy levels X Irritability
Inability to Concentrate Recklessness, lack of caution and
Appetite/weight fluxuation judgement
Thoughts of death or suicide Increased activity
Suicide attempts Unrealistic, elaborate plans
Hopelessness Feeling godlike/invincible
PSYCHOSIS PANIC ATTACKS
Hallucinations/illusions Trembling
X Delusions Palpitations
Self-reference: Nausea/chills
X Thinks people are watching him/her Choking/chest pain
Thinks people are talking about him/her Sweating
Thinks radio/television/print media have X Fear of death
messages to him/her Fear of going crazy
Random topic-jumping while speaking Agoraphobia (fear of crowds, public, open
areas)
GENERALIZED ANXIETY BORDERLINE PESONALITY
X Excessive time spent worrying X Fear of abandonment/rejection
Restlessness, edginess A string of unstable relationships
Easily fatigued A feeling of emptiness
Muscle tension Low self esteem
Inability to sleep Intense anger/outbursts
Inability to concentrate Self-injurious behaviour
impulsivity
SOCIAL PHOBIA OBSESSIVE-COMPULSIVE DISORDER
Avoiding social situations for fear of Repetitive washing or cleaning
embarrassment Repetive counting or checking things
X Fear others will humiliate X Repeating certain words or phrases to self
Fear of criticism
ANTISOCIAL BEHAVIORS EATING DISORDERS
Arrests Food binging
Compulsive lying Continually thinking about food
Incidents of violence Purging (laxatives, forced vomiting)
Theft X Obsession with body weight/image
vandalism Unrealistic image of body weight
Lack of empathy/remorse
X Lack of concern for safety of others
POST TRAUMATIC STRESS DISORDER TOURETTES SYNDROME
X Experienced/Witnessed a traumatic event X Nervous tics/twitches
Dreams/flashbacks to traumatic event Echolalia (immediately repeating sentences
Continually going over the event in his/her mind others have just said)
Fear of things associated with event Coprolalia (uncontrollable outbursts of
Easily startled/jumpy profanity)
4. MEDICAL HX
Previous/current illnesses:
No
Surgeries/hospitalizations:
None
Head injury (+/- LOC) and workup/imaging:

High Severity but recovering quickly
Medications:
None
Alcohol use:
No
Substance use: (caffeine, nicotine, over-counter/illicit med/drugs)

Nicotine
5. PERSONAL HX
Place of birth:
Jackson, MS
As a child: (family structure, parents occupations; relationships with parents and siblings; abuse, traumatic events)
Patient had an average childhood, steady family.
General observations and recommendations:
General Admission : Observation for 48h.
Dr. David Lamarche_PhD, MD
Date Signed: 01/03/2014

Case Number: 0103-087A
Date: March 1, 2014
Name: Adrian Kelo Marital status: Unmarried
Sex: M Occupation: Student
DOB: 09-09-1991 Age: 21 Financial situation: Average

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
Post trauma , physical damage in skull resulting in mental illness, multiple fractures and hemorrhage.
Multiple surgeries at St. Anne. Was admitted to ICU for 3 months before rehabilitation.

Serious but recovering gradually.
Medications:
No
Alcohol use:
No

Caffeine, Nicotine
5. PERSONAL HX
Place of birth:
Illinois, USA
Tragic Accident resulting in death of parents and siblings in front of subjects eyes. Subject the only
survivor of the tragedy.

Date: March 1, 2014
Name: Amelia Clarke Marital status: Unmarried
Sex: F Occupation: Historian
DOB: 11-04-1967 Age:48 Financial situation: High

X Sense of Guilt/worthlessness others
X Thoughts of death or suicide X Increased activity
X Thinks people are talking about him/her Sweating
areas)
impulsivity
Fear of criticism
Dreams/flashbacks to traumatic event X Nervous tics/twitches
Experienced/Witnessed a traumatic event Echolalia (immediately repeating sentences
4. MEDICAL HX
No
None

Medications:
None
Alcohol use:
No

Caffeine and nicotine
5. PERSONAL HX
Place of birth:
Green Bay, WI
Parents both had time consuming occupations, which meant they were not around very much and patient
had to care for younger siblings.

Date: March 1, 2014
Name: Andrew Stevens Marital status: Married
Sex: M Occupation: Military Sergeant
DOB: 16-05-1953 Age:61 Financial situation: Average

Lack of Sleep Speedy, nonsensical talking
Lack of Interest in anything Needs less sleep
Sense of Guilt/worthlessness Feeling above the rules that apply to
X Low Energy levels others
Inability to Concentrate X Irritability
Appetite/weight fluxuation X Recklessness, lack of caution and
Thoughts of death or suicide judgement
Suicide attempts Increased activity
X Hopelessness X Unrealistic, elaborate plans
Low mood for >2 weeks X Feeling godlike/invincible
areas)
impulsivity
Fear of criticism
4. MEDICAL HX
Tumor
Surgery to remove tumor

Serious but recovering slowly
Medications:
Yes, chemotherapy
Alcohol use:
No

Caffeine,
5. PERSONAL HX
Place of birth:
Pheonix, Arizona
No negative influences, a supportive upbringing

Date: March 1, 2014
Name: Arabella Telford Marital status: Married
Sex: F Occupation Historian :

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Medium Severity but recovering quickly
Medications:
None
Alcohol use:
Yes

Nicotine,
5. PERSONAL HX
Place of birth:
Manhattan, KS
Steady upbringing, traumatic event of car crash as a child, lost a sibling.

Date: March 1, 2014
Name: Archie Rochester Marital status: Married
Sex: M Occupation: First Sergeant

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

5. PERSONAL HX
Place of birth:
Yuma, AZ
Healthy upbringing with a good family structure.

Date: March 1, 2014
Name: Aston Harfield Marital status: Unmarried
Sex: M Occupation: Geologist

areas)
X Restlessness, edginess A string of unstable relationships
Easily fatigued X A feeling of emptiness
impulsivity
Fear of criticism
Theft Obsession with body weight/image
vandalism
Lack of empathy/remorse Unrealistic image of body weight
Continually going over the event in his/her mind Echolalia (immediately repeating sentences
Fear of things associated with event others have just said)
Easily startled/jumpy Coprolalia (uncontrollable outbursts of
Experienced/Witnessed a traumatic event profanity)
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

Nicotine,
5. PERSONAL HX
Place of birth:
New Orleans
Solid family structure, no signs of abuse or traumatic events..

Date: March 1, 2014
Name: Bill Green Marital status: Unmarried
Sex: M Occupation: Neuroscientist

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

Nicotine, caffeine
5. PERSONAL HX
Place of birth:
Nashville, TN
Was bullied as a child and received lack of support from parents resulting in self esteem issues..

Date: March 1, 2014
Name: Callum Stanford Marital status: Married
Sex: F Occupation: Military Specialist

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Low Severity but recovering gradually
Medications:
None
Alcohol use:
No

Nicotine, caffeine
5. PERSONAL HX
Place of birth:
Kansas City, MO
Grew up in care system

Date: March 1, 2014
Name: Camilla Stephenson Marital status: Married
Sex: F Occupation: Corporal Military

Low mood for >2 weeks X Needs less sleep
X Hopelessness Feeling godlike/invincible
Thinks people are talking about him/her Choking/chest pain
Thinks people are watching him/her Sweating
messages to him/her X Fear of going crazy
areas)
impulsivity
Fear of criticism
4. MEDICAL HX
Asthma
None

Medications:
None
Alcohol use:
No

5. PERSONAL HX
Place of birth:
San Diego, CA
Healthy upbringing with divorced parents, moved around a lot, found it difficult to fit in

Date: March 1, 2014
Name: Carl Major Marital status: Unmarried
Sex: M Occupation: Staff Sergeant

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
No
None

Medications:
None
Alcohol use:
Yes

Nicotine
5. PERSONAL HX
Place of birth:
Helena, MT
Hints of a distant relationship with parents

Date: March 1, 2014
Name: Carmen Jacobs Marital status: Married
Sex: F Occupation: Military Sergeant

Inability to Concentrate X Recklessness, lack of caution and
X Appetite/weight fluxuation judgement
Hallucinations/illusions X Trembling
areas)
X Inability to concentrate Self-injurious behaviour
impulsivity
Fear of criticism
4. MEDICAL HX
Thyroid Cancer
Surgery to operate (remove cancer)
Treatments of chemotherapy

Medications:
None
Alcohol use:
No

Nicotine,
5. PERSONAL HX
Place of birth:
Detroit, MI
Signs of mild neglect as a child

Date: March 1, 2014
Name: Carol Rivers Marital status: Married
Sex: F Occupation: Private Officer

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

Caffeine
5. PERSONAL HX
Place of birth:
Miami, FL
Went into care between the ages of 3-11

Date: March 1, 2014
Name: Corey Samson Marital status: Unmarried
Sex: M Occupation: Corporal Military

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
No
None

Medications:
None
Alcohol use:
No

5. PERSONAL HX
Place of birth:
Sacramento, CA
Parents divorced when patient was age 4, patients father in and out of life, caused issues with patient
such as lack of trust and a tendency to worry

Date: March 1, 2014
Name: Emily Walters Marital status: Unmarried
Sex: F Occupation: Private Officer (Military Ground Army)

X Inability to Concentrate Recklessness, lack of caution and
X Thoughts of death or suicide Increased activity
areas)
impulsivity
X Avoiding social situations for fear of Repetitive washing or cleaning
X Fear others will humiliate Repeating certain words or phrases to self
Fear of criticism
Theft
Lack of empathy/remorse Obsession with body weight/image
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

Caffeine
5. PERSONAL HX
Place of birth:
Columbia, SC
Good upbringing but was traumatized by parents divorce..

Date: March 1, 2014
Name: Fiona Archer Marital status: Married

X Lack of Sleep Needs less sleep
X Lack of Interest in anything Feeling above the rules that apply to
areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

Nicotine,
5. PERSONAL HX
Place of birth:
Harrisburg, PA
No signs of abuse or negative relationships as a child.

Date: March 1, 2014
Name: Frank Cardle Marital status: Unmarried

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

Nicotine, caffeine
5. PERSONAL HX
Place of birth:
Pensaola, FL
No negative signs, excelled as a child with a supportive family

Date: March 1, 2014
Name: Fred Bannerman Marital status: Unmarried
Sex: M Occupation: Biologist

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
Appendicitis
Removal of appendix

Medications:
No
Alcohol use:
Yes

Nicotine,
5. PERSONAL HX
Place of birth:
Columbus, OH
Good childhood, grew up without a father.

Date: March 1, 2014
Name: Hazel Rogers Marital status: Married
Sex: F Occupation: Private First Class

Low mood for >2 weeks Needs less sleep
areas)
impulsivity
Fear of criticism
Theft
Experienced/Witnessed a traumatic event others have just said)
Continually going over the event in his/her mind Nervous tics/twitches
4. MEDICAL HX
No
None

Medications:
None
Alcohol use:
Yes

Nicotine
5. PERSONAL HX
Place of birth:
Helena, MT
Good childhood and solid family

Date: March 1, 2014
Name: Jamie Welldon Marital status: Married
Sex: M Occupation: Military Corporal

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

Nicotine,
5. PERSONAL HX
Place of birth:
Harrisburg, PA
No signs of abuse or negative relationships as a child.

Date: March 1, 2014
Name: Jasper Gray Marital status: Unmarried
Sex: M Occupation: Scientist (Biology)

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
Diabetes
None

Medications:
Insulin
Alcohol use:
No

Caffeine
5. PERSONAL HX
Place of birth:
Knoxville, TN
Steady upbringing and supportive family.

Date: March 1, 2014
Name: Jessica Myers Marital status: Married
Sex: F Occupation: Military Sergeant

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
No
None

Medications:
None
Alcohol use:
No

Nicotine
5. PERSONAL HX
Place of birth:
Salem, OR
Hints of neglect from parents, close relationships with siblings .

Date: March 1, 2014
Name: Joseph Daniels Marital status: Married
Sex: M Occupation: Military Specialist

X Thoughts of death or suicide Increased activity
messages to him/her X Fear of going crazy
areas)
impulsivity
X Fear of criticism
Dreams/flashbacks to traumatic event X Echolalia (immediately repeating
Continually going over the event in his/her mind sentences others have just said)
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

Nicotine, caffeine
5. PERSONAL HX
Place of birth:
Kansas City, MO
Signs of mild abuse as a child by family members (verbal/psychological/neglect)

Date: March 1, 2014
Name: Leroy Ferguson Marital status: Unmarried
Sex: M Occupation: Mathematician

Delusions Palpitations
Thinks people are watching him/her Sweating
areas)
impulsivity
Fear of criticism
vandalism X Unrealistic image of body weight
Lack of concern for safety of others

Echolalia (immediately repeating
Dreams/flashbacks to traumatic event sentences others have just said)
Experienced/Witnessed a traumatic event Nervous tics/twitches
Continually going over the event in his/her mind Coprolalia (uncontrollable outbursts of
Fear of things associated with event profanity)
Easily startled/jumpy
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

5. PERSONAL HX
Place of birth:
Philadelphia, NJ
Healthy upbringing with a good family structure.

Date: March 1, 2014
Name: Mark Greyford Marital status: Unmarried
Sex: M Occupation: Military Private First Class

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
No

Serious but recovering quickly
Medications:
No
Alcohol use:
No

Caffeine,
5. PERSONAL HX
Place of birth:
Chicago, IL
Distant upbringing from parents, was in care system.

Date: March 1, 2014
Name: Michael Ashford Marital status: Married

areas)
X Easily fatigued A feeling of emptiness
impulsivity
Fear of criticism
4. MEDICAL HX
No
None

None
Medications:
None
Alcohol use:
No

Nicotine
5. PERSONAL HX
Place of birth:
Denver , CO
average childhood, steady family.

Patient had unique marking / burning (?) back of the head

Case Number: 0103-001B
#Ref Patient Alpha ?

438 777 3994
Date: March 1, 2014
Name: Mike Fielding Marital status: Married

X Lack of Sleep Speedy, nonsensical talking
Lack of Interest in anything Needs less sleep
Sense of Guilt/worthlessness Feeling above the rules that apply to
X Low Energy levels others
Inability to Concentrate Irritability
Appetite/weight fluxuation Recklessness, lack of caution and
Thoughts of death or suicide judgement
Suicide attempts Increased activity
Hopelessness Unrealistic, elaborate plans
Low mood for >2 weeks Feeling godlike/invincible
X Thinks people are talking about him/her X Sweating
Random topic-jumping while speaking X Agoraphobia (fear of crowds, public, open
areas)
Restlessness, edginess X A string of unstable relationships
impulsivity
X Fear of criticism
4. MEDICAL HX
No
None

Medications:
None
Alcohol use:
No

Nicotine
5. PERSONAL HX
Place of birth:
Miami,FL
Good childhood and solid family

Date: March 1, 2014
Name: Phillip Heathfield Marital status: Married
Sex: M Occupation: Linguist

areas)
impulsivity
Fear of criticism

experienced/Witnessed a traumatic event others have just said)
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
Yes

Nicotine,
5. PERSONAL HX
Place of birth:
Madison, WI
Steady upbringing and supportive family.

Date: March 1, 2014
Name: Priscilla Hollins Marital status: Unmarried
Sex: F Occupation: Military Private

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Recovering gradually.
Medications:
Yes, Prozac
Alcohol use:
No

Nicotine
5. PERSONAL HX
Place of birth:
Charleston, SC
Traumatic accident, lost a parent in a car crash at a young age, good relationship with other close
family members.

Date: March 1, 2014
Name: Rachel Harwood Marital status: Married
DOB: 23-10-1960 Age: 54 Financial situation: High

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
Type 2 Diabetes
None

Recovering quickly
Medications:
Yes, Insulin
Alcohol use:
No

Nicotine,
5. PERSONAL HX
Place of birth:
Atlanta, GA
Good relationship with parents as a child, split home, dealt with a traumatic divorce. Close with siblings.
No other traumatic events.

Date: March 1, 2014
Name: Sam Winchester Marital status: Unmarried
Sex: M Occupation Physicist :

Speedy, nonsensical talking
Low mood for >2 weeks Feeling above the rules that apply to
Lack of Interest in anything others
Sense of Guilt/worthlessness X Irritability
Low Energy levels Recklessness, lack of caution and
Inability to Concentrate judgement
Appetite/weight fluxuation Increased activity
Thoughts of death or suicide Unrealistic, elaborate plans
Suicide attempts Feeling godlike/invincible
Hopelessness
areas)
impulsivity
Fear of criticism
Theft

Experienced/Witnessed a traumatic event others have just said)
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
Yes

Nicotine,
5. PERSONAL HX
Place of birth:
Manhattan, KS
No signs of abuse as a child, but had distant relationships with father and siblings

Date: March 1, 2014
Name: Samuel Atkins Marital status: Unmarried

X Delusions X Palpitations
Random topic-jumping while speaking X Agoraphobia (fear of crowds, public, open
areas)
impulsivity
Fear of criticism
vandalism
4. MEDICAL HX
Kidney Disease
Removal of Left kidney

Medications:
Dialisis treatment
Alcohol use:
Yes

Nicotine,
5. PERSONAL HX
Place of birth:
Columbus, OH
Good childhood, grew up without a father.

Date: March 1, 2014
Name: Sarah White Marital status: Unmarried
Sex: F Occupation: Mathematician

Low mood for >2 weeks Needs less sleep
Low Energy levels Irritability
areas)
impulsivity
Fear of criticism
X Arrests Food binging
4. MEDICAL HX
None
None

Medications:
No
Alcohol use:
Yes

Caffeine, nicotine,
5. PERSONAL HX
Place of birth:
Jacksonville, FL
Good relationships with immediate family.

Date: March 1, 2014
Name: Sophie Hollins Marital status: Unmarried
Sex: F Occupation: Linguist

X Lack of Interest in anything Feeling above the rules that apply to
X Low Energy levels X Irritability
X Thinks radio/television/print media have X Fear of death
X Random topic-jumping while speaking Agoraphobia (fear of crowds, public, open
areas)
Easily fatigued X A feeling of emptiness
X Muscle tension Low self esteem
X Inability to sleep Intense anger/outbursts
impulsivity
X Avoiding social situations for fear of X Repetitive washing or cleaning
Fear of criticism
4. MEDICAL HX
None
No

Serious but recovering quickly
Medications:
No
Alcohol use:
Yes

Nicotine,
5. PERSONAL HX
Place of birth:
Seattle, WA
Moved around a lot and was brought up with a single mother, but remained close to her mother and
siblings.

Date: March 1, 2014
Name: Steph White Marital status: Married
Sex: F Occupation: Physicist

Speedy, nonsensical talking
Low mood for >2 weeks Feeling above the rules that apply to
Lack of Interest in anything others
Sense of Guilt/worthlessness X Irritability
Low Energy levels Recklessness, lack of caution and
Inability to Concentrate judgement
Appetite/weight fluxuation X Increased activity
Thoughts of death or suicide Unrealistic, elaborate plans
Suicide attempts Feeling godlike/invincible
Hopelessness
areas)
Inability to sleep X Intense anger/outbursts
X Inability to concentrate X Self-injurious behaviour
impulsivity
Fear of criticism
X Compulsive lying X Continually thinking about food
4. MEDICAL HX
None
None

High Severity but recovering gradually
Medications:
None
Alcohol use:
No

Nicotine, caffeine
5. PERSONAL HX
Place of birth:
Orlando, FL
Supportive family structure, big family.

Date: March 1, 2014
Name: Steve Whitefield Marital status: Married
Sex: M Occupation: Military Specialist

Lack of Interest in anything X Feeling above the rules that apply to
areas)
X Muscle tension Low self esteem
impulsivity
Fear of criticism
4. MEDICAL HX
No
None

Medications:
None
Alcohol use:
No

Nicotine
5. PERSONAL HX
Place of birth:
Los Angeles, CA
Hints of a distant relationship with parents, close relationships with siblings .

Date: March 1, 2014
Name: Tabitha Richards Marital status: Unmarried
Sex: F Occupation: Military Private

Self-reference: X Nausea/chills
Thinks radio/television/print media have Sweating
messages to him/her X Fear of death
Random topic-jumping while speaking Fear of going crazy
Thinks people are watching him/her Agoraphobia (fear of crowds, public, open
areas)
impulsivity
Fear of criticism
Arrests X Food binging
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
None

Caffeine
5. PERSONAL HX
Place of birth:
Houston, TX
Solid family structure.

Date: March 1, 2014
Name: Tim Smithwood Marital status: Unmarried
Sex: M Occupation Sergeant Major:

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
No

Nicotine,
5. PERSONAL HX
Place of birth:
Jacksonville, FL
No signs of abuse as a child, but had distant relationships with father and siblings

Date: March 1, 2014
Name: Toby Williams Marital status: Married
Sex: M Occupation: Military Officer Corporal

X Nausea/chills
Choking/chest pain
Self-reference: Sweating
X Thinks people are watching him/her X Fear of death
Thinks people are talking about him/her Fear of going crazy
Thinks radio/television/print media have Agoraphobia (fear of crowds, public, open
messages to him/her areas)
Random topic-jumping while speaking
X Easily fatigued A feeling of emptiness
Inability to concentrate X Self-injurious behaviour
impulsivity
Fear of criticism
vandalism

Continually going over the event in his/her mind Echolalia (immediately repeating sentences
Fear of things associated with event others have just said)
Easily startled/jumpy Coprolalia (uncontrollable outbursts of
profanity)
Experienced/Witnessed a traumatic event
4. MEDICAL HX
None
None

Recovering slowly.
Medications:
No
Alcohol use:
Yes

Nicotine,
5. PERSONAL HX
Place of birth:
Springfield, MO
Distanced relationship with parents

Date: March 1, 2014
Name: Tony Fox Marital status: Unmarried
Sex: M Occupation: Professor

areas)
impulsivity
Fear of criticism
4. MEDICAL HX
None
None

Medications:
None
Alcohol use:
Yes

Caffeine, nicotine,
5. PERSONAL HX
Place of birth:
Denver, Colorado
Traumatic event as a child, saw her mother commit suicide.


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Douglas Mental Health University

Psychiatric Assessment Form

2. PSYCHIATRIC INCIDENT RESULTING IN ADMISSION TO TREATMENT

Incident case 0#441 Reference Captain William Patrick

3. POSSIBLE PSYCHIATRIC ISSUES:

Head injury (+/- LOC) and workup/imaging:

Substance use: (caffeine, nicotine, over-counter/illicit med/drugs)

Patient had an average childhood, steady family.

General observations and recommendations:

General Admission : Observation for 48h.

Dr. David Lamarche_PhD, MD

Date Signed: 01/03/2014

2. PSYCHIATRIC INCIDENT RESULTING IN ADMISSION TO TREATMENT

Incident case 0#441 Reference Captain William Patrick

3. POSSIBLE PSYCHIATRIC ISSUES:

Head injury (+/- LOC) and workup/imaging:

Substance use: (caffeine, nicotine, over-counter/illicit med/drugs)

General observations and recommendations:

General Admission : Observation for 48h.

Dr. David Lamarche_PhD, MD

Date Signed: 01/03/2014

2. PSYCHIATRIC INCIDENT RESULTING IN ADMISSION TO TREATMENT

Incident case 0#441 Reference Captain William Patrick

3. POSSIBLE PSYCHIATRIC ISSUES:

Head injury (+/- LOC) and workup/imaging:

Substance use: (caffeine, nicotine, over-counter/illicit med/drugs)

General observations and recommendations:

General Admission : Observation for 48h.

Dr. David Lamarche_PhD, MD

Date Signed: 01/03/2014

2. PSYCHIATRIC INCIDENT RESULTING IN ADMISSION TO TREATMENT

Incident case 0#441 Reference Captain William Patrick

3. POSSIBLE PSYCHIATRIC ISSUES:

Head injury (+/- LOC) and workup/imaging:

Substance use: (caffeine, nicotine, over-counter/illicit med/drugs)

No negative influences, a supportive upbringing

General observations and recommendations:

General Admission : Observation for 48h.

Dr. David Lamarche_PhD, MD

Date Signed: 01/03/2014

2. PSYCHIATRIC INCIDENT RESULTING IN ADMISSION TO TREATMENT

Incident case 0#441 Reference Captain William Patrick

3. POSSIBLE PSYCHIATRIC ISSUES:

Head injury (+/- LOC) and workup/imaging:

Substance use: (caffeine, nicotine, over-counter/illicit med/drugs)

Steady upbringing, traumatic event of car crash as a child, lost a sibling.

General observations and recommendations:

General Admission : Observation for 48h.

Dr. David Lamarche_PhD, MD

Date Signed: 01/03/2014

2. PSYCHIATRIC INCIDENT RESULTING IN ADMISSION TO TREATMENT

Incident case 0#441 Reference Captain William Patrick

3. POSSIBLE PSYCHIATRIC ISSUES:

Head injury (+/- LOC) and workup/imaging:

Substance use: (caffeine, nicotine, over-counter/illicit med/drugs)

Healthy upbringing with a good family structure.

General observations and recommendations:

General Admission : Observation for 48h.

Dr. David Lamarche_PhD, MD

Date Signed: 01/03/2014

2. PSYCHIATRIC INCIDENT RESULTING IN ADMISSION TO TREATMENT

Incident case 0#441 Reference Captain William Patrick

3. POSSIBLE PSYCHIATRIC ISSUES:

Head injury (+/- LOC) and workup/imaging: