Additional Notes

The previous blog entry re: the reason for Cathy's admission via the Baker Act was written by Carlos H. Ruiz, MD, on December 4th.

Here's another entry, written on December 6 by Maheridra 8. Shah, MD:

REASON FOR ADMISSION AND HISTORY OF PRESENT ILLNESS: The patient was referred to the emergency department after the patient was noted to be
increasingly agitated and paranoid at the extended care facility. The
patient has been claiming that people with motor wheelchairs are driving
towards her. The patient has also been demanding too much pain
medication, has been unmanageable and argumentative and, hence, was sent
for further stabilization.

Since admission, the patient has been refusing voluntary stabilization. She has been demanding pain medications. Does get paranoid and states that she was removed from the nursing home because she knew too much. The patient does claim that the patient is being mismanaged at the extended care facility and they are not keeping proper medication logs.

This physician further states:

A 53·year-old female with poor personal hygiene and grooming. Good eye contact. Her mood is irritable with appropriate affect. Her speech is spontaneous and goal-directed, pressured at times.

MENTAL STATUS EXAMINATION:

Denies any auditory or visual hallucinations or suicidal or homicidal ideation at this time. The patient is alert and oriented in all 3 spheres. Her cognitive function is grossly intact. She does get paranoid and suspicious easily. Insight and judgment is fair. Impulse control remains poor.

DIAGNOSTIC

AXIS I:

A. Adjustment disorder with mixed emotional features.
B. Rule out major depression with psychotic features.
C. Opiate dependence.

AXIS II: Deferred.
AXIS III: [physical/medical diagnoses deleted by blog author for confidentiality reasons]
AXIS IV: Multiple medical problems. No support system.
AXIS V: 40, upon evaluation. Past year 45.

FORMULATION OF PLAN:
1. I agree Dr Allen. The patient, at this time, continues to meet
criteria for involuntary placement and needs further inpatient
psychiatric evaluation and stabilization for a period not to exceed 3
weeks.
2. Continue to assess less restrictive means of stabilization and discuss
appropriate placement issues.
3. Agree with close medical supervision and pain management

Two days later, a major change in her medications (not listed for confidentiality reasons), and the biggest issue is that she got angry that another patient was physically harassing her at the nursing home! Paranoid? Well, hell, who wouldn't be by now? I certainly would be under the same circumstances. Suspicious? Agitated? For sure! And, hey, yours truly has been diagnosed with "adjustment disorder" as a result of the depression brought on by a bought of invasive cervical cancer. I readily and happily admit that I take medications to help me with my symptoms. Cancer is quite the mortality reality check and I'm here to tell you, it ain't no fun. But should I be involuntarily committed for divulging that information or as a result of my psychiatrist's diagnosis? Maybe I should be involuntarily committed because having cancer made me really damn angry? I did become quite agitated at times about the whole thing.

What a bunch of asshats these Florida physicians are. And anyone else involved in this entire scheme. (Yikes! That sounded a little paranoid, didn't it? Good thing NC doesn't have a Baker Act!)