IDENTIFICATION: Mr. O.M a 57-year-old single male.

PRESENTING COMPLAINT: The patient reported history of difficulty of sleeping and Auditory Hallucination HISTORY OF PRESENT ILLNESS: O.M 57-year-old male who reported significant medical history of Hematoma on his head. He did not report any other significant history of medical problems. According to the chart, he had a problem with his elevated blood pressure. Apart from that, there was no other significant history provided. The patient stated that he had a very difficult in sleeping. He was not emotionally v disturbed. The patient stated that he was diagnosed with hyperactivity and was treated with medication, Thorazine, which actually sedated him too much and made him like a zombie. He stated that he took the medication for two years but later on stopped it, after two years, because of the significant side effects and no improvement.

He stated that he was tried on other medications, which he does not remember, but all of his medications. He stated that he was getting into a lot of trouble, which included fighting, anger control problems as well. At one point, he had tried to injured his back to the point that he was admitted to a hospital. He stated that during his college days he endured a lot of stress.

At the time of assessment, the patient stated that he continued to have flashbacks and had difficulty sleeping. He is having lots of side effects including dry mouth, constipation, and weight gain. The patient stated that he was willing to take some other antidepressant and agreed to have a washout period. He was very understanding about the risk of changing the medication including some period when he would be without medication and his condition could get worse, but he was willing to take that chance. At the time of assessment, he reported that he was eating okay. He continued to complain of some depressed mood. Denied any suicidal ideation. He reported significant homicidal ideation against the family. He did not report any specific homicidal ideations. . He felt safe.

The patient reported extensive history of alcohol. He stated that he started drinking alcohol at a very young age. He would steal from his

grandparents, but he started drinking on regular basis at age 15. His last drink was in his college days. He admitted to having blackouts, shakes, but denied any DUIs or public intoxication charges. He was 4/4 on CAGE questions. PAST MEDICAL HISTORY: As discussed above. PAST PSYCHIATRIC HISTORY: As discussed above. PERSONAL HISTORY: The patient was single and had 3 sister and 1 brother ALLERGIES: NO KNOWN DRUG ALLERGIES. FAMILY HISTORY: Significant for some kind of mental illness and alcohol . He did not report any history of suicide in the family. MENTAL STATUS EXAMINATIONO.M is a 57year-old male sitting on a chair. He was alert, oriented, and cooperative. Concentration and memory intact. Speech was normal rate, flow, and tone. Language was appropriate and goal directed. Affect was somewhat sad. No suicidal ideation. No active homicidal ideation, although he had homicidal ideation against his father and his family. No auditory or visual hallucinations or delusions noted. He seems to have reasonable insight into his situation. His judgment was intact. DIAGNOSES: Axis I: 1. Auditory hallucinations 2. Alcohol dependence. 3.

Axis II: Antisocial personality disorder, borderline personality disorder. Axis V: Global Assessment of Functioning is 70-75 at the time of assessment. TREATMENT PLAN: The patient was seen. He was educated about symptoms of mental illness and available resources, risks, benefits, side effects of his medications including present medication, elavil and depakote. He was able to ask questions. He understood the side effects of dry mouth, constipation, blurring of vision, weight gain, organ effects

including effects of Elavil on the heart as well as effects of valproic acid on the liver, pancreas, bone marrow, and blood. He was able to understand about the risks of hair loss, weight gain, tremors, and other side effects from Depakote. The patient had stated that his medications were not really helpful with his condition. He was interested in taking another antidepressant. He was explained in detail that since he was on Elavil, that he would have to have a washout before another medication could be started. He was able to understand and ask questions about the risk of changing the medication including worsening of mood disorder, psychosis, risk of suicide. He wanted to try another antidepressant. He agreed to undergo a period of washout of 7 to 10 days. . His last labs were discussed with him. The patient agreed to continue Depakote at the present time with a plan that once his Celexa is stable that his Depakote dose would be reduced to minimum dose possible. His case was discussed in detail with Mr. E.M, who is going to provide him with therapy focusing on the issue of his, mental illness, and substance abuse. I will continue to follow him closely and provide medication and therapy. I will see the patient back in approximately 4 weeks. We will continue to do regular blood tests as well.