Patient Status Update

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Patient suffered an extreme outlier episode of hallucination.

Description:
Though the patient’s condition has certainly improved as a whole, the intensity of this particular hallucination punctuates an alarming diversion from the gradual trend towards improvement.

Given the curious context and abrupt onset of this episode, Dr. Ingram and I suspect that the patient has been begun disposing of her medication.

Patient Status Update

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Under medication and cognitive therapy, Brie’s condition has improved significantly. Progress is such that additional freedoms have been granted. Float chamber is no longer necessary for treatment, and the patient will be moved to a more open area of the facility.

Though we are confident in Brie’s improvements, I have requested that the staff discretely observe her in order to monitor her behavior in a new setting.

While outdoors, Brie took to continued isolation. Though she was reported to have spent considerable time in conversation with herself, this instance is likely a result of prolonged exposure to the float chamber. In this more open setting, I anticipate the patient’s residual tendencies toward self-confinement will gradually give way to a more natural interest in human interaction.

Clinical Examination #4

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Summary:
During the examination, Brie once again exhibited little interest or ability to participate.

The session’s only substantive information came about in a discussion of Crew’s fiancé, Sara, a topic to which the patient’s lucidity improved, becoming immediately responsive. Below is a transcript of the subsequent dialogue:

Sprague and Brie

Upon further discussion of the subject, Brie revealed that her recurring nightmares routinely feature Sara strangling her younger sister Jess, another of Brie’s siblings with whom she was profoundly connected.

Diagnosis and recommendation:

It is obvious to conclude that a considerable amount of the emotional trauma Brie suffers stems from this unresolved conflict with Sara. As past examinations have shown, Crew and Brie shared a bond of particular closeness and strength throughout their lives. Given the contextual evidence, it follows to assume that Brie holds Sara accountable for straining the relationship between her and her brother, and subsequently influencing the inciting incident.

Simple exposure and reconciliation of the relationship should dilute the intensity of the patient’s emotional traumatization, thus beginning to alleviate the severity of these delusions as a whole.

Clinical Examination #3

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Summary:
As a means of determining the extent to which the patient’s  familial dynamic has affected the severity of her delusions, I attempted to engage Brie in a discussion of her other siblings. 

However, the patient was largely uncooperative. In her present state of sedative-induced delirium, she reverted to repeatedly muttering the phrase “blood is blood,” as a rationale for her refusal to cooperate. However, I believe this information may be vital for a more effective diagnosis and treatment. Though unfortunate, an inspection of the patient’s private phone messages (which were made available at the time of the patient’s referral to the facility) has become necessary. The following is a transcript of a message conversation between the patient and her sister, Jess:

bandj

Distrust for Crew’s fiancé Sara developed early, and largely out of the fierce possessiveness the patient harbors for her siblings.

The continuous fear of replacement exhibited above indicates the patient’s personal concern for preserving her relationships, as they were. Given the singularity of her distrust, fear, and jealousy in relation to her siblings, it is logical to conclude that Brie’s concerns were and are generally irrational.

Clinical Examination #2

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Clinical Examination #2 (8/7/16)

Summary:
Under increased sedative medication, Brie’s condition seems to have improved, albeit slightly. The frequency of her severe episodes has notably decreased, though behavior is discernibly more lethargic. Brie displayed low energy and little interest in participation. Throughout the examination, the patient’s only attempt at communication was the muttering of the phrase “blood is blood” in monotonous repetition.

Diagnosis and recommendation:
At present, the patient’s current state of lethargy is preferable to that of her previous episodes. As such, dosage will remain the same.

Patient Status Update #1

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Patient Status Update —

Patient experienced a severe and violent episode of hallucination:

Description:
Dr. Ingram rushed into my office with reports that Brie could be heard screaming desperately for help. Upon arrival, I found the patient flailing violently in her float chamber. As Dr. Ingram and I attempted to subdue the patient to a calmer state, the screams and thrashing escalated. The severity of the episode required that Brie be tranquilized for her own safety, and so as not to exacerbate the condition of other patients.

After the patient reached a sedate condition, the following sketches were discovered in her room:

Etchings

In relation to Brie’s description, it is safe to assume that this is a depiction of Crew as he appears in her hallucinations. The meaning of the etchings, while presently unclear, is unsettling. Further investigation is necessary.

As a preventive measure against the continuing intensity of these episodes, the patient’s prescribed sedative medication has been increased in dosage.

maskandeyes

Clinical Examination #1

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Clinical Examination #1 (8/4/16)
Summary:
Upon examination, it is clear the patient suffers a state of near-perpetual paranoia. As such, isolation via float chamber is to be administered until therapy and medication are able to dilute the severity of her delusions.

These delusions are bizarre in nature; Brie claims to be pursued by an incarnation of her older brother, Crew, by whom she was attacked in the inciting domestic violence incident. However, during the altercation, Brie administered a fatal puncture wound to Crew, killing him. Nonetheless, her description of the hallucinations may be found in the following transcript of the examination:

Clinical Examination #1

Diagnosis and recommendation:
The link between memory of the event and the visual manifestation of Brie’s hallucinations seems to confirm my impression of the delusions as post-traumatic.

However, when pressed for further answers regarding the topic, the patient’s nervous state worsened significantly. As such, sufficient cognitive treatment should be conducted before revisiting this topic of the examination.

Patient #61006 — Brie

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PSYCHOLOGICAL EVALUATION
(Confidential)

PATIENT #61006

Name: Brie
Date of Birth: 5/1/89
Age: 27 years and 4 months
Referred by: Family
Place of Examination: Cottonwood Sanatorium
Date of Admission: 8/2/16
Date of Report: 8/3/16
Examiner: Dr. Janet Sprague, Psy.D., University of California, Los Angeles

Reason for Referral:
Patient #61006 (Brie) suffers severe paranoid delusions induced by an isolated incident of domestic violence between siblings. Brie claims to experience vivid, residual hallucinations of the event, in addition to regularly recurring nightmares. Patient has no previous history of psychiatric evaluation.

Initial Analysis:
Though further analysis is necessary, my initial impression of the case is post-traumatic in nature and calls for a combined treatment program of cognitive behavioral therapies and medication.