Prepúštacia správa, translated from Slovak to English Patient: Location: Hospit.from: Žiak Ján ID: 79 ******** Košútska 8, 036 01 Martin, Tel. 0904 *** *** Code: 2400 03/feb/2014 to: 24/feb/2014 Psychiatry JLFUK and UNM History: RA: mother's sister is being treated for depression OA: surpassed serious injuries or operations, no physical illness is left untreated , yet without psychiatric intervention SPA: graduated in Electrical Engineering at an univerzity in Bratislava, then 3 years postgraduate program, left 1 year before the end of the study, since then about 4 years unemployed, lives at home with his parents, has two siblings, character is rather introverted, not very societal LA: 0 AA: 0 Parera: Patient so far without psychiatric intervention, brought by RZP summoned by the father of the patient. Described about 4 years of gradual changes in behavior concluding with a close up and a loss of interest in surroundings. Exaggerated /probably depressed/ symptomatic last year with apathy, aboulia, hyporexia in an almost psychotic depth. Urgently admitted because of a risk of an oversight Diseases until now: Subj: Patient is tensious, falsely tuned, with paranoid incredulous setting. A meaningful interview cannot be implemented. Heteroanamnesis from his father: Patient is In this state since about the last year. Does not leave his room, communicates only minimally, locks door and sits by the computer. No friends and does not go anywhere either. Minimum eating, weight loss. Indications of certain changes go back as far as 4 years ago. When finished college, started there doing PhD studies, devoted to teaching and then left 1 year before the end, i.e after about 3 years, do not know why it ended. And hasn’t completed doctoral studies. Since then, what are probably those 4 years, does not do anything, just at home and increasingly closing himself. He only knows that there was some problem with housing. Lived on campus and was there to receive some apartment. Finally, however, the apartment got someone else and he was frustrated enough of it. Then actually ended also study and returned home. Objective findings: Consciousness lucid, correct orientation in general terms, contact restricted due to significant intrapsychotic tension, due to lack of cooperation and paranoid setup, setting is depressed delusional, facial expressions and affectivity petrified, does not answer the questions asked, the presence of significant anxiety, thinking bradypsychotic vs paranoid and delusional depressed levels in depth, suicidal ideas can not be excluded, structure can not be clearly assessed, coherence is likely to be maintained, anamnestic hyporexia, aboulia, anhedonia, complete isolation from the surrounding area and activities, personality psychotically altered, premorbidly rather introverted Laboratory and auxiliary examination: Results from 04/feb/14: Minerals in serum: S_Na: 134, S_K: 4.1, S_Cl: 103, Serum: S_GLU: 4.7, S_KRE: 101, S_KMOC: 605, S_TBIL: 44.6, S_GMT: 0.25, S_ALT: 0.22, S_AMS: 0.54, blood count: B_WBC: 6.80, B_RBC: 4.54, B_HGB: 142, B_HCT: 0.43, B_MCV: 93.6, B_MCH: 31.3, B_MCHC: 334, B_RDW: 13.5, B_PLT: 226, B_MPV: 9.5, B_%NEU: 55.3, B_%LYM: 32.9, B_%MON: 9.7, B_%EOS: 1.7, B_%BAS: 0.4, B_*NEU: 3.80, B_*LYM: 2.20, B_*MON: 0.70, B_*EOS: 0.10, B_*BAS: 0.00, B_PDW, 16.8, Results from 05/feb/14 Serum: S_CHOL: 6.26, S_TRG: 0.69, Coagulation: P_PT%: 88.2, P_PTIN: 1.10, P_APTT: 27.9, P_APTr: 0.93, P_TT: 13.6 PSYCHOLOGICAL TESTING: Obj. psychol.: At the personality trait strongly dominated by introversion. Indicated are also features psychasthenia and paranoia. The combination of these personality traits refers to mental immaturity, an individuality not searching any close relationships, acting coolly, with a few distinct emotions, with a lack of confidence. Patient prefers solitary activities, highlighted the tendency to social isolation and avoidance behavior. On the basis of the projective methodology isn’t contact with reality significantly disturbed at this moment. Perception of reality and the current mental state of the patient, are largely influenced by predispositions of patient’s personality. From the emotional point of view it is highlighted a depressing living. Patient thoughts contain fear of the future. Conclusions: The premorbid personality trait component strongly dominated by introversion with a tendency to social isolation and retiringness. With schizoid personality traits. Perception of reality without pathological changes at this moment. Depressive syndrome chronified (medium difficulty level). Improving state at the moment. Registration: Mgr. Dana Flešková, PhD. Therapy: Oxazepam, Alventa, Olanzapine, Zolpidem Epicrisis: The patient admitted to first psychiatric hospitalization, without psychiatric treatment until now. On receipt at the forefront a depressed mood with hypobulia and anhedonia, insomnia, social isolation, limited criticism with signs of paranoid thinking with depressive content. Premorbidly it is a personality with highlighted features of introversion, psychological examination confirmed schizoid features at personality level. Due to the nature, course and response to treatment we diagnose it as a chronic, untreated depressive affective disorder. During hospitalization gradually adjusted to the combination therapy Venlafaxín/300mg/ + Olanzapine/5mg/ with gradual recovery of affect, restoration of activities, more appropriate sociability, stabilized sleep. Significant improvement of state when released for outpatient care. Diagnoses: F32.3: Depression episode with psychotic features Recommendation: Regular psychiatric controls. Inclusion of interim controls basic laboratory parameters and ECG via practitioner. Last therapy department at: Alventa cps. 300mg/M, Olanzapine tbl. 5 mg/E Doc.MUDr.I.Ondrejka, PhD head of the clinic MUDr.Zoltán Kovács deputy of department head Kulhan Tomáš MUDr. physician