CHIEF COMPLAINT: Chief Complaint: AMS
Reason for MICU transfer: Intubated

PRESENT ILLNESS: 45F hx of catatonic schizophrenia p/w AMS.  She was last seen
normal 2 days prior.  This afternoon, she was found by her
friend/neighbor at home on her couch, ?unresponsive, with
drool/mucous coming down her face.  The friend came to check on
her because had not heard from her in a couple days.  There were
no pills found around the patient, no emesis, no evidence of
fall or trauma.  The friends called an ambulance, who took the
patient to the hospital.
.
Patient was given Narcan by EMS, which did not improve her
mental status.  Normal fingerstick or 115 en route.  No
additional history available.
.
In the ED, VS were T: 98, HR: 96, BP: 114/77, Resp: 16, O2 Sat:
99 on a nonrebreather.  Unclear if pt was not protecting airway
or was not satting well on RA.  GCS of 5.  Opened eyes and
furrowed brow to voice and pain stimulus, but did not move
extremeties.  Patient intubated for protection of airway in
light of AMS.  Lab results showed WBC of 12.8, otherwise
unremarkable.  EKG showed TWI in aVR, no ST changes, PR interval
of 124, QRS of 78, QTc of 435.  Head CT done and normal.  Chest
x-ray showing L basilar atelectasis, otherwise unremarkable.
.
On arrival to the MICU, patient was sedated on propofol, VS T:
99.6, P: 83, BP: 116/62, R: 18, O2: 100%.
.
Review of systems:
(+) Per HPI
(-) Unable to be completed upon admission due to pt mental
status

MEDICAL HISTORY: 1.  Nephrolithiasis x1 episode with hydronephrosis, hospitalized
at [**Hospital1 18**] in [**2191-1-25**].
2.  Fibroid uterus detected on recent CT scan, no symptoms.
3.  Headaches.  Presumably migraine in nature, uses ibuprofen
one to two times per month for this.
4.  Schizophrenia, was diagnosed in [**2185**] when she had a "nervous
breakdown".  She has had multiple psychiatric admissions since
then and is now on two medications.  She had a recent
psychiatric admission as well and generally is admitted to our
hospital.  She is followed by outside psychiatrist, Dr. [**Last Name (STitle) **]
and a therapist.  Per DC summary in [**2188**], hx of catatonia, PTSD,
past dx schizophrenia v.
schizoaffective disorder, and cluster B traits.
5.  Asthma, mild.
PSYCHIATRIC HISTORY:
Current treaters:
Dr. [**Last Name (STitle) **], psychiatrist at [**Hospital **] Community Health Center,
([**Telephone/Fax (1) 109138**], last visit middle of [**Month (only) 1096**].
[**Doctor First Name **] Theodat, therapist [**Hospital **] Community Health
Center,([**Telephone/Fax (1) 109138**], missed lsat visit bc she was ??????too
preoccupied with [**Holiday **],?????? but does have another appt next
Wed.

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from webOMR.
1. Acetaminophen [**Telephone/Fax (1) 1999**] mg PO Q8H:PRN pain
2. butalbital-acetaminophen-caff *NF* 50-325-40 mg Oral Q6H
severe headache
Do not take with other medications containing
acetaminophen/Tylenol.
3. Aripiprazole 5 mg PO DAILY
4. Risperdal Consta 37.5 mg IM Q2W (SA)
5. Multivitamins 1 TAB PO DAILY
6. Ibuprofen 600 mg PO DAILY:PRN headache
7. Calcarb 600 With Vitamin D *NF* (calcium carbonate-vitamin
D3) 600 mg(1,500mg) -400 unit Oral daily
8. albuterol sulfate *NF* 1-2 puffs Inhalation Q8H PRN wheezing
or shortness of breath
9. Sertraline 50 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam
Vitals: T: 99.6, P: 83, BP: 116/62, R: 18, O2: 100%
General: Intubated, sedated
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: sedated, pupils ERR 3-->2, 2+ reflexes throughout, except
3-beat pedal clonus, no rigidity

FAMILY HISTORY: FAMILY PSYCHIATRIC HISTORY: Per [**Name (NI) **] pt's M c hx schizophrenia &
bipolar d/o, S c schizophrenia

SOCIAL HISTORY: She is on disability.  She recently moved into a different
apartment for subsidized housing in [**Location (un) **] that has an
elevator.  She really likes her new apartment a lot better than
the old one.  In terms of her diet, she has been avoiding fried
food, pastries, sweets, and eating a lot more fruits and
vegetables.  She has also been avoiding carbohydrates in
general. This is in order to try to lose weight.  She does to
the gym at least two times per week.  She also does a lot of
walking.  She does not smoke.  She avoids alcohol.  She lives
alone.  She has a boyfriend that she has had for 20 years, but
she is not sexually active with him as he is more of a friend or
a partner and he also lives with his family.
Catatonic type schizophrenia, chronic,Hyperosmolality and/or hypernatremia,Asthma, unspecified type, unspecified,Leiomyoma of uterus, unspecified,Leukocytosis, unspecified,Posttraumatic stress disorder
Catatonia-chronic,Hyperosmolality,Asthma NOS,Uterine leiomyoma NOS,Leukocytosis NOS,Posttraumatic stress dis
Admission Date:  [**2192-7-17**]              Discharge Date:   [**2192-7-21**]

Date of Birth:  [**2149-3-4**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2751**]
Chief Complaint:
Chief Complaint: AMS
Reason for MICU transfer: Intubated


Major Surgical or Invasive Procedure:
Intubation [**7-17**]
Mechanical ventilation
Extubation

History of Present Illness:
45F hx of catatonic schizophrenia p/w AMS.  She was last seen
normal 2 days prior.  This afternoon, she was found by her
friend/neighbor at home on her couch, ?unresponsive, with
drool/mucous coming down her face.  The friend came to check on
her because had not heard from her in a couple days.  There were
no pills found around the patient, no emesis, no evidence of
fall or trauma.  The friends called an ambulance, who took the
patient to the hospital.
.
Patient was given Narcan by EMS, which did not improve her
mental status.  Normal fingerstick or 115 en route.  No
additional history available.
.
In the ED, VS were T: 98, HR: 96, BP: 114/77, Resp: 16, O2 Sat:
99 on a nonrebreather.  Unclear if pt was not protecting airway
or was not satting well on RA.  GCS of 5.  Opened eyes and
furrowed brow to voice and pain stimulus, but did not move
extremeties.  Patient intubated for protection of airway in
light of AMS.  Lab results showed WBC of 12.8, otherwise
unremarkable.  EKG showed TWI in aVR, no ST changes, PR interval
of 124, QRS of 78, QTc of 435.  Head CT done and normal.  Chest
x-ray showing L basilar atelectasis, otherwise unremarkable.
.
On arrival to the MICU, patient was sedated on propofol, VS T:
99.6, P: 83, BP: 116/62, R: 18, O2: 100%.
.
Review of systems:
(+) Per HPI
(-) Unable to be completed upon admission due to pt mental
status

Past Medical History:
1.  Nephrolithiasis x1 episode with hydronephrosis, hospitalized
at [**Hospital1 18**] in [**2191-1-25**].
2.  Fibroid uterus detected on recent CT scan, no symptoms.
3.  Headaches.  Presumably migraine in nature, uses ibuprofen
one to two times per month for this.
4.  Schizophrenia, was diagnosed in [**2185**] when she had a "nervous
breakdown".  She has had multiple psychiatric admissions since
then and is now on two medications.  She had a recent
psychiatric admission as well and generally is admitted to our
hospital.  She is followed by outside psychiatrist, Dr. [**Last Name (STitle) **]
and a therapist.  Per DC summary in [**2188**], hx of catatonia, PTSD,
past dx schizophrenia v.
schizoaffective disorder, and cluster B traits.
5.  Asthma, mild.
PSYCHIATRIC HISTORY:
Current treaters:
Dr. [**Last Name (STitle) **], psychiatrist at [**Hospital **] Community Health Center,
([**Telephone/Fax (1) 109138**], last visit middle of [**Month (only) 1096**].
[**Doctor First Name **] Theodat, therapist [**Hospital **] Community Health
Center,([**Telephone/Fax (1) 109138**], missed lsat visit bc she was ??????too
preoccupied with [**Holiday **],?????? but does have another appt next
Wed.

Past diagnoses: catatonic schizophrenia, PTSD, cluster B
personality

numerous prior hospitalizations, including [**4-2**] and [**7-2**] on
[**Hospital1 **] 4; has participated in partial at [**Hospital1 1680**] and Gateway
program; reports she intermittently attends [**Location (un) 15852**] House

Prior Med Trials include abilify, risperdal, zyprexa, depakote;
has received ECT in the past

PAST MEDICAL HISTORY:
migraine HA
asthma

PCP [**First Name4 (NamePattern1) 698**] [**Last Name (NamePattern1) **] at [**Hospital1 18**] at ([**Telephone/Fax (1) 1300**]

[**Location (un) 535**] [**Location (un) **] ([**Telephone/Fax (1) 35208**])

ALLERGIES: NKDA (previously listed allergy to risperidone
deleted
as she is tolerating this well)

Social History:
She is on disability.  She recently moved into a different
apartment for subsidized housing in [**Location (un) **] that has an
elevator.  She really likes her new apartment a lot better than
the old one.  In terms of her diet, she has been avoiding fried
food, pastries, sweets, and eating a lot more fruits and
vegetables.  She has also been avoiding carbohydrates in
general. This is in order to try to lose weight.  She does to
the gym at least two times per week.  She also does a lot of
walking.  She does not smoke.  She avoids alcohol.  She lives
alone.  She has a boyfriend that she has had for 20 years, but
she is not sexually active with him as he is more of a friend or
a partner and he also lives with his family.

SUBSTANCE ABUSE HISTORY: Nonsmoker. Denies EtOH or illicits.

SOCIAL HISTORY:
Per [**Location (un) **] and updated: There is a history of sexual abuse. Patient

has a bachelor's and master's degree in business administration.

On disability SSDi. Has a boyfriend [**Name (NI) **] [**Name (NI) 109139**]. No children.
Born in [**Hospital1 8**]. She is currently living alone in an apartment

in [**Location (un) **]. In [**Month (only) **] she completed a vocational training
in computers through [**Hospital 350**] Rehabilitation services but
feels she is not well enough to work.


Family History:
FAMILY PSYCHIATRIC HISTORY: Per [**Name (NI) **] pt's M c hx schizophrenia &
bipolar d/o, S c schizophrenia

Mother died of recurrent breast cancer originally diagnosed in
her 40s.  She has two sisters who are relatively healthy.  One
gets mammograms regularly.  She has a father with bilateral hip
replacements and kidney stones.

Physical Exam:
Admission Exam
Vitals: T: 99.6, P: 83, BP: 116/62, R: 18, O2: 100%
General: Intubated, sedated
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: sedated, pupils ERR 3-->2, 2+ reflexes throughout, except
3-beat pedal clonus, no rigidity


Pertinent Results:
Admission Labs:
9:19p   Arterial Gas
pH 7.49 pCO2 33 pO2 525 HCO3 26 BaseXS 3
Intubated; FiO2%:100; AADO2:146; Req:35; Rate:16/; TV:450;
PEEP:5; Mode:Assist/Control
freeCa:1.12
Lactate:0.8
O2Sat: 99
.
Urine Benzos, Barbs, Opiates, Cocaine, Amphet, Mthdne All
negative
UCG: Negative
.
Na:144
K:3.8
Cl:106
TCO2:24
Glu:114
Lactate:1.0
.
U/A
Color Yellow
Appear Clear
SpecGr 1.026
pH   6.0
Urobil Neg
Bili Neg
Leuk Neg
Bld Neg
Nitr Neg
Prot 100
Glu Neg
Ket 40
RBC 4
WBC <1
Bact Few
Yeast None
Epi <1
Other Urine Counts
Mucous: Many
.
ALT: 14
AP: 56
Tbili: 0.5
Alb: 5.0
AST: 16
Lip: 37
.
Serum ASA, EtOH, Acetmnphn, Benzo, Barb, Tricyc Negative
.
12.8 > 13.7 < 386
       41.4
.
PT: 14.7  PTT: 27.9  INR: 1.4
Fibrinogen: 351
.
[**2192-7-19**] RPR negative
.
Images:

EEG: [**7-18**]:
This is an abnormal awake and sleep EEG, because of intermittent

left temporal slowing in the theta range and a single sharp wave
in the left anterior temporal lobe. These findings are
indicative of a potentially epileptogenic region of dysfunction
in the left temporal region.

CXR [**2192-7-17**]
Endotracheal tube is low lying, terminating approximately 1.5 cm
from the carina. Orogastric tube tip is seen within the distal
stomach. The cardiac, mediastinal and hilar contours are normal.
The pulmonary vasculature is not engorged. Minimal streaky
opacity in the left lung base may reflect atelectasis. No large
pleural effusion or pneumothorax is present. There are no acute
osseous abnormalities.
IMPRESSION:
1. Low lying endotracheal tube terminating approximately 1.5 cm
from the carina, for which withdrawal is recommended.
2. Standard position of orogastric tube.
3. Left basilar atelectasis.
.
CT HEAD [**2192-7-17**]
There is no evidence of hemorrhage, edema, mass effect, or large

territorial infarction.  The ventricles and sulci are normal in
size and
configuration for age.  The basal cisterns appear patent and
there is
preservation of [**Doctor Last Name 352**]-white matter differentiation.  No fracture
is identified. Partial opacification of the nasal cavity and
ethmoidal air cells is likely related to the patient's intubated
state.  The visualized paranasal sinuses are otherwise clear.
The mastoid air cells and middle ear cavities are clear. The
globes are unremarkable.
No ICH.
.
EKG: normal sinus, rate ~100, TWI in aVR, no ST changes, PR
interval of 124, QRS of 78, QTc of 435

Brief Hospital Course:
43F w/ hx of catatonic schizophrenia p/w AMS. Intubated in the
ED secondary to increased secretions and failure to protect her
airway. Extubated same day in MICU.

** On day of discharge, Ms. [**Known lastname 84729**] boyfriend (who was to pick
her up from the hospital) discussed with nursing that Ms. [**Known lastname **]
did not want to go home, but to a hotel after discharge. He was
concerned that in the past, she always stated that if she was
going to commit suicide or hurt herself, she would do it at a
hotel. Patient denied suicidal ideation and plan, homicidal
ideation to intern, attending, and nursing. However, she was not
amenable to going home instead of hotel, and her boyfriend was
not able to supervise her in the hotel. She felt that she wanted
to escape from her apartment as she hears voices there. The
voices do not tell her to kill herself. Consulted psychiatry,
who felt that if she refused to go home, she was not safe to go
to a hotel alone. Boyfriend attempted to convince her to return
home, but she refused. Psychiatry spoke to her and due to
auditory hallucinations and concern for safety in a hotel alone,
decided she would benefit from transfer to inpatient psychiatry.
Since she did not want to be transferred to inpatient psychiatry
service, section 12 was invoked given her psychiatric
decompensation and auditory hallucinations, and she was
transferred to [**Hospital1 **] 4. **

ACUTE ISSUES
# AMS: Unclear etiology. In the MICU, the following potential
diagnoses were considered non-convulsive seizure vs. catatonia
vs. med overdose vs. NMS. vs Seratonin syndrome vs. Dystonia vs.
infection.  Essentially NML acid-base status, NML EKG, other
labs NML except WBC of 12.8, so toxic ingestion is not likely.
Unclear if pt was ever actually truly unresponsive. A CXR and UA
were normal arguing against an infectious process. Ativan 2mg
was given for concern of catatonia. Psych medications were held
and psych was consulted as was neurology who recs an EEG. After
extubation she was Aox3 and able to describe the events that
brought her into the hospital.
.
Once pt was transferred to the medicine floor, her affect
improved significantly. She had some improving psychomotor
retasrdation. Denied suicidal ideation. Psychiatry saw her and
felt that she was sad and tearful but at no danger to herself or
others. Neurology reviewed her EEG with abnormal epileptiform
waves in the temporal region and determined that given she had
no h/o epilepsy, this presentation of AMS was not eplilepsy. In
addition, her response to ativan suggests catatonia. Psych was
less convinced that this was an episode of catatonia given this
episode was not preceeded by an unusual affect or features of
psychosis.
.
# Leukocytosis: Normal urine, no fever, CXR just showing
atelectasis. While we considered that she could have aspirated
if she was altered, WBC trended down without intervention.
.
.
# Schizophrenia / Depression: Continued home sertraline 150 QD
and abilify 15mg QD per psych
** see paragraph above.**
.
CHRONIC ISSUES
# Asthma: Mild, just on PRN albuterol. Not active during this
hospitalization
- albuterol if not clear chest physical exam or if resp status
declines
.
# Headaches: Tylenol PRN. Not active.
.
TRANSITION ISSUES
{ ] Outpatient psych follow-up
TRANSITION ISSUES:
[ ] f/u BCx [**7-17**] and [**7-18**]
[ ] Please ensure patient has been followed by Psych VNA
services.

Medications on Admission:
Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from webOMR.
1. Acetaminophen [**Telephone/Fax (1) 1999**] mg PO Q8H:PRN pain
2. butalbital-acetaminophen-caff *NF* 50-325-40 mg Oral Q6H
severe headache
Do not take with other medications containing
acetaminophen/Tylenol.
3. Aripiprazole 5 mg PO DAILY
4. Risperdal Consta 37.5 mg IM Q2W (SA)
5. Multivitamins 1 TAB PO DAILY
6. Ibuprofen 600 mg PO DAILY:PRN headache
7. Calcarb 600 With Vitamin D *NF* (calcium carbonate-vitamin
D3) 600 mg(1,500mg) -400 unit Oral daily
8. albuterol sulfate *NF* 1-2 puffs Inhalation Q8H PRN wheezing
or shortness of breath
9. Sertraline 50 mg PO DAILY

Discharge Medications:
1. Aripiprazole 15 mg PO DAILY
2. Sertraline 150 mg PO DAILY
3. albuterol sulfate *NF* 1-2 puffs Inhalation Q8H PRN wheezing
or shortness of breath
4. OLANZapine 2.5 mg PO HS
Please give tonight with aripiprazole.


Discharge Disposition:
Extended Care

Facility:
Deaconness 4

Discharge Diagnosis:
Altered mental status


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Ms. [**Known lastname **]

It was a pleasure taking care of you at the [**Hospital1 771**]. You were admitted because you were
found to have altered mental status. You were admitted to the
ICU, where an extensive work-up was performed to understand why
your mental status had changed. After extensive testing of your
blood, urine, and several imaging studies, you did not have any
evidence of trauma to your head, infection in your brain,
disruption in blood flow to your brain. We obtained an
electroencephalogram, which measured your brain wave activity,
and found it to be abnormal. We discussed these results with
psychiatrists and neurologists to better understand what had
caused you to have an alteration in your mental status. We
concluded that you did not have a seizure, and that most likely
your episode of altered mental status was related to your
catatonic schizophrenia.

We made no changes to your outpatient medications. Please
continue to take your medications as prescribed.

Followup Instructions:
We called the [**Location (un) **] Community [**Hospital 4189**] Health Center and left
a message for your psychiatrist Dr. [**Last Name (STitle) **], letting him know that
you are being discharged from the hospital. Someone from the
center will call you to schedule a follow up appointment. If you
do not hear from anyone within the next few days please call Dr.
[**Last Name (STitle) **] at [**Telephone/Fax (1) 5260**] to set up a follow-up appointment.
.
You have the following upcoming appointments:
.
Department: [**Hospital3 249**]
When: FRIDAY [**2192-7-27**] at 11:10 AM
With: [**Company 191**] POST [**Hospital 894**] CLINIC [**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST
Best Parking: [**Hospital Ward Name 23**] Garage
.
Department: [**Hospital3 249**]
When: TUESDAY [**2192-10-2**] at 11:00 AM
With: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3990**], [**First Name3 (LF) **] [**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST
Best Parking: [**Hospital Ward Name 23**] Garage
.
Department: [**Hospital3 249**]
When: WEDNESDAY [**2193-4-3**] at 11:00 AM
With: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3990**], [**First Name3 (LF) **] [**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST
Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2192-7-23**]
{'Catatonic type schizophrenia, chronic,Hyperosmolality and/or hypernatremia,Asthma, unspecified type, unspecified,Leiomyoma of uterus, unspecified,Leukocytosis, unspecified,Posttraumatic stress disorder'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Chief Complaint: AMS
Reason for MICU transfer: Intubated

PRESENT ILLNESS: 45F hx of catatonic schizophrenia p/w AMS.  She was last seen
normal 2 days prior.  This afternoon, she was found by her
friend/neighbor at home on her couch, ?unresponsive, with
drool/mucous coming down her face.  The friend came to check on
her because had not heard from her in a couple days.  There were
no pills found around the patient, no emesis, no evidence of
fall or trauma.  The friends called an ambulance, who took the
patient to the hospital.
.
Patient was given Narcan by EMS, which did not improve her
mental status.  Normal fingerstick or 115 en route.  No
additional history available.
.
In the ED, VS were T: 98, HR: 96, BP: 114/77, Resp: 16, O2 Sat:
99 on a nonrebreather.  Unclear if pt was not protecting airway
or was not satting well on RA.  GCS of 5.  Opened eyes and
furrowed brow to voice and pain stimulus, but did not move
extremeties.  Patient intubated for protection of airway in
light of AMS.  Lab results showed WBC of 12.8, otherwise
unremarkable.  EKG showed TWI in aVR, no ST changes, PR interval
of 124, QRS of 78, QTc of 435.  Head CT done and normal.  Chest
x-ray showing L basilar atelectasis, otherwise unremarkable.
.
On arrival to the MICU, patient was sedated on propofol, VS T:
99.6, P: 83, BP: 116/62, R: 18, O2: 100%.
.
Review of systems:
(+) Per HPI
(-) Unable to be completed upon admission due to pt mental
status

MEDICAL HISTORY: 1.  Nephrolithiasis x1 episode with hydronephrosis, hospitalized
at [**Hospital1 18**] in [**2191-1-25**].
2.  Fibroid uterus detected on recent CT scan, no symptoms.
3.  Headaches.  Presumably migraine in nature, uses ibuprofen
one to two times per month for this.
4.  Schizophrenia, was diagnosed in [**2185**] when she had a "nervous
breakdown".  She has had multiple psychiatric admissions since
then and is now on two medications.  She had a recent
psychiatric admission as well and generally is admitted to our
hospital.  She is followed by outside psychiatrist, Dr. [**Last Name (STitle) **]
and a therapist.  Per DC summary in [**2188**], hx of catatonia, PTSD,
past dx schizophrenia v.
schizoaffective disorder, and cluster B traits.
5.  Asthma, mild.
PSYCHIATRIC HISTORY:
Current treaters:
Dr. [**Last Name (STitle) **], psychiatrist at [**Hospital **] Community Health Center,
([**Telephone/Fax (1) 109138**], last visit middle of [**Month (only) 1096**].
[**Doctor First Name **] Theodat, therapist [**Hospital **] Community Health
Center,([**Telephone/Fax (1) 109138**], missed lsat visit bc she was ??????too
preoccupied with [**Holiday **],?????? but does have another appt next
Wed.

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from webOMR.
1. Acetaminophen [**Telephone/Fax (1) 1999**] mg PO Q8H:PRN pain
2. butalbital-acetaminophen-caff *NF* 50-325-40 mg Oral Q6H
severe headache
Do not take with other medications containing
acetaminophen/Tylenol.
3. Aripiprazole 5 mg PO DAILY
4. Risperdal Consta 37.5 mg IM Q2W (SA)
5. Multivitamins 1 TAB PO DAILY
6. Ibuprofen 600 mg PO DAILY:PRN headache
7. Calcarb 600 With Vitamin D *NF* (calcium carbonate-vitamin
D3) 600 mg(1,500mg) -400 unit Oral daily
8. albuterol sulfate *NF* 1-2 puffs Inhalation Q8H PRN wheezing
or shortness of breath
9. Sertraline 50 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam
Vitals: T: 99.6, P: 83, BP: 116/62, R: 18, O2: 100%
General: Intubated, sedated
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: sedated, pupils ERR 3-->2, 2+ reflexes throughout, except
3-beat pedal clonus, no rigidity

FAMILY HISTORY: FAMILY PSYCHIATRIC HISTORY: Per [**Name (NI) **] pt's M c hx schizophrenia &
bipolar d/o, S c schizophrenia

SOCIAL HISTORY: She is on disability.  She recently moved into a different
apartment for subsidized housing in [**Location (un) **] that has an
elevator.  She really likes her new apartment a lot better than
the old one.  In terms of her diet, she has been avoiding fried
food, pastries, sweets, and eating a lot more fruits and
vegetables.  She has also been avoiding carbohydrates in
general. This is in order to try to lose weight.  She does to
the gym at least two times per week.  She also does a lot of
walking.  She does not smoke.  She avoids alcohol.  She lives
alone.  She has a boyfriend that she has had for 20 years, but
she is not sexually active with him as he is more of a friend or
a partner and he also lives with his family. 

### Response:
{'Catatonic type schizophrenia, chronic,Hyperosmolality and/or hypernatremia,Asthma, unspecified type, unspecified,Leiomyoma of uterus, unspecified,Leukocytosis, unspecified,Posttraumatic stress disorder'}
