CHIEF COMPLAINT: altered mental status

PRESENT ILLNESS: 38M with history of depression, anxiety, bipolar disorder,
PTSD, schizophrenia, heroin abuse, and hepatitis B and C, was
found wandering the halls of [**Hospital **] Hospital today, stating
that he was short of breath and his brother had dropped him off
there. He was refusing blood draws and IVs, and was reportedly
disoriented and having hallucinations, with dilated pupils. He
had a psychiatric evaluation there, in which he is reported as
not taking his psych meds, having lost his outpatient
psychiatrist, and not having a PCP. [**Name10 (NameIs) **] denied SI, but reported
auditory hallucinations. He was transferred to [**Hospital1 1680**] HRI for
inpatient mood stabilization and restarting his medications.

MEDICAL HISTORY: -Depression/anxiety
-bipolar
-PTSD
-schizophrenia
-heroin abuse
-Hepatitis B and C
-gastritis

MEDICATION ON ADMISSION: -trihexiphenidyl (anticholinergic) 5 mg [**Hospital1 **]
-celexa 40 mg QAM
-suboxone 8 mg QD
-alprazolam 1 mg TID
-ASA 81
-thorazine 50 mg TID (anticholinergic)
-valium 10 mg QHS
([**First Name8 (NamePattern2) **] [**Hospital **] Hospital d/c med list, patient also on
levofloxacin 750 mg PO daily, for five days, with no specified
stop date)

ALLERGIES: Penicillins

PHYSICAL EXAM: On admission:
Vitals: Afebrile BP:106/54 P:102 R:17 O2:99% on ventilator
A/C 600x18, 5 PEEP, 50% FiO2
General: Sedated, intubated. No acute distress
HEENT: Mydriasis with pupils non-reactive and symmetric, 5 mm
bilaterally. Sclera anicteric, MMM, oropharynx clear. Very poor
dentition.
Neck: supple, JVP not elevated, no LAD
Lungs: CTAB, no wheezes, rales, ronchi
CV: RRR, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: softly distended, bowel sounds present, no rebound
tenderness or guarding, no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. Firm 3 cm subcutaneous nodule over dorsum of right hand,
with overlying erythema.

FAMILY HISTORY: Unable to obtain

SOCIAL HISTORY: Tobacco:  1 ppd. Per outside facility reports, active heroin use
as possible as 1-2 days ago. +cocaine on tox screen.
Poisoning by parasympatholytics (anticholinergics and antimuscarinics) and spasmolytics,Acute respiratory failure,Drug withdrawal,Opioid type dependence, continuous,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted,Acute alcoholic intoxication in alcoholism, continuous,Cocaine abuse, unspecified,Dysthymic disorder,Unspecified schizophrenia, unspecified,Bipolar disorder, unspecified,Esophageal reflux,Antisocial personality disorder,Leukocytosis, unspecified,Old myocardial infarction,Physical restraints status
Pois-parasympatholytics,Acute respiratry failure,Drug withdrawal,Opioid dependence-contin,Hpt B chrn wo cm wo dlta,Undet pois-med agnt NEC,Ac alcohol intox-contin,Cocaine abuse-unspec,Dysthymic disorder,Schizophrenia NOS-unspec,Bipolar disorder NOS,Esophageal reflux,Antisocial personality,Leukocytosis NOS,Old myocardial infarct,Physical restrain status
Admission Date:  [**2131-10-4**]              Discharge Date:   [**2131-10-12**]

Date of Birth:  [**2092-12-28**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 4891**]
Chief Complaint:
altered mental status

Major Surgical or Invasive Procedure:
intubation and mechanical ventilation

History of Present Illness:
 38M with history of depression, anxiety, bipolar disorder,
PTSD, schizophrenia, heroin abuse, and hepatitis B and C, was
found wandering the halls of [**Hospital **] Hospital today, stating
that he was short of breath and his brother had dropped him off
there. He was refusing blood draws and IVs, and was reportedly
disoriented and having hallucinations, with dilated pupils. He
had a psychiatric evaluation there, in which he is reported as
not taking his psych meds, having lost his outpatient
psychiatrist, and not having a PCP. [**Name10 (NameIs) **] denied SI, but reported
auditory hallucinations. He was transferred to [**Hospital1 1680**] HRI for
inpatient mood stabilization and restarting his medications.

He was subsequently transferred to [**Hospital1 1680**] this afternoon, then
transferred to [**Hospital1 18**] ED for altered mental status. [**Hospital1 1680**]
records also indicate that the patient last used heroin two days
prior to arrival. While at [**Hospital1 1680**], he was reportedly agitated,
restless, anxious, and showing "sn/sx congruent with opiate w/d
as evidenced by enlarged pupils and diaphoresis." He was given
received diphenhydramine 50 mg, haloperidol 10 mg, thorazine 50
mg, diazepam 10 mg, and alprazolam. He was subsequently
transferred to [**Hospital1 18**].

In the ED, the patient did not have triage vitals measured. He
was found to have dry mucous membranes and no bowel sounds. A
foley catheter was placed with subsequent drainage of 400 cc
urine output. Fingerstick was 149. ECG showed sinus tachycardia,
with normal axes and intervals. He was placed in four-point
restraints, but remained agitated. He received multiple doses of
IM and IV lorazepam.

He was seen by toxicology who recommended treating
anticholingergic +/- sympathomimetic toxidrome with
benzodiazepines, and holding physostigmine, given mixed
ingestion picture. Toxicology also recommended monitoring serial
ECG's to ensure QRS stability, and treating QRS widening with
NaHCO3. The patient eventually underwent rapid sequence
intubation for airway protection and agitation.

On initial arrival to the floor, the patient is intubated and
sedated, and we were unable to obtain review of systems.


Past Medical History:
-Depression/anxiety
-bipolar
-PTSD
-schizophrenia
-heroin abuse
-Hepatitis B and C
-gastritis

Social History:
Tobacco:  1 ppd. Per outside facility reports, active heroin use
as possible as 1-2 days ago. +cocaine on tox screen.

Family History:
Unable to obtain

Physical Exam:
On admission:
Vitals: Afebrile BP:106/54 P:102 R:17 O2:99% on ventilator
A/C 600x18, 5 PEEP, 50% FiO2
General: Sedated, intubated. No acute distress
HEENT: Mydriasis with pupils non-reactive and symmetric, 5 mm
bilaterally. Sclera anicteric, MMM, oropharynx clear. Very poor
dentition.
Neck: supple, JVP not elevated, no LAD
Lungs: CTAB, no wheezes, rales, ronchi
CV: RRR, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: softly distended, bowel sounds present, no rebound
tenderness or guarding, no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. Firm 3 cm subcutaneous nodule over dorsum of right hand,
with overlying erythema.

On discharge:
VS: Tc 97.5 Tmax 98.7 BP 150/90  HR 91  RR 20 O2 sat 97%RA
GA: alert and oriented, lethargic, answers questions slowly but
appropriately, cooperative, no longer tremulous or diaphoretic
HEENT: Pupils no longer dilated, equal and reactive to light.
Moist mucous membranes. no LAD. no JVD. neck supple.
Cards: RRR S1/S2 heard. no murmurs/gallops/rubs.
Pulm: CTAB no crackles or wheezes
Abd: soft, obese, NT, no rebound/guarding
Extremities: wwp, no edema. Radial, DPs, PTs 2+.
Skin: Firm 3 cm subcutaneous nodule over dorsum of right hand
between 1st and 2nd digits with no erythema, no fluctuance,
multiple subcutaneous nodules on left and right forearm that pt
attributes to IV heroin use, nontender, nonerythematous


Pertinent Results:
On admission:
[**2131-10-4**] 09:30PM BLOOD WBC-12.5* RBC-5.03 Hgb-13.7* Hct-38.6*
MCV-77* MCH-27.3 MCHC-35.6* RDW-15.5 Plt Ct-333
[**2131-10-4**] 09:30PM BLOOD Neuts-57.2 Lymphs-37.1 Monos-4.3 Eos-0.5
Baso-0.9
[**2131-10-4**] 11:52PM BLOOD PT-15.3* PTT-25.5 INR(PT)-1.3*
[**2131-10-4**] 09:30PM BLOOD Glucose-113* UreaN-21* Creat-1.2 Na-140
K-3.7 Cl-102 HCO3-23 AnGap-19
[**2131-10-4**] 09:30PM BLOOD ALT-35 AST-29 CK(CPK)-160 AlkPhos-91
TotBili-0.7
[**2131-10-4**] 09:30PM BLOOD cTropnT-<0.01
[**2131-10-5**] 03:29AM BLOOD cTropnT-<0.01
[**2131-10-5**] 09:21AM BLOOD CK-MB-20* cTropnT-<0.01
[**2131-10-4**] 09:30PM BLOOD Lipase-23
[**2131-10-4**] 09:30PM BLOOD Albumin-4.9 Calcium-10.9* Phos-3.6 Mg-2.1
[**2131-10-6**] 12:24AM BLOOD calTIBC-261 VitB12-458 Folate-9.1
Ferritn-264 TRF-201
[**2131-10-6**] 12:24AM BLOOD TSH-1.1
[**2131-10-4**] 09:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2131-10-5**] 01:40AM BLOOD Type-ART pO2-188* pCO2-51* pH-7.30*
calTCO2-26 Base XS--1
[**2131-10-4**] 09:36PM BLOOD Glucose-116* Lactate-2.4* K-3.7
[**2131-10-5**] 04:06AM BLOOD freeCa-1.25
[**2131-10-4**] 09:47PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.031
[**2131-10-4**] 09:47PM URINE Blood-LG Nitrite-NEG Protein-500
Glucose-NEG Ketone-15 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2131-10-4**] 09:47PM URINE RBC-[**2-23**]* WBC-0-2 Bacteri-OCC Yeast-NONE
Epi-0-2
[**2131-10-4**] 09:47PM URINE CastHy-0-2
[**2131-10-5**] 03:36AM URINE AmorphX-MOD
[**2131-10-4**] 09:47PM URINE bnzodzp-POS barbitr-NEG opiates-NEG
cocaine-POS amphetm-NEG mthdone-NEG
.
MICRO:
URINE CULTURE (Final [**2131-10-7**]):    NO GROWTH.
Blood Culture, Routine (Final [**2131-10-11**]):    NO GROWTH.
RAPID PLASMA REAGIN TEST (Final [**2131-10-8**]): NONREACTIVE.
.
On discharge:

[**2131-10-12**] 04:45AM BLOOD WBC-8.4 RBC-4.81 Hgb-12.9* Hct-38.1*
MCV-79* MCH-26.7* MCHC-33.7 RDW-15.8* Plt Ct-327
[**2131-10-12**] 04:45AM BLOOD Glucose-95 UreaN-8 Creat-0.7 Na-139 K-4.2
Cl-103 HCO3-26 AnGap-14
[**10-4**] ECG: Artifact is present. Sinus tachycardia. Left atrial
abnormality. Right axis deviation. Diffuse ST segment changes
most consistent with early repolarization, although pericardial
disease cannot be excluded. No previous tracing available for
comparison.

Chest X-ray [**2131-10-5**]:
No previous images. Endotracheal tube tip lies approximately 2.5
cm above the carina. There is enlargement of the cardiac
silhouette with engorgement of pulmonary vessels consistent with
increased pulmonary venous pressure. Some opacification at the
left base with silhouetting of the hemidiaphragm is consistent
with atelectasis and effusion, though superimposed pneumonia
could be definitely excluded in the appropriate clinical
setting.
Respiratory motion somewhat degrades the image and a repeat
study could be helpful.

CT head w/o contrast [**2131-10-5**]:
FINDINGS: There is no evidence of intracranial hemorrhage,
edema, mass effect or acute territorial infarction. The
ventricles and sulci are normal in size and configuration. The
[**Doctor Last Name 352**]-white matter differentiation is well preserved.  There is
no evidence of fracture. There is mucosal thickening of the
ethmoid air cells. There are aerosolized secretions within the
nasal cavity. The mastoid air cells are clear and well aerated.
IMPRESSION: No acute intracranial process.

Right hand U/s [**2131-10-5**]:
Subcutaneous edema corresponding with the palpable right hand
abnormality.

Hand X-ray [**2131-10-8**]:
FINDINGS: Diffuse soft tissue swelling of the hand. No definite
radiopaque foreign bodies. Multiple punctate metallic densities
project over the radiographs, most likely artifact. No acute
fractures or dislocations. No periostitis, focal cortical
thickening, or cortical disruption. Mild ulnar negative
variance.

IMPRESSION: Diffuse soft tissue swelling.

TTE [**2131-10-8**]:
The left atrium is mildly dilated. Left ventricular wall
thickness, cavity size and regional/global systolic function are
normal (LVEF >55%). Tissue Doppler imaging suggests a normal
left ventricular filling pressure (PCWP<12mmHg). Right
ventricular chamber size and free wall motion are normal. The
diameters of aorta at the sinus, ascending and arch levels are
normal. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic regurgitation. The
mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse.

IMPRESSION: Normal study. No structural heart disease or
pathologic flow identified. If clinically indicated, a cardiac
MRI would be best able to identify the presence of an inflammed
pericardium.

Brief Hospital Course:
38 y/o M with hx of depression/anxiety, schizophrenia, PTSD,
bipolar disorder, and polysubstance abuse presents with altered
mental status, with medication history concerning for
anticholinergic toxicity and positive urine tox for cocaine.

# Intoxication/Altered mental status: Pt presented to ED in
altered mental status and agitated.  He was intubated due to
concern that he could not protect his airway; he was extubated
the following day without complications.  Detailed medication
history in addition to home medications revealed high likelihood
of anticholinergic toxicity. Tox screen also revealed cocaine
and benzodiazepine ingestion.  Serum tox was negative for ASA,
APAP, TCA, and etoh. Per OSH notes, patient also recently on
heroin, and had self-discontinued his home psych medications.
His altered mental status was believed to be likely
multifactorial with concurrent toxic and withdrawal effects.
Head CT was performed which was unremarkable.  Patient was seen
by toxicology who felt that pt's clinical picture could
represent a mixed anticholinergic and sympathomimetic toxidrome.
 Serial EKGs were taken which showed a wandering pacemaker but
was otherwise unremarkable with normal intervals.  He was
monitored on the CIWA scale for possible withdrawal from
alcohol/benzos and required only minimal doses of diazepam.
Patient was also seen by psychiatry who recommended holding all
psych medications until mental status cleared.  He was
eventually restarted on his thorazine when mental status
improved but this was discontinued when he developed episodes of
tachycardia with HR to the 130s.  Tachycardia resolved with the
discontinuation of thorazine.

# Bipolar d/o, PTSD, schizophrenia:  Psychiatry consult
recommended that all psych medications be held until they could
be re-prescribed by pt's outpatient psychiatrist.  During
hospital course, thorazine was restarted but discontinued soon
after because pt became tachycardic; pt remained asymptomatic
during these episodes of tachycardia. Tachycardia resolved with
discontinuation of thorazine, IV hydration, and small dose of IV
benzodiazepene x 1. Social work consult was obtained because pt
did not have a PCP nor did he have a psychiatrist.  He could not
see his former psychiatrist due to insurance reasons.  With the
help of social work, pt was set up with a PCP who would be able
to refer him to a new psychiatrist in a timely fashion.  He was
instructed to follow-up with his new psychiatrist to restart his
psychiatric medications.

# Chest pain: Pt complained of chest pain during hospital course
that appeared musculoskeletal as it was reproducible with
palpation and pt reported more pain with movement.  EKG showed
no ischemic changes and troponins were flat x 4.  CK was
elevated, peaking at 1405 but downtrended without any
intervention.  TTE was obtained due to history of cocaine use to
rule out cardiac events.  EF was >55%; TTE was unremarkable.  He
was monitored on telemetry without significant events.

# Hepatitis B/C: LFT's were within normal limits.  He should
follow-up with his outpatient PCP for further management of his
hepatitis B/C.

# Anemia: Pt had a microcytic anemia.  Iron studies revealed a
low iron but normal ferritin level.  He should follow up with
his PCP for [**Name9 (PRE) 8019**] of thalassemia as outpatient.

# Hand lesion: Pt had several firm subcutaneous lesions on right
dorsum of hand and several on both forearms which he attributed
to IV drug use.  Ultrasound of the right hand showed
subcutaneous edema; x-ray showed no foreign bodies.  Pt reported
no pain; lesions were not erythematous or warm to touch.  Hi
exam remained stable throughout several days of the
hospitalization. He was advised to follow up with his outpatient
PCP if symptoms changed.

Medications on Admission:
-trihexiphenidyl (anticholinergic) 5 mg [**Hospital1 **]
-celexa 40 mg QAM
-suboxone 8 mg QD
-alprazolam 1 mg TID
-ASA 81
-thorazine 50 mg TID (anticholinergic)
-valium 10 mg QHS
([**First Name8 (NamePattern2) **] [**Hospital **] Hospital d/c med list, patient also on
levofloxacin 750 mg PO daily, for five days, with no specified
stop date)

Discharge Medications:
1. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*30 Tablet, Chewable(s)* Refills:*0*
3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Anticholinergic toxicity
Benzodiazepine withdrawal
Cocaine intoxication
Opiate withdrawal

Secondary Diagnosis:
Depression/Anxiety
Schizophrenia
Bipolar disorder
GERD


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


Discharge Instructions:
It was a pleasure taking care of you at the hospital.  You were
admitted with confusion that was likely due to a combination of
the medications you were taking and the street drugs that you
may have also been used.  Your heart rhythm was monitored
because many of these drugs can affect your heart.  Your EKG and
blood tests showed that you likely did not have a heart attack.
An ultrasound of your heart was also normal.  Your confusion
cleared during your hospital stay.  You were seen by our
psychiatry team who recommended holding all of your medications
while you were in the hospital. It is very important that you
follow-up with a primary care doctor who can refer you to a
psychiatrist.  This psychiatrist can then prescribe to you the
medications you were normally taking.

We also obtained some imaging tests to further evaluate the
nodule on your right hand.  An ultrasound showed that there was
swelling and an x-ray confirmed that there was no foreign body
in your hand.  Please follow up with your primary care doctor if
your symptoms worsen.

The following changes were made to your medications:
1) All your psychiatric medications were stopped because of your
confusion. You should follow-up with your new psychiatrist to
discuss which medications to restart.
2) You were started on pantoprazole 40mg daily for GERD.
3) You were started on thiamine, folic acid, and a multivitamin.

Followup Instructions:
You will need to establish care with a new primary care doctor
in order to be referred to a psychiatrist.  We have arranged the
following appointment for you with a new primary care physician
in your area:

Tuesday [**10-16**], at 11:45
Dr. [**First Name8 (NamePattern2) 2894**] [**Last Name (NamePattern1) **]
[**Street Address(2) 87774**]
[**Location (un) 8973**], [**Numeric Identifier 87775**]
[**Telephone/Fax (1) 87776**]



Completed by:[**2131-10-18**]
{'Poisoning by parasympatholytics (anticholinergics and antimuscarinics) and spasmolytics,Acute respiratory failure,Drug withdrawal,Opioid type dependence, continuous,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted,Acute alcoholic intoxication in alcoholism, continuous,Cocaine abuse, unspecified,Dysthymic disorder,Unspecified schizophrenia, unspecified,Bipolar disorder, unspecified,Esophageal reflux,Antisocial personality disorder,Leukocytosis, unspecified,Old myocardial infarction,Physical restraints status'}


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: altered mental status

PRESENT ILLNESS: 38M with history of depression, anxiety, bipolar disorder,
PTSD, schizophrenia, heroin abuse, and hepatitis B and C, was
found wandering the halls of [**Hospital **] Hospital today, stating
that he was short of breath and his brother had dropped him off
there. He was refusing blood draws and IVs, and was reportedly
disoriented and having hallucinations, with dilated pupils. He
had a psychiatric evaluation there, in which he is reported as
not taking his psych meds, having lost his outpatient
psychiatrist, and not having a PCP. [**Name10 (NameIs) **] denied SI, but reported
auditory hallucinations. He was transferred to [**Hospital1 1680**] HRI for
inpatient mood stabilization and restarting his medications.

MEDICAL HISTORY: -Depression/anxiety
-bipolar
-PTSD
-schizophrenia
-heroin abuse
-Hepatitis B and C
-gastritis

MEDICATION ON ADMISSION: -trihexiphenidyl (anticholinergic) 5 mg [**Hospital1 **]
-celexa 40 mg QAM
-suboxone 8 mg QD
-alprazolam 1 mg TID
-ASA 81
-thorazine 50 mg TID (anticholinergic)
-valium 10 mg QHS
([**First Name8 (NamePattern2) **] [**Hospital **] Hospital d/c med list, patient also on
levofloxacin 750 mg PO daily, for five days, with no specified
stop date)

ALLERGIES: Penicillins

PHYSICAL EXAM: On admission:
Vitals: Afebrile BP:106/54 P:102 R:17 O2:99% on ventilator
A/C 600x18, 5 PEEP, 50% FiO2
General: Sedated, intubated. No acute distress
HEENT: Mydriasis with pupils non-reactive and symmetric, 5 mm
bilaterally. Sclera anicteric, MMM, oropharynx clear. Very poor
dentition.
Neck: supple, JVP not elevated, no LAD
Lungs: CTAB, no wheezes, rales, ronchi
CV: RRR, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: softly distended, bowel sounds present, no rebound
tenderness or guarding, no organomegaly
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. Firm 3 cm subcutaneous nodule over dorsum of right hand,
with overlying erythema.

FAMILY HISTORY: Unable to obtain

SOCIAL HISTORY: Tobacco:  1 ppd. Per outside facility reports, active heroin use
as possible as 1-2 days ago. +cocaine on tox screen. 

### Response:
{'Poisoning by parasympatholytics (anticholinergics and antimuscarinics) and spasmolytics,Acute respiratory failure,Drug withdrawal,Opioid type dependence, continuous,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted,Acute alcoholic intoxication in alcoholism, continuous,Cocaine abuse, unspecified,Dysthymic disorder,Unspecified schizophrenia, unspecified,Bipolar disorder, unspecified,Esophageal reflux,Antisocial personality disorder,Leukocytosis, unspecified,Old myocardial infarction,Physical restraints status'}
