Thu, 11 Jul 2002 12:21:16
PRESBYTERIAN HEALTH NETWORK
CLIENT ASSESSMENT REPORT #46892
of Mental Health
FOR PATIENT #46892
NAME: Berto Tazar
ADDRESS: 4097 N. Lakeshore Drive, Suite 7082
Anxiety, Behavior Problems (see notes), Compulsions, Delusions, Depressed Mood,
Grief, Low Self-Esteem, Memory Problems, Paranoia, Poor Judgement, Ruminations,
Sleep Problems, Other (Extreme paranoia leads patient to refusal to communicate
directly with therapists, will communicate only "through" patient
Pedro Vasquez, whom he calls "Sancho.")
OF PRESENT ILLNESS
stress factors including loss of employment & unrequited love preceded
patient's descent into a delusional state. Patient, a copywriter by trade,
began writing fantastical email messages to friends and casual acquaintances
describing a journey in the past, to 14th Century medieval Italy. What may have
started as a healthy distraction from stress factors soon became
obsessive behavior. As they become more and more violent, his medieval
fantasies also became the sole focus of his existence. Patient remained indoors
for several weeks, drawing and writing these email messages, became
increasingly withdrawn from his social contacts, and ceased his search for new
employment. His delusions culminated in a violent attack on one of his friends,
Skip Valent, who later admitted the patient. At the time of his admittance,
patient was exhibiting signs of autism, slack jaw, glazed eyes, and a total lack of
communication with admitting staff. He soon thereafter however exhibited a
violent mood swing, challenging staff to a "joust" after grabbing hold of an
orderly's broom. After this episode, patient was put in restraints, and resumed
his feigned catatonia. Patient was released from restraints 72 hours later.
Patient refuses to communicate with staff, but is reading email
messages sent to him by friends and loved ones. Patient does speak (conspiratorially)
with fellow patient Pedro Vasquez, who will be transferred early next week to a
OF PAST PSYCHIATRIC TREATMENT
drug or past alcohol use: Patient's brother, Ernesto Tazar, reports that Patient is a light drinker
and occasional marijuana smoker.
of suicidal ideation or attempt:
no (though patient exhibits signs of self-neglect).
suicide risk: Not at
of homicidal ideation or attempt:
yes (Patient attacked his best friend with a bicycle lock).
homicide risk: No? Patient has been generally
complacent in the treatment environment, but his delusions vary in intensity.
of other violence (arson, fire, etc.?): none while medicated.
Living Arrangement: Private
home/apartment, sole occupant.
environment adequate and safe:
yes (though patient has been served eviction notice, so new living arrangements
may be necessary).
events in childhood/adolescence/adulthood: Patient was physically and verbally abused as a child by
father. Said abuse was not of a sexual nature. Patient's father was
institutionalized during patient's teenage years. Patient's mother deceased in
(alcoholism, drugs), Brother (alcoholism)
(diagnosed schizophrenic), Brother (clinically depressed)
Illness: Mother died of
breast cancer, both grandmothers died of cancer (breast, ovarian), grandfathers
both died of heart disease.
Relationship with Parents:
Mother dead, father institutionalized (Woodlawn Mental Health Center, Palo
Alto, CA). No discernable present relationship with father.
Relationship with Siblings:
Strong relationship with brother, Ernesto (residing near Los Angeles, CA).
Distant relationship with sister, Olivia (residing near Chattanooga, TN). Both
siblings have attempted contact via email. Brother Ernesto has consulted with
attending physicians. Brother Ernesto plans to visit at start of August, may
help with living arrangements.
Patient had strong relationship with deceased mother. Patient in monthly phone
contact with brother, annual contact with sister. Patient alienated from
father. Patient never married, but did have string of significant monogamous
Members to Involve in Treatment:
Brother -- Ernesto Tazar
close friends: 3-4
casual friends: 10-12
From Friends: Moderate
(admitted with assistance of friend Skip Valent, three other friends have
Social Supports: no
(fallout with best friend preceded hospitalization), Social Isolation (in two
months preceding hospitalization, Patient had dropped off contact with most of
Deaths/Losses: Death of mother had significant effect,
and patient has suffered from recurring incidents of unrequited love.
History: yes (childhood
verbal/emotional abuse, physical abuse, adulthood verbal/emotional abuse in
highest grade: BA in
English, Italian minor, UCLA
Achievement Problems: no
History: Journalist, LA
Times (2 years), Barker, Barnum and Bailey Circus (2 Years), copywriter, OGVB
Marketing (11 years), currently unemployed
of Legal Problems: no
Beliefs: Buddhist (light
and Understands English:
and Recreational Activities:
tai chi, creative writing (fiction), videogames, drawing
Dysfunction: unable to
Dressed and Groomed: yes
(poor grooming upon admittance, acceptable since admittance).
X 3: Person-yes.
Activity: soft (when
speaking to fellow patient, does not speak to physicians)
Hallucinations: unable to determine
Describe: Patient believes that he is imprisoned
in 14th Century Italy, and that medical staff are his captors.
Clinician: D. BARTHELME, MD