Dr. Daniel Frost

Date of Exam: 2/2/2018   Time of Exam: 1:22 PM
Patient Name: Eric Swain  Patient Number: 68731-D

Eric came into the office exhibiting symptoms of IED (Intermittent Explosive Disorder). Symptoms decreased as he sat in the office alone. Symptoms are increasing daily and the current medication is doing very little anymore to combat the outbursts.
Eric describes himself as volatile.  Angry with occasional onsets of normal or calm behavior. Feeling irrationally irritable frequently, leading to physical altercations with staff and other guests at Grabill House.  Medication is seemingly ineffective and Eric is put on danger status.

Content of Therapy:
Eric described himself as bloodthirsty and used various expletives to describe what he felt. He also made physical threats against myself and the staff in my office.  Every subtle motion or word is understood by him as either an insult or a threat.

Therapeutic Interventions:
Eric was instructed to use self-talk in an attempt to rationalize. Eric also attempted some basic coping exercises in an attempt to calm himself down. The focus was on using coping and calming skills to try to decrease emotional stress without the use of sedatives. 

Mental Status:
Eric is violently irritable, distracted, badly groomed, and appears delusional. He exhibits speech that is loud and sharp in rate, volume, and inarticulate. Language skills are somewhat intact. Mood is angry and irrational. His affect is congruent with mood. There are several signs of delusions, bizarre behaviors, and other indicators of a psychotic process.
Associations are not intact, thinking is irrational, and thought content is not appropriate for an average person. Homicidal ideas or intentions are overt and outright.
Cognitive functioning is appropriate to age.
Short and long-term memory is intact.
Clinically, IQ appears to be just under the average range.
Insight into illness is fair.
Social judgment is hindered.
There are signs of high anxiety.
Eric shows a high propensity for violence.

 The following Diagnoses are based on currently available information and may change as additional information becomes available.
– Axis I: Intermittent Explosive Disorder, 312.34 (Active)
– Possible other comorbidities that are currently undiagnosed.

Instructions / Recommendations / Plan:

Link to Treatment Plan Problem: Anxiety
Short-Term Goals: Eric will have anxiety and outburst symptoms less than 50% of the time for one month.
Target Date: 4/25/2018

No progress in reaching these goals or resolving problems was apparent today.
Recommend continuing the current intervention and short-term goals. It is felt that more time is needed for the intervention to work. 
Recommend a change in medication to another block of treatments.
Return 1-2 weeks or earlier if needed.

Time spent counseling and coordinating care: 45-50 min
Session start: 1:22 PM
Session end: 2:12 PM
Daniel Frost, PsyD
Electronically Signed
By: Sara Witt, RN
On: 2/02/2018 2:12 PM

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