Chief Complaint: Everly Mann is a 24-year-old African-American female presenting to the clinic with a report of “I see lots of spiders crawling on my body and hands and legs, but no one else can see them. I feel them on my arms and legs. I think they are attracted to the hamburgers.”
History of Present Illness:
Onset: Diagnosed 1 year ago after first psychotic break, voices returned recently as well as tactile and visual hallucinations—spiders on legs and feet. Presents with disheveled appearance, flat affect, tangential speech, reports auditory, visual, and tactile hallucinations daily, some audio hallucinations as well and states her thoughts are being told to others aloud.
Location: Is distracted and poorly performing at work, misses work and is frequently late and unable to concentrate at home with family or alone as well.
Duration: Symptoms are continuous. Auditory hallucinations returned about 6 weeks ago and have drastically increased. Tactile and visual hallucination returned about 5 weeks ago and have gradually increased.
Characteristics: Hears three voices talking to her, “a good voice and a mean voice and a third that is just blubber.” Reporting the “mean voice” making derogatory comments. Denies command voices.
Aggravating: When in public places, is very suspicious that others can hear her thoughts and possibly whispering about her. Has become agitated, chaotic, fearful, and yelled at strangers in public.
Relieving: Can be distracted for a while with music or a movie. Seroquel PO worked adequately for almost a year, then the patient felt she was well enough to stop medication.
Temporal: Worse in the a.m. after waking.
Severity: Outbursts at times when responding to voices or suspicious of others. Whispers constantly to answer voices.