CONFIDENTIAL
11th August 1992
Dr E.S. Barnett, The Director,
P.O.Box 221, Psychiatric Unit,
TE PUKE Tauranga Hospital,
Private Bag,
Tauranga.
Dear Dr Barnett,
re: Malcolm James Lorenzo BAKER,
DOB: 28.07.55,
42 Spencer Ave, MAKETU.
DATE OF ADMISSION: 06.07.92 (Sec 21 revocation of leave)
DATE OF DISCHARGE: 14.07.92 (6/12 predischarge leave)
? Chronic Schizophrenia
? Substance Abuse
? Borderline Personality Disorder
MEDICATION: Stelazine 5mg b.d. 10 mg nocte
FOLLOWUP: Referred back to G.P.
Reason for Mode of Referral:
Only a couple of days after discharge from the Tauranga Psychiatric Unit Malcolm has, reportedly, been causing a nuisance in town, trespassing at night. He appeared agitated and his house was left in a mess. Malcolm was a patient on 12/12 leave and his leave was canceled and he was transferred to Tokonui Hospital.
Assessment on Admission:
On admission Malcolm could not (didn't want to) give relevant information regarding the reasons for his admission. He said he was discharged from the Tauranga Psychiatric Unit about 10 days before after being found trespassing while working for his "security firm". Just prior to his present admission he returned to a garage to pay 60c he owed them and then the police arrived and accused him of trespassing. He said there was no other reason for his admission.
This initially rather nervous and 'freaky' man settled down during the interview with reasonable eye contact but basically poor rapport. Spontaneous speech but at times slightly elevated and tangential. Euthymic in mood and affect reactive. There was no indication for impairment of cognitive functioning. IQ ?above average.
Insight and judgment were poor. On physical examination he appeared a thin healthy man and was essentially nil of note. On routine additional investigations I mention those results which were abnormal. General biochemistry: Creatinine 0.078; Billirubin 30. Haematology: RBC 4.45 with Hb 138; total WBC 11.2 with neutrophils 7.84 and eosinophils 0.78. Routine urinalysis was positive for protein and there was a trace of ketones and blood.
Course in the Ward:
Malcolm stayed in a locked ward, I.P.C. for five days and was then transferred to Ward 9, an open ward. He was initially put on the medication as above mentioned. He was generally co-operative and reasonably settled. There was little structured conversation. He soon disputed his admission and wanted to sign himself out. Not able to pick up the clue of his formal status. One day talking about his being contaminated by eating shellfish from the Hiroshima area and another day talking about heart attacks, in a rather loose fashion. When he came under my care five days after his admission he told me that he was offered two options after his "trespassing": 1. go to jail; 2. go to Tokonui. His insight regarding his behaviour in the community is, roughly estimated, somewhere between nil and nought.
He told me that he went to the U.K. where he worked as a journalist. I think this is only 50% correct - that is, he went to the U.K. He denied any followup other than through his G.P, yourself. He made it quite clear that he wanted to go back to Tauranga and I could only but appreciate that his condition was not such that impatient care in Tokonui was required. He was, he stated, prepared to take the medication as prescribed and not change the same without consultation with you. On that basis he was discharged and I also advised that if you thought he should see a psychiatrist in Tauranga, he should do so and he should realize if he is not compliant he will end up in Tokonui Hospital again. He picked this up, I wonder whether it will sink in.
I met his aunt who expressed her concern re Malcolm, and more specifically his behaviour. She thinks he is a schizophrenic and I told her that I could not confirm or exclude this. She was far from happy with his discharge initially, but appreciated our view that there was little we could offer him here in Tokonui, that there were no reasons for maintaining him here, and that in such a situation we refer patients back to the area they came from.
From the file I learned that he was under Section 21, 12/12 leave and this had been reviewed in January of this year. Following this his leave was extended for another year. On that status he was discharged.
Yours sincerely,
DR J.D. VAN DER SLUIS,
CONSULTANT PSYCHIATRIST.
11th August 1992
Dr E.S. Barnett, The Director,
P.O.Box 221, Psychiatric Unit,
TE PUKE Tauranga Hospital,
Private Bag,
Tauranga.
Dear Dr Barnett,
re: Malcolm James Lorenzo BAKER,
DOB: 28.07.55,
42 Spencer Ave, MAKETU.
DATE OF ADMISSION: 06.07.92 (Sec 21 revocation of leave)
DATE OF DISCHARGE: 14.07.92 (6/12 predischarge leave)
? Chronic Schizophrenia
? Substance Abuse
? Borderline Personality Disorder
MEDICATION: Stelazine 5mg b.d. 10 mg nocte
FOLLOWUP: Referred back to G.P.
Reason for Mode of Referral:
Only a couple of days after discharge from the Tauranga Psychiatric Unit Malcolm has, reportedly, been causing a nuisance in town, trespassing at night. He appeared agitated and his house was left in a mess. Malcolm was a patient on 12/12 leave and his leave was canceled and he was transferred to Tokonui Hospital.
Assessment on Admission:
On admission Malcolm could not (didn't want to) give relevant information regarding the reasons for his admission. He said he was discharged from the Tauranga Psychiatric Unit about 10 days before after being found trespassing while working for his "security firm". Just prior to his present admission he returned to a garage to pay 60c he owed them and then the police arrived and accused him of trespassing. He said there was no other reason for his admission.
This initially rather nervous and 'freaky' man settled down during the interview with reasonable eye contact but basically poor rapport. Spontaneous speech but at times slightly elevated and tangential. Euthymic in mood and affect reactive. There was no indication for impairment of cognitive functioning. IQ ?above average.
Insight and judgment were poor. On physical examination he appeared a thin healthy man and was essentially nil of note. On routine additional investigations I mention those results which were abnormal. General biochemistry: Creatinine 0.078; Billirubin 30. Haematology: RBC 4.45 with Hb 138; total WBC 11.2 with neutrophils 7.84 and eosinophils 0.78. Routine urinalysis was positive for protein and there was a trace of ketones and blood.
Course in the Ward:
Malcolm stayed in a locked ward, I.P.C. for five days and was then transferred to Ward 9, an open ward. He was initially put on the medication as above mentioned. He was generally co-operative and reasonably settled. There was little structured conversation. He soon disputed his admission and wanted to sign himself out. Not able to pick up the clue of his formal status. One day talking about his being contaminated by eating shellfish from the Hiroshima area and another day talking about heart attacks, in a rather loose fashion. When he came under my care five days after his admission he told me that he was offered two options after his "trespassing": 1. go to jail; 2. go to Tokonui. His insight regarding his behaviour in the community is, roughly estimated, somewhere between nil and nought.
He told me that he went to the U.K. where he worked as a journalist. I think this is only 50% correct - that is, he went to the U.K. He denied any followup other than through his G.P, yourself. He made it quite clear that he wanted to go back to Tauranga and I could only but appreciate that his condition was not such that impatient care in Tokonui was required. He was, he stated, prepared to take the medication as prescribed and not change the same without consultation with you. On that basis he was discharged and I also advised that if you thought he should see a psychiatrist in Tauranga, he should do so and he should realize if he is not compliant he will end up in Tokonui Hospital again. He picked this up, I wonder whether it will sink in.
I met his aunt who expressed her concern re Malcolm, and more specifically his behaviour. She thinks he is a schizophrenic and I told her that I could not confirm or exclude this. She was far from happy with his discharge initially, but appreciated our view that there was little we could offer him here in Tokonui, that there were no reasons for maintaining him here, and that in such a situation we refer patients back to the area they came from.
From the file I learned that he was under Section 21, 12/12 leave and this had been reviewed in January of this year. Following this his leave was extended for another year. On that status he was discharged.
Yours sincerely,
DR J.D. VAN DER SLUIS,
CONSULTANT PSYCHIATRIST.