PSYCHOLOGICAL EVALUATION
ROBERT F. FIERSTEIN, Ph.D
Patient Name: LYNNE KORBINI
#12688571
Date: JANUARY 19, 2016
Referral: ROBERT SLAYTON, MD
PSYCHIATRIST
Accompanied by: SELF ONLY
CHIEF COMPLAINT: PATIENT WAS HAVING SEVERE MOOD SWINGS. SHE WAS HAVING BOUTS OF CRYING SPELLS AND THEN AN HOUR LATER WOULD BE SPENDING MONEY SHE DID NOT HAVE AND GAMBLING AT THE CASINO AND EUPHORIC IN HER MOOD.
Sleep: PATIENT REPORTED THAT SHE HARDLY SLEPT AT NIGHT. SHE DESCRIBED AN ERRATIC SLEEP PATTERN. SHE WOULD SLEEP DURING THE DAY; "CAT NAPS". OVERALL, SHE DID NOT FEEL THAT SHE GOT ENOUGH SLEEP AND IT AFFECTED HER EMOTIONS.
Interests: PATIENT REPORTED HAVING MANY INTERESTS SUCH AS KNITTING, CREATIVE WORK PROJECTS, PHOTOGRAPHY, INTERIOR DESIGN, MAKING HOMEMADE GIFTS. THE PROBLEM SHE REPORTED WAS THAT SHE COULD NOT FINISH A PROJECT SHE STARTED. SHE STATED THAT SHE WAS TOO HYPER TO SIT DOWN AND COMPLETE ANYTHING. SHE WAS EASILY DISTRACTED OR WORKED MAINLY IN BURSTS OF ENERGY AND THEN WOULD COLLAPSE INO EXHAUSTION.
Guilt: PATIENT STATED THAT SHE DID NOT FEEL GUILTY ABOUT ANYTHING SHE DID WHEN SHE WAS FEELING "HIGH" (MANIC). SHE INSTEAD FELT AN EXAGGERATED SENSE OF IMPORTANCE AND THOUGHT THAT EVERYONE LIKED HER AND LIKED EVERYTHING SHE DID. WHEN SHE WAS MORE DEPRESSED, SHE FELT HORRIBLE ABOUT THE THINGS SHE SAID TO FAMILY AND FRIENDS AND WAS ASHAMED OF HER BEHAVIOR.
Energy: THE PATIENT COMPLAINED ABOUT HAVING MOOD SWINGS WITH REGARD TO HER ENERGY. SHE HAD NO CONSISTENCY IN HER LIFE. SHE WAS EITHER FEELING HIGHLY ENERGIZED OR DEEPLY DEFLATED. SHE FELT NO MIDDLE GROUND. SHE LIKED WHEN SHE HAD A LOT OF ENERGY BECAUSE SHE GOT HER RESPONSIBILITIES DONE, BUT WHEN SHE WAS DEPRESSED SHE BECAME A COUCH POTATO.
Concentrating: PATIENT REPORTED FEELING MORE FOCUSED WHEN SHE WAS FULL OF ENERGY THAN WHEN SHE WAS DEPRESSED. BUT WHEN SHE WAS ENERGIZED, SHE COULD NOT FOCUS ON ONE THING TOO LONG. SHE WOULD JUMP FROM ONE THING TO ANOTHER.
Appetite: HER APPETITE WAS INCONSISTENT. PATIENT STATED THAT MANY TIMES SHE DIDN'T EVEN THINK ABOUT FOOD AND HAD A LOW APPETITE FOR FOOD. WHEN SHE WAS DEPREESED SHE USUALLY ATE MORE, BECAUSE SHE WAS A BLOB ON THE COUCH.
Suicidal Ideation: PATIENT STATED THAT SHE NEVER FELT SUICIDAL. SHE IS CATHOLIC AND IT WOULD BE AGAINST HER RELIGION TO KILL HERSELF. SHE SAID WHEN SHE WAS DEPRESSED AND FEELING VERY REGRETFUL FOR SOME OF HER BEHAVIOR SHE WISHED SHE WAS GONE, BUT NEVER PUT TOGETHER A PLAN.
Homicidal Ideation: PATIENT SAYS SHE IS NON-VIOLENT AND HAS NEVER HURT ANYONE AND NEVER WOULD EVEN IF SHE WAS HIGH.
Mood (range 0-10): PATIENT SAID HER RANGE OF EMOTIONS IS FROM 2-10. SOMETIMES SHE CAN BE REALLY LOW AND SOMETIMES REALLY HIGH.
BEHAVIORS
Patient history of...
Lying
Stealing
Physical Aggression
Fire Setting
Truancy
Forced Sexual
Cruelty - Animals
Running away
Oppositional/Defiant
Drugs
Details of behaviors selected: PATIENT STATED THAT GROWING UP SHE WAS A "GOOD CATHOLIC GIRL" AND NEVER DID BAD THINGS. SHE SAID SHE WAS SHY AS A CHILD AND REALLY LIVED IN HER OWN WORLD.
Stressors: PATIENT'S PRESENT STRESSORS ARE HER HEALT, FINANCES, HER AGING PARENTS AND THEIR HEALTH ISSUES, HER HUSBAND GET MORE BLIND,
HISTORY OF CHIEF COMPLAINT: PATIENT STATED THAT SHE NEVER REMEMBER FEELING SO MUCH ENERGY THAT SHE COULD HARDLY DO ANYTHING. IT WASN'T UNTIL RECENT YEARS THAT SHE DISCOVERED THAT SHE WAS SPENDING A LOT MORE THAN SHE HAD AND SHE WAS GAMBLING MORE, TOO. THEN SHE FELT SHE HAD DEVELOPED A SLEEP DISORDER BECAUSE SHE WOULD ONLY GET 2-4 HOURS OF SLEEP A NIGHT.
MEDICAL HISTORY
Allergies: PATIENT REPORTS HAVING ALLERGIES FROM POLLEN AND CERTAIN FOODS.
Medical History: PATIENT REPORTS BEING MOSTLY HEALTHY MOST OF HER LIFE. SHE HAD A PROBLEM WITH WEIGHT GAIN
Medications: PATIENT IS SEEING A PSYCHIATRIST WHO MANAGES HER MEDICATION. SHE PROZAC UP TO 60MG AND 1MG OF KLONOPIN, SHE ALSO TAKES TOPAMAX FOR MIGRAINES, AND OTHER MEDS.
Surgical History: NONE REPORTED OTHER THAN A PORT INSERTED FOR USE WITH IV MEDS USED DURING ECT.
Head Trauma/Loss of Consciousness: PATIENT REPORTED BEING IN A SIGNIFICANT ACCIDENT LAST YEAR AND HAD A CONCUSSION ON TOP OF MORE FREQUENT MIGRAINES.
FAMILY HISTORY
Father: PATIENT'S FATHER IS NAMED JOHN AND HE'S 88 YEARS OLD AND IN POOR HEALTH WITH CROHNS DISEASE AND OTHER AILMENTS. PATIENT IS VERY CLOSE TO HIM AND NOT SURE WHAT SHE WILL DO IF HE IS NOT LONGER IN HER LIFE.
Mother: HER MOTHER'S NAME IS JOAN AND SHE IS 83 YEARS OLD AND HER HEALTH IS RELATIVELY GOOD, BUT ALSO HAS A WEIGHT PROBLEM AND IT AFFECTS HER ABILITY TO AMBULATE. SHE HAS HAD KNEE SURGERY AND NEEDS A WALKER TO GET AROUND.
Paternal Grandfather/Grandmother: NO INFORMATIN OFFERED.
Maternal Grandfather/Grandmother: NO INFORMATION OFFERED.
Maternal Aunts/Uncles: WITHIN THE PAST COUPLE OF YEARS MOST OF THE PATIENT'S AUNTS AND UNCLES HAVE PASSED A WAY. PATIENT HAS HAD MANY SIGNIFICANT LOSSES IN THE LAST FEW YEARS.
Paternal Aunts/Uncles: SEE ABOVE.
SOCIAL HISTORY
Social Summary: PATIENT DESCRIBES HERSELF AS A VERY SOCIAL PERSON WHEN SHE IS HIGH. IN GENERAL THE PATIENT HAS FEW FRIENDS, BUT DOESN'T SOCIALIZE VERY MUCH WITH MANY. SHE WILL ONLY SOCIALIZE IF HER HUSBAND WANTS HER TO AT A BUSINESS MEETING. PATIENT SAYS SHE'S MORE OF AN INTROVERTED TYPE.
Problems with any of the following: PATIENTS BIGGEST AREAS OF CONCERN ARE FINDING MEANINGFUL WORK THOUGH SHE IS UNABLE TO WORK FULL TIME. AND SHE SHOULD RE-ESTABLISH HER SOCIAL NETWORKS AND SEE HER FRIENDS ON A REGULAR BASIS. PATIENT REPORTS NO ISSUES WITH DRUGS AND ALCOHOL USE AND ABUSE.
Pregnancy/Labor/Delivery
Developmental Delays
School
Work
Friends
Smoking
ETOH
Drugs
Physical/Sexual Abuse
Gangs
Legal
Details of problems selected: SEE ABOVE. WHEN PATIENT IS DOWN AND DEPRESSED AND LACKING ENERGY SHE FEELS SHE CANNOT SOCIALIZE WITH FRIENDS AND FAMILY.
Worries: PATIENT WORRIES ABOUT THE HEALTH OF HER PARENTS, HUSBAND AND SELF. SHE ALSO WORRIES A LOT ABOUT FINANCES AS SHE HAS LOST A LOT.
Sexual Oreintation: PATIENT SAYS SHE IS HETEROSEXUAL. SHE SPEAKS TO MEN, BUT HAS NO RELATIONSHIP AT THIS TIME.
Heterosexual
Homosexual
Bisexual
Undecided
Sexually Active: NOT AT THIS TIME.
WISHES: PATIENT HAS EXPRESS A WISH TO HAVE HER PARENTS LIVE FOREVER. SHE SEEMS TO HAVE DIFFICULTY DEALING WITH LOSS AND WANTS TO PREVENT IT FROM HAPPENING FOR AS LONG AS SHE CAN.
Long Term Goal: PATIENT'S GOALS ARE TO HAVE MORE CONSISTENCY IN HER MOOD. SHE WANTS TO FIND A PART TIME JOB AND STAY WITH IT. SHE WANTS TO CREATED SOME PRODUCTS AND SELL THEM TO FRIENDS AND FAMILY. SHE WOULD ALSO WOULD LIKE TO TEACH CLASSES AT THE LIBRARY AND DO SOME INTERIOR DESIGN WORK.
Mental Status Examination
Affect: STABLE, FLAT, ELATED, INCONSISTENT
Judgement: PATIENT'S JUDGMENT IS NOT ALWAYS THOUGHT OUT. HER SPONTANEOUS DECISIONS ARE DIFFICULT TO MAKE SENSE OUT OF. PATIENT QUESTIONS HER SELF SOMETIMES AND NOT SURE SHE CAN EXPLAIN WHY SHE DOES SOME OF THE THINGS SHE DOES.
Insight: PATIENT ADMITS THAT SHE DOES NOT HAVE A LOT OF INSIGHT INTO WHY SHE THINKS THE WAY SHE DOES AND WHY SHE DOES SOME OF THE THINGS SHE DOES.
Intelligence: PATIENT APPEARS TO HAVE AVERAGE INTELLIGENCE THOUGH ITS POSSIBLE THAT ECT HAS IMPAIRED HER ABILITY TO TAP HER IQ FUNCTION.
Abstraction: PATIENT POSSESSES A MORE CONCRETE INTELLECT, THOUGH HAS SOME ABILITY TO DO ABSTRACT THINKING. SHE SAID THAT SHE IS CONFUSED BY ABSTRACTIONS UNLESS SHE'S HAVING A SURGE OF ENERGY AND EUPHORIA.
DIAGNOSIS: BIPOLAR II, GENERALIZED ANXIETY DISORDER.
PROGNOSIS: IF PATIENT IS COMPLIANT WITH TREATMENT PLAN, HER CONDITION CAN STABILIZE. PART OF THE PROBLEM WITH MOOD SWINGS IS THAT EMOTIONAL STABILITY IS DIFFICULT TO ESTABLISH MORE CONSISTENTLY ON A LONG TERM BASIS.
RECOMMENDATIONS: PATIENT SHOULD JOIN AN ONLINE AND IN PERSON SUPPORT GROUP TO LEARN COPING STRATEGIES FOR DEALING WITH HER ILLNESS. PATIENT SHOULD READ DR. ELLEN FRANKS BOOK FOR BIPOLARS AND LEARN HOW TO ESTABLISH A CONSISTENT DAILY PLAN OF LIFE. PATIENT SHOULD ATTEND HER THERAPY SESSIONS ON A REGULATED AND CONSISTENT BASIS. PATIENT MUST COMPLY WITH HER MEDICATION REGIMEN.
Name ROBERT FIERSTEIN , Ph.D
First Name
Last Name
Email: DRBOBFIERSTEIN@AOL.COM
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drbobfierstein@aol.com
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SYMPTOMS
PEERS: THE PATIENT HAS FRIENDS, BUT SHE SAYS HER ERATIC MOODS HELP PREVENT HER FROM BEING CLOSE. SHE DOESN'T TRUST HERSELF TO STAY IN A RELATIONSHIP WITH ANY DEGREE OF CONSISTENCY.
Interests: PATIENT HAS MANY INTERESTS. SEE ABOVE.
Speech: PATIENT'S SPEECH IS SLOW, ORGANIZED, MUCH UNNECESSARY DETAIL, RUN ON.
Thought: THERE IS NO EVIDENCE OF PSYCHOTIC THINKING. HER THOUGHTS ARE ORGANIZED, LOGICAL, FLIGHT OF IDEAS, MAKING UNUSAL CONNECTIONS, INCONSISTENCY AT TIMES,
Memory; DUE TO OVER 100 ECT TREATMENTS, PATIENT STATED THAT HER LONG TERM MEMORY IS GONE. HER SHORT AND INTERMEDIATE MEMORY IS INTACT TO A LARGE EXTENT.
Mood: DEPRESSED, ANXIOUS, EXCITABLE, EUPHORIC, ERATIC.
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