Felicia Allen was a 32-year-old woman brought to the emergency room (ER) by police after she apparently tried to steal a bus. Because she appeared to be an "emotionally disturbed person," a psychiatry consultation was requested.

According to the police report, Ms. Allen threatened the driver with a knife, took control of the almost empty city bus, and crashed it. A more complete story was elicited from a friend of Ms. Allen's who had been on the bus but who had not been arrested. According to her, they had boarded the bus on their way to a nearby shopping mall. Ms. Allen became frustrated when the driver refused her dollar bills. She looked in her purse, but instead of finding exact change, she pulled out a kitchen knife that she carried for protection. The driver fled, so she got into the empty seat and drove the bus across the street into a nearby parked car.

On examination, Ms. Allen was handcuffed, heavyset young woman with a bandage on her forehead. She fidgeted and rocked back and forth in her chair. She appeared to be mumbling to herself. When asked what she was saying, the patient made momentary eye contact and just repeated, "Sorry, sorry." She did not respond to other questions.

More information was elicited from a psychiatrist who had come to the ER soon after the accident. He said that Ms. Allen and her friend were longtime residents at the state psychiatric hospital where he worked. They had just begun to take passes every week as part of an effort toward social remediation; it had been Ms. Allen's first bus ride without a staff member.

According to the psychiatrist, Ms. Allen had received a diagnosis of "childhood-onset treatment-resistant paranoid schizophrenia."She had started hearing voices by age 5.Big, strong, intrusive, and psychotic, she had been hospitalized almost constantly since age 11. Her auditory hallucinations generally consisted of a critical voice commenting on her behavior. Her thinking was concrete, but when relaxed she could be self-reflective.She was motivated to please and recurrently said her biggest goal was to "have my own room in my own house with my own friends." The psychiatrist said that he was not sure what had caused her to pull out the knife. She had not been hallucinating lately and had been feeling less paranoid, but he wondered if she had been more psychotic than she had let on. It was possible that she was just impatient and irritated. The psychiatrist also believed that she had spent almost no period of life developing normally and so had very little experience with the real world.

Ms. Allen had been taking clozapine for 1 year, with good resolution of her auditory hallucinations. She had gained 35 pounds during that time, but she had less trouble getting out of bed in the morning, was hoping that she could eventually get a job and live more independently, and had insisted on continuing to take the clozapine. The bus trip to the shopping mall was intended to be a step in that direction.

AN ASSESMENT REPORT ON CLIENT FELICIA ALLEN THAT INCLUDE

1. DEMOGRAPHIC

2.MENTAL STATUS

3.DIAGNOSIS - SCHIZOPHRENIA 295.90 (F20.9) Brief Psychotic disorder 298.8 (F23)

4.CONCLUSION