UNIVERSITY HOSPITAL
A Member of Boston University Medical Center
DISCHARGE SUMMARY
Name: RIVA, James Case no. 585232
Date
ADMISSION: 7/31/78 Ward b3 Service psychiatry
DISCHARGE: 8/3/78 CC: DR. R. Greenberg
Dr. R. Cooper
HISTORY OF PRESENT ILLNESS: The patient is a 21-year-old white male with
a six-year history of psychosis who was
admitted with a chief complaint of "my brain has been altered by human
hands, and I am here to get it fixed." The patient was admitted to McLean
Hospital at age 15 for psychotic behavior: details of this are unspecified
at this time. He was followed as an outpatient there for a while but
under no psychiatric care for the last three years. The patient has
been increasingly withdrawn and neglectful of personal hygiene in the past
year. He had been living with his mother and brother, age 19, (his parents
are divorced) until last year until his mother arranged to have the patient
move to a rooming house. The patient ran away to Florida for six
weeks this past winter to "get away" but eventually called for money and
returned. Since then, the patient has been engaging in increasingly bizarre
behavior such as dissecting a cat, wandering the streets at night,
writing on a wall with animal blood. the patient has been concerned
about his memory and the function of his mind in general.

PAST MEDICAL HISTORY: The patient's parents separated on ad off
since the patient was age 13. The divorce
was completed two years ago. His brother, age 19, lives with and is in
business with the patient's mother. The patient is described by mother
as having been a "sensitive child, a loner." The patient is too
disorganized at this time to give a reliable past history. The patient
left high school just before graduating.

MENTAL STATUS EXAMINATION: The patient was dressed in jeans and polo
shirt with long, uncombed hair. He was
constantly looking around the room in an suspicious manner. Speech was
fluent and coherent. He was reluctant to discuss problems with me but
was gradually able to do so. He has delusions about being 700 ears old
and of being persecuted by a person named------ for hundreds of years
and telepathic control. He claims to be able to thought broadcast at
times. He also has had visual hallucinations. Mood is suspicious
and discouraged. The affect is flat with several episodes of inappropriate
laughter. Memory: immediate 5 digits forward and 4 backward with one
error: recent memory was intact; remote memory was intact. Serial 7's
no error; Proverbs: glass house, "you shouldn't throw rocks or people
will break your glass." Rolling stone: "if you keep moving, you won't
get anything." Apple and orange: "Both sour and acid fruits." Insight
is poor. Judgment poor to fair. He feels that he won't hurt himself
but that is because persecutors, "just put me back together."

PHYSICAL EXAMINATION: Unremarkable.

LABORATORY DATA: Routine lab studies had not returned to the
chart at the time of this dictation.

HOSPITAL COURSE: During his short hospital stay, the patient
was noted to be extremely fearful with
intense feelings of persecution. He refused to take medications on a
regular basis. He also expressed a desire to "take blood" from someone
to replenish himself. He was unable to agree to take medications or to
contract not to do violence. Therefore, he was transferred to section 1
to Taunton State Hospital on 8/3/78. Because he was transferred, he was
discharged on no particular medications. He had received Haldol
10 mg twice while here on Robinson 3.

DISCHARGE DIAGNOSIS: 1. Paranoid schizophrenia.

PROCEDURES: None.

Richard Cooper, M.D.
[signature]

RC/ts shm
Tr. 8/8/78