1. 6th May 2010Dr Charles Heaney Presentation on SH 1 Case Presentation of D.M. Dr. Charles Heaney, 09/09/2010

2. 6th May 2010Dr Charles Heaney Presentation on SH 2 D.M.

3. 6th May 2010Dr Charles Heaney Presentation on SH 3 Summary 37 year old gentleman Single Self employed

4. 6th May 2010Dr Charles Heaney Presentation on SH 4 Reason for Admission Grandiose Ideas Disinhibited behaviour

5. 6th May 2010Dr Charles Heaney Presentation on SH 5 Circumstances Leading to Admission Was knocking on neighbours doors and claiming to be “GOD” and had special powers in early hours of 14/07/2010. Said that he was born with two hearts and that he died at age 2 or 3.

6. 6th May 2010Dr Charles Heaney Presentation on SH 6 Background to Presentation First Presentation to Psychiatric Services. According to GP, never had any psychiatric issues. No other collateral history as mother has died and does not keep in touch with Father or Brother. Difficult to take history from as claims not to remember his past.

7. 6th May 2010Dr Charles Heaney Presentation on SH 7 Background to Presentation Reviewed in Mental Health Assessment and was found to have no insight to his grand delusions. Observed to be naked in Section 136 suite and to have taken a shower while awaiting assessment. Said that he died at age 2 or 3 but because of two hearts came back to life and has a heart with special powers.

8. 6th May 2010Dr Charles Heaney Presentation on SH 8 Background to Presentation (continued) - Says that he can talk to fish and other animals. -Says that he can change the weather. -Also, says that he can heal people. -Claims that he cured someone with a brain tumour. -On direct questioning, says that persons name is, ‘Dug’, but is unable to give any other information. -Was put under Section 2 of the Mental Health Act

9. 6th May 2010Dr Charles Heaney Presentation on SH 9 Past Psychiatric History None noted by G.P.

10. 6th May 2010Dr Charles Heaney Presentation on SH 10 Past Medical History None noted by G.P.

11. 6th May 2010Dr Charles Heaney Presentation on SH 11 Current Medication NIL

12. 6th May 2010Dr Charles Heaney Presentation on SH 12 Family History Unable to ascertain. Has a brother that he does not communicate with who is also under psychiatric services. Father was alcoholic, mother committed suicide.

13. 6th May 2010Dr Charles Heaney Presentation on SH 13 Personal History Born and brought up in Harlow. Normal vaginal birth and normal developmental milestones. Did G.C.S.E.’s Did BTEC in Engineering. Has worked as paper rounds,

14. 6th May 2010Dr Charles Heaney Presentation on SH 14 Personal History Works as a Gardener.

15. 6th May 2010Dr Charles Heaney Presentation on SH 15 Current Social Circumstances Lives on own with two fish tanks and two tortoises.

16. 6th May 2010Dr Charles Heaney Presentation on SH 16 Support Network No family or friends.

17. 6th May 2010Dr Charles Heaney Presentation on SH 17 Drug & Alcohol History Occasional Ethanol. No Cigarettes. No use of illicit substances

18. 6th May 2010Dr Charles Heaney Presentation on SH 18 Forensic History No previous custodial sentence

19. 6th May 2010Dr Charles Heaney Presentation on SH 19 Mental State Examination on Admission Poor self hygiene with good rapport and eye contact established and maintained. Has about 8 hours sleep a night and had a good appetite. Disorganized in his speech. Has Grandiose Delusions. Has Persecutory and Paranoid ideation. Auditory Hallucinations.

20. 6th May 2010Dr Charles Heaney Presentation on SH 20 Mental State Examination on Admission -Poor Cognition noted. -ACE-R attempted. Attention and Orientation 8/18 Memory 6/26 Fluency 8/14

21. 6th May 2010Dr Charles Heaney Presentation on SH 21 On Examination Yellow pigmentation. Thinning of outer third of Eyebrows (sign of Hertoghe) Dry itchy skin Rest of Physical Examination was unremarkable.

22. 6th May 2010Dr Charles Heaney Presentation on SH 22 Fould’s Hierarchy of Diagnosis Organic Psychotic Affective Neurotic Personality

23. 6th May 2010Dr Charles Heaney Presentation on SH 23 Progress on the Ward At ward review on 20/07/2010, does not remember how he got onto ward. Patient discussed how he has special powers, and has cured, “Dug” of a brain tumour. Await final blood results and then attempt trial of Risperidone

24. 6th May 2010Dr Charles Heaney Presentation on SH 24 Investigation’s TSH >100.00 mU/l (0.35-5.0) Free Thyroxine <5.15 pmol/L Slight Anaemia, rest of initial bloods within normal limits.

25. 6th May 2010Dr Charles Heaney Presentation on SH 25 Progress on the Ward Referred to Endocrine, has been started on trail of Levothyroxine.

26. 6th May 2010Dr Charles Heaney Presentation on SH 26 Hypothyroidism Impaired Memory. Hair Loss. Impaired Cognitive Function. Yellowing of Skin (Impaired conversion of beta-carotene). Dry Skin. Myexdema Madness. No Weight Gain. No nonpitting odema noted

27. 6th May 2010Dr Charles Heaney Presentation on SH 27 Myexdema Madness uncommon consequence of hypothyroidism, hypothyroidism Particularly Hashimoto's thyroiditis.Hashimoto's thyroiditis Chronically under-active thyroid can lead to slowly progressive dementia, delirium, and in extreme cases to hallucinations, coma, or psychosis.thyroiddementiadeliriumhallucinations comapsychosis particularly in the elderly