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I stare at thecursor blinking on my screen, then scroll through the twelve-page document I drafted last night.
CONFIDENTIAL PSYCHIATRIC OBSERVATION REPORT
Patient:Rex Cassius Wentworth Anderson
Prepared by:Olivia Lin, MD, Psychiatrist
Purpose:Observation summary, initial diagnostic impressions, and treatment recommendations for transfer of care.
Note:This report is compiled based on observation and informal clinical dialog. It is intended as a transition document forfuture formal care.
I. OBSERVED PRESENTING SYMPTOMS
The following symptoms were observed or reported:
Dissociative episodes:Includes moments of blackouts or “lost time,” particularly under emotional stress or after ingesting large doses of stimulants (e.g., Velowake). The subject had completed a sleep study in the past, and the blackout moments did not qualify under the clinical definition of sleepwalking. However, the symptoms mimicked sleepwalking and may be other forms of dissociation.
Internalized hallucinations:Subject reports recurrent, lifelike conversations with a persona named “Casey.” The subject acknowledges this voice is not real but often experiences him as emotionally and viscerally present. Casey typically appears after the subject ingests Velowake.
Emotional dysregulation:Extreme guilt, shame, and persistent low self-worth, often masked by risk-taking behavior and performative charisma. Emotional outbursts and mood swings are often noticed by the practitioner.
Chronic insomniaandstimulant overuse(Velowake, up to 800mg caffeine daily) potentially exacerbate symptoms. Velowake is a drug currently under trials to treat narcolepsy symptoms.
Hypervigilance, emotional numbing, and avoidancewhen discussing early trauma or recent emotional intimacy. The subject would attempt to deflect the topic of discussion usingvarious tactics, ranging from flirtation to belligerent threats.
II. PROVISIONAL DIAGNOSTIC IMPRESSIONS
Complex PTSD (C-PTSD)withdissociative features, stemming from:
Early childhood trauma related to maternal loss.
