Initial Assessment

Patient: Crichton, John Robert
Date: May 28, 1999
Length: 60 minutes

History of Presenting Illness: Patient is a 30 year old single white male who was referred for evaluation by IASA. Family history shows no known signs of metal illness or drug abuse. He is a graduate of MIT with a degree in Astrophysics. Pt is currently an astronaut for IASA and has worked without difficulty there for 3 years. Pt has been working on a project which is well documented elsewhere (see Farscape mission). IASA referring officials have provided the following information. The pt was ordered to abort his experiment due to an electromagnetic wave in space. The pt did not do so and as a result landed in a controlled crash which destroyed the Farscape module. Pt was evaluated at the Emergency Department for medical clearance. Upon waking, the pt became violent and attacked his father without provocation. Pt was placed in restraints, sedated, and allowed to regain control. Upon calming, pt displayed insight into his actions and verbalized the inappropriateness of acting in a violent manner. Pt was then released from treatment in the custody of his family. Pt is now referred for full evaluation by attending physician Dr. Bettina Fairchild.

Mental Status Exam: Upon my initial arrival to my office, I found the patient already in the room. He was seated behind my desk and was using my telephone to order a pizza. He displayed an alert state of consciousness. He maintained strong eye contact. He displayed significant levels of wariness and paranoia.

His thought content revealed evidence of markedly delusional thinking. The patient reported multiple delusional ideations including reporting that I am a plant from Delfya (I am currently unaware of the meaning of this...is Delfya a company competing with IASA??) and that my name is actually Zaan, even suggesting that we have had intercourse despite the fact we have never met before this occasion. Pt approached me and placed his hands on either side of my head for a reason known only to him, he then reacted as if he expected something to happen and was disappointed when nothing occurred. Pt seems to be trying to find some form of close contact, someone with whom he can trust with these actions.

He makes references to a ship of aliens from Moya and is focused on someone named Erin, I can assume he is speaking of Dr. Fairchild in this instance as this is the name he called her after the attack on his father. Pt seems to have given new identities to people with whom he as worked with or had a passing knowledge of. The patient also displays evidence of marked paranoia about the integrity of his body, reporting that people want to attack his mind/brain (scorpio?? Astrology? Planets Delfya/Moya? Something called Maltus). The delusions appear somewhat entrenched and may be fixed in nature. The pt also appears to be racially preoccupied in his thoughts and is very concerned over working with me. (Am I first the blue person pt has seen...watch for ethnic/racial transference issues)

The pt's thought processes reveal loose associations at times but are largely logical overall...discounting the incomprehensible delusional material. Pt also displayed evidence of psychomotor agitation, during first session it was the constant movement around the room. Second session, the pt continued to clutch a pillow as if needing something to ground him in this reality. He described his mood as "I don't know" but his affect was fearful and hypervigilant and feels he is being manipulated. His concentration was intact. No overt evidence of responding to internal stimuli and the pt denied auditory or visual hallucinations.

Assessment: The pt appears to be displaying psychotic symptoms of paranoia, delusions, and LOA. While history does not support a diagnosis of schizophrenia, a diagnosis of psychosis NOS is appropriate. Psychosis secondary to head trauma appears to be ruled out with the serial CT scans from the ED but a post-concussive syndrome remains a rule out diagnosis. Given the pt's focus on people being replaced by these aliens, a diagnosis of Capgras Syndrome may be appropriate as well.

Plan: Weekly insight oriented psychotherapy sessions. Consider trial of antipsychotic medication...preferably Risperdal with its low incidence of sedation and weight gain. Pt does not wish medication intervention at present. Will continue to monitor symptoms and for any further signs of assaultive or aggressive behaviors. If they reoccur, may need to consider a trial of a mood stabilizer such as Depakote.

Addendum: The patient's violent behavior escalated, resulting in the assault and near death of a police officer. This was unknown until a few hours ago. While reviewing and discussing treatment and possible return to duty with IASA Director, Douglas Logan, Col. Jack Crichton, Douglas Knox, and Dr. Bettina Fairchild. Pt arrived, appearing fevered, sweaty, uncomfortable and clearly distracted as he circled the room saying he did not have a future in our 'reality', his delusions clearly taking a more active role in his mind. Speaking of the person named Scorpius once more, and claiming this man needed to release him. (Pt did not state what he needed released from.) Pt then pulled out a firearm and shot his father, then each person in the room. Security arrived and restrained the pt as he was about to shoot me as well. Pt is now under heavy sedation in the psychiatric wing at the Brevard Co. Hospital awaiting electroconvulsive therapy, this treatment is the only recourse for such an acutely psychotic and dangerous patient.

End Patient Assessment by Dr. Jean Kaminsky, Cape Canaveral Air Force Base

Transfer file and police report (see attachment) to Dr. William Brander, Director of Psychiatry, Brevard Co. Hospital