January 8, 1992

The patient was seen for 30 minutes for medication review and follow-up. He reported that two days after he started Lithium, 300 mg twice daily, along with his 150 mg of Pamelor daily, his mood improved significantly. He had more difficulties over the weekend when he went to a science fiction convention with some friends and his mood dropped down but he again feels like it is coming back. We talked about his problem with interactions with friends and his feelings that there was nobody specifically he could talk to after the friend who was staying with them from Australia returns home. He and his girlfriend are having more difficulties and she told him that she saw somebody else on two occasions in the past three months and he is feeling like she “cheated on me.” At this point, his suicidal thoughts have decreased markedly. Although he is still not very communicative with his family, his overall affect looks much better and the only side effect he has noted is a slight tremor which he doesn't feel is a problem. His serum lithium level was .6. . Other laboratory values were essentially normal except for a slightly elevated alkalinephosphatase. I would like to see him again in one week for 45 minutes. No changes were made in medications.

The Cheese Man, M.D.