January 29, 1992

The patient was seen for 45 minutes for medication review and follow-up. He was very drowsy today and I noticed he was sleeping in th car in the parking lot before hand. He indicated that he is very angry with his family, but mostly with his mother. He commented how he feels that his mother goes behind his back and will get angry with his friends while not confronting him directly. He is also noticing considerable side effects from the Lithium, mostly tremor and increased urination and some diarrhea. He cut the dosage back to 300 mg twice daily from the previous 900 mg a day. He is still taking 200 mg of Nortriptyline at night. While I am somewhat concerned about the amount of Nortriptyline, he did not follow through on getting a drug level. He agreed to try to do that this week. I want him to reduce his Lithium dose to just 300 mg tonight and for the next couple of days and if he notices no differences to stop it entirely. I will see him again next week.

The Cheese Man, M.D.