A comprehensive report on Josh, elaborating on all his previous experiences with psychiatric treatment and medication.
OCEAN VIEW HOSPITAL
HEALTH AND HAPPINESS
FINAL PSYCHIATRIC EVALUATION
DR. A. HILL
Jeremy Harris, MD
Whale Point Surgery
Referred on 04/02/2007 after incident at school
Oliver Purkiss, MD, MPH
Pastoral Wellbeing Center
Referred on 10/19/2009 after incident at school
Roisi Williams, MD
Santa Buena Medical Center
Referred on 12/09/2008 after disagreement over treatment
Sarah North, MD, PhD
Referred on 11/29/2013 after patient's response to drugs tapered badly
12/19/2013 - Present
Alan Hill, MD, MPH
Referred on 03/14/2014 due to potential suicide risk
History of Prescribed Antidepressants
Fluoxetine (06/18/2006 - 01/24/2010)
Patient reported that side-effects (headaches, nausea) were becoming too severe, and wanted to change drug.
Duloxetine (02/13/2010 - 11/01/2013)
Patient claimed that the drug was no longer having any effect. Reported that his mood had badly worsened.
Amitriptyline (11/29/2013 - 04/05/2014)
Patient began self-medicating, taking stronger doses.
Phenelzine (04/15/2014 - present)
30mg dose. Twice daily, increasing to three times daily after 2 weeks.
If the patient reports any of the following symptoms, please contact a physician IMMEDIATELY.
Side effects: hypotension, blurred vision, dizziness, insomnia, vomiting, diarrhea, muscle tremors, liver damage (hepatitis),
On withdrawal: nausea, insomnia, nightmares, agitation, hallucinations, paranoia, aggressiveness, slurred speech, ataxia, catatonia, shocks
Summary of Treatment
Patient arrived delirious/confused. Strong symptoms of major depressive disorder, related to death/disappearance of sisters.
Placed patient under observation.
ECT was considered, given patient's history of tapering drug effects, but rejected.
CBT, IPT, psychoanalysis, etc, failed to produce any improvement.
New course of drugs was necessary.
Patient moved onto a non-selective MAOI. Rationale being that SSRIs and SNRIs have proven ineffective in the past.
Phenelzine 60mg initially. Higher than average dose was necessary to see reduction of symptoms.
After 2 weeks, patient's symptoms and mood were greatly improved.
Discharged on 16th May after final consultation proved satisfactory.
Dr. Alan Hill
OCEAN VIEW HOSPITAL
1 Pinnacle Drive
Washington Pictures Incorporated
|30||Nights residence (observed)||395||11850.00|
|1||Phenelzine (200x 15mg)||105.24||105.24|
|14||Review Consultation (1 hour)||595||8330.00|
|7||CBT (1 hour)||745||5215.00|
BALANCE DUE: $26250.24
After entering the Psycho's workshop, walk to the desk on your right side and open up the drawer.
- This clue can only be found by Sam if she escaped from the Psycho in Chapter 5.
- Hannah's Diary states Josh went to a hospital.
- This clue foreshadows the diminishing sanity of Josh, as he starts suffering the same drug withdrawal effects mentioned in the Journal later in the game.
- The drugs that were prescribed to Josh are all focused around serotonin, a kind of neurotransmitter. Depression can be triggered, if there is a decrease of production of serotonin.
- Fluoxetine is a SSRI which stands for "selective serotonin re-uptake inhibitor", and this can help increase serotonin in the brain.
- Duloxetine is a selective serotonin/norepinephrine re-uptake inhibitor.
- Amitriptyline and Phenelzine are the earliest anti-depressants developed.
- The drugs that he took were effective, but for his depression only, and never was effective for his suspected second mental illness, Schizophrenia.
- His main issue was suspected to be Schizophrenia, and thus was never treated: he was treated for the wrong disorder, called Major Depressive Disorder.