FYI, a Preview of One Practitioner's Results. an M.D. As Well
Cory,
FYI, a preview of one practitioner's results. An M.D. as well.
Perhaps he should write an entire article.
Best,
Tom
----- Original Message -----
From: fred starr
To: Tom Collura Private
Sent: Thursday, March 05, 2009 11:51 AM
Subject: Fwd: norb1-Potential case study.
Dear Tom,
This is just one of many. I have around 6 or 7 cases of mTBI similar to this one and was considering putting a poster together for ISNR. I also have an autism success story, an 3 Alz patients, and several ADD treatment cases.
For this patient, the qEEG images are in order from earliest to latest, and her CPT results before and after z-score training. Her history is listed below, followed by 2 emails from mom. She has completed 20 sessions of 4 channel Z-score training at F3 F4 T3 T4. She has been readmitted to Harvard, and will begin there in the fall. She is currently medication free.
Norb1 Intake Note
8/18/2008
See NP note for additional details.
ID: 21 year old, AAF junior college student currently on academic leave from Harvard University.
CC: “I am required to get mental health treatment to go back to school next year.”
HPI: Pt states that she is currently doing well. States that she is not exp any sx c/w ED. She is not taking her stimulant as it makes her nervous, and she does not think that she needs it. Current sx of depression are moderate.
Major difficulties at this time are difficulty making friends, and socializing. Pt states that she feels isolated, and this causes her to retreat into her fantasy life.
The patients “fantasy life,” started in 3rd grade and is based on Sweet Valley High book series. She states that she loses herself in this life in which she thinks imagines herself as being white, having 30 brothers and sisters, and a boyfriend. In this world she is popular and socially outgoing. The pt understands that this world is not real. She believes that she uses it as a crutch to avoid actually socializing.
The pt was hit by a car in 2006. She reports that she lost consciousness and was kept in the hospital for 4 days after the event. Leading up to that event, the pt had no history of academic difficulty. After that event the pt was diagnosed with ADHD and placed on stimulant. Although the pts ED sx began long before this event the accident may have created some neurological trauma that is causing learning and attention problems.
Problem List:
Poor social skills
Low self esteem
School Failure
Strengths:
Good verbal skills
Intelligent
Family support
Rich Imagination
Motivated
Meds: Celexa, 20mg QD
Adderall – Noncompliant
Past Med: Prozac, 20mg
MSE: Fair skinned AAF appearing and sounding younger then stated age. The pts voice is high pitched and resounds more like a girl or 10, then an young female of 21. The pt is without makeup and has mild facial acne.
Her eye contact is good, she is motivated and cooperative. The pt’s facial reactivity is spontaneous, and wnl. Her mood is described an ok. She does not report any appreciable benefit from Celexa. Affect is mood congruent. There is normal range and reactivity to her affect. Insight is fair. The pt understands that she needs help. Does not voice antecedents or triggers to her illness.
Thought Process is linear, Thought content is logical. There is no evidence of psychosis. There are no safety issues at this time.
Assessment:
Anorexia, Binge Purging Type, Remission
ADD: By report
MDE: Moderate, Partial Remission
mTBI by report
Social Phobia
Plan:
1) Obtain Medication Free qEEG to determine diagnosis and possible NFB treatment
2) Taper Celexa, over 2 weeks.
3) Follow up with CWM next week for 25 min check in
4) Start O3 and SNT.
5) Labs Pending
6) Encourage Mindfullness Training
7) Pt will obtain Miracle of Mindfullness.
8) Follow up with Carly every week to every other week.
9) Monitor Wt, and ED sx.
10) Assist pt with supportive therapy, assistance with returning to school, medication management, and NFB if necessary.
11) Help pt develop insight into her illness, and learn to seek out assistance before she has relapsed completely.
Email from mom
10/08
I do see improvement in Brittany. She seems to be following through better and completing tasks. She has discussed with me the recommendations about her past rigidity in scheduling things. I generally agree that she needs to learn how to give her self some room to alter her plans and still accomplish her task. You might try asking her if she still achieved the things she wanted to with the flexibility. For example working out in the morning. Brittany says it is important to her and will prepare the night before but then decide to sleep in. She still seems to be an all or nothing person. It seems as if she doesn't hold herself to a strict schedule, it will get done but with more stress. And if she gives herself room to be flexible it turns into procrastination and it either never gets done or if asked about it she then pushes herself to re-arrange things and then that leads into a frenzy or putting off something else. This is what her life appeared to be like in school. I think there is a middle ground she needs to learn and that is Prioritization. Making her breakfast on the days I said I would is a priority for me even when I am tired and have early meetings. But plan to make that happen because it is a priority. My simple take on an example. Otherwise she seems to be happier. I do think she still needs to connect to friends or form some new relationships. She spends a lot of time at home especially on the weekends.
2/09
Second Email from Mom:
First, I would would like to thank you and Dr. Starr on the excellent work you have done with Brittany. She has come a long way and I see a great deal of improvement. Her organization is better and her confidence is up. We met with Dr. Starr about a week or so ago to review test scores. She is going to do another round of bio feedback to work on specifically her reading comprehension area of the brain. I would like for her to continue to see you once a week in the same format as before if agreeable with you.
fS
------Forwarded message ------
From: fred starr <
Date: Thu, Mar 5, 2009 at 10:33 AM
Subject: norb1
To: drstarr <
--
Fred S. Starr, M.D.
Medical Director
17th Avenue Psychiatry
www.17ap.com
Complementary, Alternative, and Traditional Mental Health Treatment
"There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle." Albert Einstein
E-MAIL POLICY DISCLOSURE STATEMENT: This e-mail is not encrypted.
This transmission (including any attachments) may contain information that may be confidential. Unless you are the intended recipient of the message you may NOT copy, forward, or otherwise use it or disclose it or its contents to anyone. If you receive this in error, please notify me immediately at , delete the information from your computer, and destroy any hard copies.
If you reply to me about a client, please do not include the person's name in the Subject line or in the body of the e-mail to safeguard confidentiality in this unsecured form of communication (use non-identifying descriptors). All communication regarding clients is considered work product and will become part of the file. Thank you
--
Fred S. Starr, M.D.
Medical Director
17th Avenue Psychiatry
www.17ap.com
Complementary, Alternative, and Traditional Mental Health Treatment
"There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle." Albert Einstein
E-MAIL POLICY DISCLOSURE STATEMENT: This e-mail is not encrypted.
This transmission (including any attachments) may contain information that may be confidential. Unless you are the intended recipient of the message you may NOT copy, forward, or otherwise use it or disclose it or its contents to anyone. If you receive this in error, please notify me immediately at , delete the information from your computer, and destroy any hard copies.
If you reply to me about a client, please do not include the person's name in the Subject line or in the body of the e-mail to safeguard confidentiality in this unsecured form of communication (use non-identifying descriptors). All communication regarding clients is considered work product and will become part of the file. Thank you