Case File 09: The Painter

Patient #0477-Δ

Primary Symptoms:
• Command auditory hallucinations
• Tactile-gustatory hallucinations
• Somatic preoccupation
• Insomnia >72 hours with hypergraphic drive
• Possible organic toxicity (suspected cadmium/pigment ingestion)

Current Prescription:
• Haloperidol 5 mg IM stat, then 5 mg IM q4-6h prn agitation/psychosis
• Lorazepam 2 mg IM q4-6h prn severe anxiety/distress (max 8 mg/24 h)
• Olanzapine 10 mg wafer nocte
• Benztropine 1 mg IM/PO bd prn extrapyramidal symptoms
• All art materials confiscated, Level 4 contraband

Next 48 h Orders:
• 1:1 nursing, arm's-reach supervision
• Soft limb restraints only if pigment-smearing or self-harm attempts
• Repeat U&E, LFT, FBC, heavy-metal screen at 06:00
• If no improvement within 24 h → urgent ECT consult

Prognosis: Guarded
Treatment Plan: Indeterminate. Prior containment measures unsuccessful.