Clinical Handover — Voluntary Presentation

To: CAMH Emergency Department / On-call Psychiatry Date: May 8, 2026 Patient: Blair Zasitko, 43, male, Toronto Prepared by patient prior to presentation

REASON FOR PRESENTATION TONIGHT

Active suicidal ideation with plan and preparatory behavior. Self-administered Columbia Suicide Severity Rating Scale (C-SSRS), today, May 8, 2026:

Patient prefers to discuss the specific plan and access to lethal means directly with the clinician.

Presenting voluntarily. Has consumed 3–5 alcoholic drinks today prior to presentation. Baseline pattern: daily alcohol use (AUDIT-C 4/4/4 in Feb 2026). Nicotine dependence.

CURRENT MEDICATIONS

• Concerta (methylphenidate ER) 36 mg daily — titrated up January 2026 (started 18 mg mid-Jan, moved to 36 mg ~Jan 23). Severe sleep disturbance on this dose. Patient questions whether stimulant titration during a severe depressive episode is appropriate.
• Propranolol 40 mg daily — for panic disorder (transformative response since Sept 2023).
• Rosuvastatin 20 mg daily.
• ASA 81 mg daily.
• Vitamin B12 daily.

No known drug allergies.

PSYCHIATRIC HISTORY

Diagnoses on record

• ADHD — formally diagnosed February 2025 by psychiatrist (CADDRA-aligned assessment; full report available).
• Panic disorder — chronic, severe ~2016–2022; largely remitted on propranolol since Sept 2023.
• Recurrent major depressive episodes with a lifelong burnout-collapse pattern (>10 cycles by patient's own count).

Medication trajectory

• Vyvanse (up to 50 mg) — eventually ineffective; abrupt discontinuation in May 2025 (precipitated psych-ER visit, see below).
• Adderall XR (max 30 mg) — initial benefit, then inadequate.
• Concerta 18 mg → 36 mg as of January 2026.

Prior suicidal crises

• November 2024: severe depression following sudden financial collapse. Patient developed an internalized plan to complete suicide after New Year's Eve; stopped planning beyond that date. Disclosed to ex-wife → parents intervened with financial support; episode de-escalated without ED visit.
• May 2025: presented to psychiatric emergency approx. one week after abrupt Vyvanse discontinuation. Form 1 was threatened but not invoked; patient agreed voluntarily and was not admitted. Outcome: resumed Vyvanse 40 mg, expedited cardiology workup.

Burnout / decompensation history Lifelong pattern of severe burnout cycles dating to high-school dropout (~age 17). Multiple workplaces ended in burnout-driven exits (Radio Shack, World Sound and Vision, The Brick, Top Choice, Inflamax, ZaPrisco). Most recent and most severe was January 7, 2026 at the PsychoEd Clinic (his employer). Patient's own words about that episode: "I broke down mentally and became mentally unstable, with definite aspects of psychosis. It's like my mind will tell me anything that it has to in order to get relief from the immediate stress. I cannot trust my own judgement when it's bad." Has been on medical leave since; does not intend to return to that role.

SELF-REPORTED ASSESSMENTS (February 6, 2026, baseline)

• GAD-7: 10 (moderate anxiety)
• DASS-21: moderate–severe across subscales
• ISI: clinically significant insomnia
• AUDIT-C: 12 (high-risk drinking)
• DAST-10: all no
• MDQ: all no (no manic features endorsed)
• C-SSRS in early Feb: Y/Y/Y/N/N/N — ideation without intent or plan.
• C-SSRS today (May 8): Y/Y/Y/Y/Y/Y — clear escalation since February.

RELEVANT MEDICAL HISTORY

• Cardiology workup completed mid-2025; cleared for stimulant use.
• Hyperlipidemia — managed on rosuvastatin.
• No other significant medical history reported. No prior psychiatric admission.

PSYCHOSOCIAL CONTEXT

• Work: On medical leave from PsychoEd Clinic since Jan 7, 2026. Will not return.
• Financial: Severe, ongoing financial stress — primary trigger of both the Nov 2024 and Jan 2026 crises.
• Housing: Currently housed; girlfriend (Hilda) lives with him.
• Substance use: Daily alcohol (heavy); nicotine; no other substances reported.

WHAT THE PATIENT IS HOPING FOR TONIGHT

1. Recognition that today's risk is meaningfully elevated above prior episodes (full C-SSRS positive, with plan and preparatory behavior).
2. Safety planning, including support with means restriction.
3. Psychiatric review of current medication regimen — particularly whether continuing stimulant titration during a severe depressive episode is appropriate.
4. Open to voluntary admission if clinically indicated.

CONTACTS

• Primary emergency contact (ex-wife): Cyra Sidhwa — 647-720-0221
• Family physician (GP): Daniel Nai — 416-975-0600
• Parents: supportive; involved during Nov 2024 crisis; reachable via patient or Cyra.
• Girlfriend (Hilda): lives with patient.
• No current treating psychiatrist. Patient is between psychiatric providers — referral was attempted in Feb 2026 but declined due to professional conflict of interest; a colleague referral was offered but not yet acted on.

This document was prepared by the patient prior to ED presentation to expedite clinical handover. A more detailed clinical history is available on the patient's laptop / phone if requested.