31 mei morpot skizofrenia katatonik
DESCRIPTION
skizofreniaTRANSCRIPT
S U P E R V I S O R D R . S A B A R P. S I R EG A R , S P . K J
MORNING REPORTsaturday, May 31th 2014
Patient Identity
Autoanamnesis Name : Mrs. S Sex : Female Age : 36 years old Address : Banjarnegara Occupation : unemployed Marital State: widowed
Alloanamnesis Name : Mrs. J Sex : Female Relation : Mother’s patient Age : 58 years old
PAT I E N T A N G RY W I T H O U T R EA S O N , S H O U T A N D I R R I TA B I L I T Y.
Reason patient was brought to emergency room
Present HistoryAbout 2013 years:• Angry without reason
• Shout• talk with her self• Decrease appetite• Poor grooming
Hospitalization in RSJ Magelang (6 march- 21
may)
About 5 days ago:• Often showed anger
• shout• Irritability
• Didn’t to take medication
About 2012 :• Angry without reason
• Shout• talk with her self• Decrease appetite• Poor grooming
Hospitalization in RSJ Magelang (15 May-11July)
2011Her husband is
death
Day of AdmissionMay, 31th 2014
Patient was brought with the complaints of:
• Showing anger• shouting• Irritability
• Don’t want to take medication
Brought to hospital by her mother
Poor utilization of leisure timeCan’t socialize with others anymore
Sleep disturbancesdecrease of appetites
• Head injury (-)• Hypertension (-)• Convulsion (-)• Asthma (-)• Allergy (-)
General medical history
•Drugs consumption (-) •Alcohol consumption (-)•Cigarette Smoking (-)
Drugs and alcohol abuse
history and smoking history
EARLY CHILDHOOD PHASE (0-3 YEARS OLD)
Psychomotoric There were no valid data on patients’ growth and development such as:
first time lifting the head (3-6 months) rolling over (3-6 months) Sitting (6-9 months) Crawling (6-9 months) Standing (6-9 months) walking-running (9-12 months) holding objects in his hand(3-6 months) putting everything in his mouth(3-6 months)
Psychosocial There were no valid data on which age patient :
started smiling when seeing another face (3-6 months) startled by noises(3-6 months) when the patient first laugh or squirm when asked to play, nor playing claps with others (6-9 months)
Communication There were no valid data on when patient started bubbling. (6-9
months)Emotion
There were no valid data of patient’s reaction when playing, frightened by strangers, when starting to show jealousy or competitiveness towards other and toilet training.
Cognitive There were no valid data on which age the patient can follow objects,
recognizing her mother, recognize her family members. There were no valid data on when the patient first copied sounds that
were heard, or understanding simple orders.
INTERMEDIATE CHILDHOOD (3-11 YEARS OLD)
Psychomotor No valid data on when patient’s first time playing hide and seek or if patient
ever involved in any kind of sports.Psychosocial
No valid data regarding patient psychosocial.Communication
No valid data regarding patient ability to make friends at school and how many friends patient have during his school period
Emotional No valid data on patient’s emotional.
Cognitive No valid data on patient’s cognitive.
LATE CHILDHOOD & TEENAGE PHASE
Sexual development signs & activity (NO VALID DATA) No data on when patient first experience of menarche, ect.
Psychomotor (NO VALID DATA) No data if patient had any favourite hobbies or games, if patient involved in
any kind of sports.Psychosocial (NO VALID DATA)
No valid data regarding patient psychosocial.Emotional (NO VALID DATA)
No valid data on patient’s emotional.Communication (NO VALID DATA)
No valid data regarding patient ability to make friends at school and how many friends patient have during his high school period
ADULTHOOD
Educational History she finished elementary school
Occupational History She’s never worked
Marital Status widowed
Criminal History No
Social Activity she was quiet
Current Situation she lives with her parents and
her son
Erikson’s stages of psychosocial development
Stage Basic Conflict Important Events
Infancy(birth to 18 months)
Trust vs mistrust Feeding
Early childhood(2-3 years)
Autonomy vs shame and doubt Toilet training
Preschool(3-5 years)
Initiative vs guilt Exploration
School age(6-11 years)
Industry vs inferiority School
Adolescence(12-18 years)
Identity vs role confusion Social relationships
Young Adulthood(19-40 years)
Intimacy vs isolation Relationship
Middle adulthood(40-65 years)
Generativity vs stagnation Work and parenthood
Maturity(65- death)
Ego integrity vs despair Reflection on life
PSYCHOSEXUAL HISTORY
Patient realizes that she is a female, and interested in man. Her attitude is
appropriate as a female.
Socio-economic history• Economic scale : low
Validity • Alloanamnesis : valid• Autoanamnesis : can’t be access
Mental State - May 31th 2014
Appearance • A female, appropriate to her age, completely clothed,
poor groomed
State of Consciousness• stupor
Speech• Quantity : can’t be access• Quality : can’t be access
BEHAVIOUR
•Hypoactive•Hyperactive•Echopraxia•Catatonia•Active negativism•Cataplexy•Streotypy•Mannerism•Automatism•Bizarre
•Command automatism•Mutism•Acathysia•Tic•Somnabulism•Psychomotor agitation•Compulsive•Ataxia•Mimicry•Aggresive•Impulsive•Abulia
ATTITUDE
• Non-cooperative• Indiferrent• Apathy• Tension• Dependent• Passive
•Infantile•Distrust•Labile•Rigid•Passive negativism•Stereotypy•Catalepsy•Cerea flexibility•Excited
Emotion
Mood
• Dysphoric• Euthymic• Elevated• Euphoria• Expansive• Irritable• Agitation
Affect• Inappropriate• Restrictive• Blunted• Flat• Labile
Disturbance of Perception
Hallucination
• Auditory (-) • Visual (-)• Olfactory (-)• Gustatory (-)• Tactile (-)• Somatic (-)
Illusion
• Auditory (-)• Visual (-)• Olfactory (-)• Gustatory (-)• Tactile (-)• Somatic (-)
Depersonalization (-) Derealization (-)
Thought Progression
Quantity
• Logorrhea• Blocking• Remming• Mutism• Talk active
Quality
• Irrelevant answer• Incoherence• Flight of idea• Poverty of speech• Confabulation• Loosening of association• Neologisme• Circumtansiality• Tangential • Verbigration • Perseveration• Sound association• Word salad• Echolalia
Content of Thought
• Idea of Reference
• Idea of Guilt
• Preoccupation
• Obsession
• Phobia
• Delusion of Persecution
• Delusion of Reference
• Delusion of Envious
• Delusion of Hipochondry
• Delusion of magic-mystic
• Delusion of grandiose
• Delusion of Control
• Delusion of Influence
• Delusion of Passivity
• Delusion of Perception
• Delusion of Suspicious
• Thought of Echo
• Thought of insertion &
withdrawal
• Thought of Broadcasting
Sensorium and Cognition
Level of education : finished elementary school General knowledge : Can’t be assessed Orientation of time : Can’t be assessed Orientations of place : Can’t be assessed Orientations of people : Can’t be assessed Orientations of situation : Can’t be assessed Working/short/long memory: Can’t be assessed Writing and reading skills : Can’t be assessed Visuospatial : Can’t be assessed Abstract thinking : Can’t be assessed Ability to self care : Can’t be assessed
Impulse control when examined
• Self control: poor• Patient response to
examiners question:poor
Insight
• Impaired insight• Intellectual Insight• True Insight
Physical State
Consciousnes : clear consciousnessVital sign :◦Blood pressure : 120/70 mmHg◦Pulse rate : 86 x/mnt◦Temperature : 36.5 C◦RR : 20 x/mnt
Review System
Head : normocephali, mouth deviation (-)
Eyes : anemic conjungtiva (-), icteric sclera (-), pupil isocore
Neck : normal, no rigidity, no palpable lymph nodes
Thorax :
Cor : S 1,2 regular
Lung : vesicular sound, wheezing -/-, ronchi-/-
Abdomen : Pain (-) , normal peristaltic, tympany sound
Extremity : Warm acral, capp refill <2”, motoric strength
Neurological exam : not examined
Mental Status Impairment
- Behavior: hiperactive, catatonia, active negativism, mutism-Attitude: non-cooperative, apaty, rigid-Affect: flat-Thought of Progression: remming-Form of thought : autism
• Often forius anger• shout• Irritability• do wan’t to take
medication
Poor utilization of leisure time
Can’t socialize with others anymore
Sleep disturbancesLoss of appetites
Symptoms
Patient is a female,36 years old, poor groomed, has no history of admittion in psychiatric ward.
RESUME - Day of admission
Axis I : F20.2 Schizophrenia CatatonicZ91.1 Disobeyed of medication
Axis II : Z03.2 No DiagnoseAxis III : -Axis IV : 3 years ago, her husband is died. Her
daughter live with her uncle and aunt.Axis V : GAF admission 20-11
Multiaxial Diagnosis
PROBLEM RELATED TO THE PATIENT
1. Problem about patient’s life3 years ago, her husband is died. Her daughter live with her uncle and aunt.
2. Problem about patient’s biological state There were abnormality imbalance neurotransmitter, increase of
serotonin, dopamine. So the patient needs psychopharmacology
PLANNING MANAGEMENT
INPATIENT (HOSPITALIZATION) To reduce 50% the symptoms :
• Often forius anger• shout• Irritability Poor utilization of leisure time Can’t socialize with others anymore Sleep disturbances Loss of appetites
Response Remission Recovery
RESPONSE PHASE
Target therapy : 50% decrease of symptoms
Emergency departmentInj Diazepam 5 mg IV (sedation) Inj Lodomer Inj. 1 amp. IM
Maintenance Resperidon tab 2x5mgPLAN : ECT
Re-assess patient
REMISSION PHASE
Target therapy : 100% remission of symptom
Inpatient management Continue the pharmacotherapy: resperidon tab 2x5 mg Improving the patient quality of life :
Teach patient about his social & environment (interact with his family, socialize with his neighbor or friends, find a hobby to do on his spare time, and find a job that fits him well.)
Outpatient management Pharmacotherapy Psychosocial therapy
RECOVERY PHASE
Continue the medication, control to psychiatric
Rehabilitation : - Help patient to interact normally with his
family, friends, and neighbor- Family education