how to present long case in pro

8/18/2019 How to Present Long Case in PRO

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Hx Presentation For Pro

Opening statement y mantap, lengkap dgn demographic details, risk factor dan past

medical hx y relevant.

For HOPI

1) Chronic cases – Initial presentation (symptoms, ix, how the dx is made in brief)

Progress which include management, control of the disease, follow up, related admission andcomplications

2) cute (include those fresh from the ward atau y recently discharge ie dlm masa 2 bulan lepas) – present mcm

biasa! "p #alau dah discharge, tutup $%PI tu dgn cerita current health status dia #at rumah semen&a#

discharge sampailah hari ini ($'I * + )!"hen, terus sambung #e past medical hx y cerita pasal

dx pt ni from the start! (tmasu# ptu#aran ubat, control complication etc)!

PaediatricsCERER!" P!"#$ %!c&te on Chronic'

Opening #tatement

I had the pleas&re talking to (adam #hamini, )hose da&ghter,

an&sya, a *+year+old Indian girl, )ho )as an ex+premat&re ay

at -th )eeks of gestation, diagnosed )ith cereral palsy sinceirth and has een on ryle/s t&e for feeding, )as admitted 0

month ago follo)ing episode of fever and shortness of reath -

days prior to admission.

HOPI

#he )as other)ise )ell &ntil - days prior to admission )hen she

developed fever and shortness of reath - days prior toadmission.

#he )as discharged )ell and c&rrently has no active complaints.

%pne&monia history'

0'irth History

I )o&ld like to proceed my presentation y looking ack at

the irth history.• !ntenatal

0


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!ccording to the mother, prenatally, she )as diagnosed to

have placenta previa ma1or.

• 2elivery

3hen, an&sya )as orn premat&re via E("#C# at -th

)eeks of gestation after her mother had leeding placenta

previa. 3he mother )as told that anisya )as orn 4at, not

crying and had cyanosis. 3herefore an&sya )as

res&scitated and int&ated.

• Postnatal

an&sya )as then admitted to 5IC6 for t)o months to )ait

for the ody )eight to increase. #he )as given expressed

reast milk. Her )eight increased from 0.00kg to -.7kg

d&ring discharge. #he )as given appointment at * and 8

months old to check for her eyes as )ell as her ears. It

revealed normal 9ndings.

Initial Presentation

"ater at ao&t one year old, (adam #hamini noticed that

an&sya )as still not ale to stand on her o)n. #he co&ld

only ottom sh&:e to move aro&nd. On f&rther ;&estioning,

mother also claimed that an&sya has )eakness )hen she

tries to grasp o1ects, )as not ale to speak any single

)ord, &t only prod&ce some incomprehensile so&nds. #he

said that sometimes an&sya is not alert and not

responding to c&es.

eca&se of that, her mother ecame )orried and ro&ght

her #elayang Hospital, admitted for - days )herey several

investigations )ere done to her and she )as diagnosed to

have cereral palsy.

Progress and Cx

0'Follo) &p

-


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#ince then, she &ndergoes reg&lar follo) &p every month

)ith paediatric o&tpatient department,ophthalmologist

months, physiotherapist.2&ring one of the follo) &p )hen she )as - years old, the

mother )as told that she has poor )eight gain and

s&ggested that ryle/s t&e sho&ld e &sed for feeding+ +carorie milk


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$o&ngest o&t of ?rd. 5ot consang&ineo&s marriage and no

history of childhood illness in the family. Father had childhood

asthma. (other 5(I.

#ocially

#tay together at epong at single storey ho&se. (other is aho&se)ife and take care of the children. read)innerD Father is

)orking as &sinessman in )iring. Earns R(

0


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adominal pain and vomiting for - days prior to

admission.

• 3he symptoms )as preceded y 0 month history of

poly&ria, polydipsia and lethargic. !t that time, there )as

also respiratory symptom like prod&ctive p&r&lent co&gh.

• (other denied any other &rinary sx like hemat&ria ordys&ria and no @I3 sx like diarrhea.

• !t cas&alty, several investigations )ere done incl&ding

lood and chest x ray. His lood s&gar noted to e high

)ith reading of --mmol


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?'CompliancePatient )as compliance to all medication and denied any

hypoglycaemic symptoms like tremor


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NEPHROTIC SYNDROME (no active complaints)

1 CHIEF COMPLINT

Harith2anial, 7 year+old oy, )ith 5ephrotic #yndrome

diagnosed year ago c&rrently on prednisolone x mg, )as

admitted today for exam p&rposes. Harith other)ise has noactive complaint.

I )o&ld like to present the hx from initial presentation.

H presented to cas&alty year ago follo)ing episode of

generali>ed ody s)elling for 0 )eek P3!. It initially

occ&rred aro&nd the eyes and grad&ally involved the

face, oth legs, adomen and the scrot&m. It )aspainless )ith no skin changes.

o 3here )as no history of insect ites %excl&de

anaphylactic reaction'.o (other noticed frothy &rine. Ho)ever there )ere no

other &rinary symptoms like hemat&ria %excl&de !@5'.o 3here )as no #O, palpitation, chest pain, etc. %r


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POP2 - monthly, and each fed ody s)elling )hichs&ggestive of relapse and re;&iring reind&ction of

prednisolone co&rse.

COMPLICTION

Over the past years, patient denies of having any sxs&ggestive of #P like fever and adominal pain and there )as

no hx of hosp admission d&e to hypovolemia or thromotic

event. "ipid monitoring also revealed normal 9ndings.

H is ale to sociali>e )ell, )ith no prolem in his ed&cation.

3here is no limitation in activity. &t he did 9nd slight diGc&lty in

follo)ing his diet regime. 3here )as no 9nancial prolems and

patient is ale to accept his condition very )ell.

NEPHROTIC SYNDROME (!it" active complaints)

1#CHIEF COMPLINT

Harith2anial, J year+old oy, )ho is kno)n to have

5ephrotic #yndrome since a&g&st last year presented to

#elayang Hospital - months ago, follo)ing episode of generali>ed ody s)elling for - days prior to admission.

C$%%ent p%esentation

o 3he prolem started - days prior to admission )hen he

presented )ith generali>ed ody s)elling. It initially

occ&rred aro&nd the eyes and grad&ally involved the

face, oth legs, adomen and the scrot&m. It )as

painless )ith no skin changes. (other did &rine dipstick


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and fo&nd o&t that there )as protein&ria of ? for ?

consec&tive days.o 3here )as no history of insect ites %excl&de

anaphylactic reaction'.o (other noticed frothy &rine. Ho)ever there )ere no

other &rinary symptoms like hemat&ria %excl&de !@5'.o 3here )as no #O, palpitation, chest pain, etc. %red ody

s)elling )ith facial p&Gness. #everal investigation )as done,and he )as con9rmed to have nephrotic syndrome and )as

prescried )ith x mg prednisolone. Remission )as achieved

after ? )eeks co&rse of prednisolone. He had one episode of

relapse )hich manifested as generali>ed ody s)elling and

&rinary protein of more than - pl&s.

He is &nder reg&lar follo) &p )ith POP2 - monthly, and eachf


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For the past - months since dx, patient is generally )ell, &rine

protein has een negative and no more relapse of nephrotic

syndrome.

S&MMRY

Harith2anial, J year+old oy, )ith #teroid #ensitive5ephrotic #yndrome since a&g&st last year presented to

#elayang Hospital - months ago, follo)ing episode of

generali>ed ody s)elling for - days prior to admission. He

)as diagnosed )ith Relapse 5#, )as reind&ce )ith

prednisolone and remission achieve after ? )eeks of co&rse.

Over the past - months, he is generally )ell, )ith no more

relapse of nephrotic syndrome.

3H!"!##E(I!

Opening statement

I have pleas&re talking to P&an !, )hose son is C, a 7 years old

malay oy )ith eta 3halassemia (a1or< H E eta 3halassemia

diagnosed at the age of x years


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(other )as &ns&re of the initial H, &t C )as started on lood

transf&sion at the age of x years


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His latest ser&m ferritin level is at 1 nmol


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Excl&de other metaolic ds

Excl&de other a&toimm&ne assoc. Mith it %a&toimm&ne

de9ciency syndrome'

Control

Follo) &p 0+? months d&ring 0st year of life

-+* months d&ring -nd or ?rd year

(akin lama makin1arak

(onitor for linear growth, weight gain, developmental progression, and

overall well-being

Complication

(ental retardation

#hort stat&re

"earning disorder

EPILEPSY

I have pleas&re talking to P&an M, )hose son is !, 8 years old

malay oy )ith Cereral Palsy dx at the age of J months old. He

)as admitted to H#" 0 month ago follo)ing episode of anormal

1erking movement of all lims on the day of admission. Over the

past * years, ! has een having m&ltiple episodes of 9ts, some

re;&iring hospital admission and t)o episode of IC6 admission

re;&iring int&ation.

!normal movement< 9ts D 1erking and shaking movement of

all lims

2rooling of saliva, &prolling of eyeall, tong&e

iting

o)el ladder incontinence

"OC, &nresponsive to call

0?


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Preceeding the event, mother noticedepam given y the mother. Post ictally, pt )asdro)sy &t mother claimed that her son )as responsive to her

call.

0 min&tes later, ! started to develop another episode of 9ts,

)ith similar semiology. Ho)ever, this episode lasted for 0

min&tes, cant e aorted y PR dia>epam and ! )as ro&ght to

E2.

Other)ise, %excl&de meningitis, 6R3I, altered ehavio&r, '

Ix done,(x done in hospital. Pt has een discharged f


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(edicineSTROKE (Acute)

(r (&hammad, 8 year+old gentleman )ho is a chronicsmoker for ? packed years, poorly controlled hypertension and

diaetes mellit&s and family history of premat&re cardiac death

)as admitted * months ago to #elayang Hospital follo)ing

episode of right sided ody )eakness associated )ith facial

asymmetry and sl&rred speech one day prior to admission.

HOPIHe )as previo&sly )ell &ntil one day prior to admission

)hen he developed )eakness of oth &pper and lo)er lims of

the right side sim&ltaneo&sly after he )oke &p from ed. He felt

a sense of heaviness of the right ody, and he co&ld not stand or

)alk properly. He re;&ired assistance from her )ife to )alk. His

)ife noted that he had sl&rred speech and facial asymmetry. He

co&ld still &nderstand and converse )ith others. He also haddiGc&lty in eating &t there is no prolem in s)allo)ing. 3here

is no history tra&ma, no pain, no sensation loss, no anormal

movement, no preceding a&ra, no changes of ehavio&r no

ladder or o)el incontinence. 3here )as also no sei>&res or

loss of conscio&sness. Patient denied any preceding symptoms

like headache, l&rry vision, pro1ectile vomiting or neck stiQness.

? ho&rs follo)ing the onset of symptoms, he )as ro&ght to

hospital. #everal Ixs )ere done incl&ding Ct scan and lood ix.

He is not s&re of the details, &t )as told that he had stroke. He

)as managed accordingly, did not re;&ire any int&ation or IC6

admission. He )as admitted for J days and discharged )ith

medications and follo) &p )ith (OP2 and physiotherapist.

Over the past * months, he regained some f&nction afterseveral physiotherapy sessions. Ho)ever he had some resid&al

symptoms. He is independent in terms of activity of daily living,

08


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ale to )alk y himself )ith the &sage of )alking stick. C&rrently

he has no active complaint, compliant to medications and still

practices sedentary lifestyle %diet, exercise, smoking'

#6((!R$

(r (&hammad, 8 year+old gentleman )ho is a chronicsmoker for ? packed years, poorly controlled hypertension and

diaetes mellit&s and family history of premat&re cardiac death

)as admitted * months ago to #elayang Hospital follo)ing

episode of right sided hemiparesis, facial asymmetry and sl&rred

speech one day prior to admission. Investigations concl&ded

that he had cererovasc&lar accident. C&rrently, patient is !2"

independent )ith minimal resid&al symptoms. !nd he stillpractices sedentary lifestyle.

RHEUMATOID ARTHRITIS (Acute on Chronic)

Opening Statement

(adam "im, *- year+old Chinese hairdresser, )as diagnosed to

have rhe&matoid arthritis 0? years ago complicated )ithmonone&ritis m&ltiplex, s1ogren/s syndrome, !IH!, Felty/s

syndrome and p&lmonary 9rosis c&rrently on methotrexate %

hydroxychloro;&ine' )as admitted for exam p&rpose. C&rrently

patient has no active complaint.

I )o&ld like to present the HOPI from the initial presentation of

this patient to hospital.

N RF RI#E# A rhe&matoid factor, rhe&matoid nod&les, small

1oints of the hands, symmetrical 1oint involvement more than

)eeks, morning stiQness 0 H ), involvement of - 1oints,

erosions of =R.

Initial presentation

#he presented 0? years ago )ith - months history of painf&ls)elling of right )rist. 3he pain )as descried as throing in

nat&re, severe, )orse in the morning and relieved at the end of

0


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the day. #he )akes &p very stiQ, and the stiQness lasted for fe)

ho&rs after doing some activity. 3he )rist 1oint )as )arm to

to&ch )ith no skin changes. Pain )as not ind&ced y any

medications or food intake. #&se;&ently, fe) days


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developed +++ and )as told that she had developed several

side eQects related to the medications incl&ding +++.%)A#mission relate# to illness

Over the past 0? years, she has een admitted ao&t -

times d&e to 0' 4are &p of R! and -' change of medication

?' side eQects of medications *' rec&rrent infection. 3he lastadmission )as one month ago )ith similar presentation %

other infections' and she )as discharged )ell.

Complication

On f&rther ;&estioning, after several years of illness, she denies

of having < she also had history of chronic dry co&gh and

occasional shortness of reath and chest pain. #he &nder)ent%high resol&tion' C3 scan, l&ng f&nction tests and )as told that

the illness has no) involved her l&ngs.

#he also complains of dryness and redness of eyes, and dryness

of the mo&th, and therefore )as prescried )ith arti9cial tears.

#he has rec&rrent fever and history of easy r&ising, she also

complains of early satiety and adominal discomfort.

Ho)ever, no )eakness or n&mness over the lims, loss of

sensation, neck pain, and o)el or ladder incontinence.

unction

&)'hsicalFor the past 0? years, this disease has limited her daily

activities, )herey she )as not ale to go o&tside eca&seshe 9nds diGc&lty in climing &p the stairs. #he cannot

s;&at and re;&ired sitting toilet. !s she )orks as a

hairdresser, she 9nds slight diGc&lty in doing her 1o. #he is

independent in terms of activity of daily living.")Emotion

Initially it )as diGc&lt for her to accept the illness. Ho)ever

as time goes y, she is no) positive )ith good morals&pport from her mothers and her reg&lar c&stomers.

$)inancial

0


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In terms of 9nancial, she receives s&pport from

aatanea1ikan(asyarakat and #OC#O < she has slight

constraints &t she is ale to cope )ith it.

Summar

(adam "im, a *- years old hairdresser )ith &nderlyingrhe&matoid arthritis complicated )ith #1ogren/s syndrome,

peripheral ne&ropathy, p&lmonary 9rosis, anemia, felty/s

syndrome and she is on le4&nomide. C&rrently she is doing )ell

)ith mild


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SSTEMIC *U'US ERTHEMATOSUS

Opening statement

(iss 5eelafo, a -* year+old singer )as admitted to H# - )eeks

ago follo)ing episodes of fever and m&ltiple 1oint pain 0 )eek

prior to admission.

HO'I

0'Explore#he )as previo&sly )ell &ntil 0 )eek prior to admission

)hen she developed fever )hich )as grad&al in onset,

intermittent in nat&re, )ith no chills or rigors, )arm to to&ch

&t no doc&mented temperat&re, relieved temporarily yparacetamol.

? days follo)ing the onset of fever, she developed pain over

small 1oints of oth hands and not migrating. 3he pain )as

constant, d&ll aching in nat&re, It )as severe )ith the score

7


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-'!dmissionFor the past - )eeks in Hospital #elayang, several

investigations )ere done )hich incl&de lood investigations

like antiody testing and radiological investigation. !fter

one )eek of admission, she )as con9rmed to have #"E and

)as started on oral prednisolone talets x 8 mg andtopical hydrocortisone. #he )as also seen y dermatologist.

?'C&rrent conditionC&rrently, patient is aferile )ith minimal 1oint pain and

resolving malar rash.Other)ise, the systemic revie) is &nremarkale.

Or

Control

0'ollo! ups#ince then she &ndergoes reg&lar follo) &p - monthly )ith

rhe&matology, gynaecology, nephrology and o&tpatient

department of H", physiotherapy every month for the 9rst

- years of diagnosis and ophthalmology ann&ally and

s&pport gro&p.")Change in me#s

3here )as several change in dosage of medications for the

past + years. #he )as initially started on prednisolone

%)eight gain, hyperglycemia, hypertensive retinopathy,

diaetic retinopathy, mood changes, rec&rrent infection,

gla&coma, cataract, moon face, dorsocervical fat pad, oral

candidiasis, acne, hirs&tism, proximal myopathy, easyr&ising, thin skin, striae, epigastric pain


22/39

%)A#mission relate# to illnessOver the past + years, she has een admitted ao&t times

d&e to 0' 4are &p of #"E and -' side eQects of medications

?' rec&rrent infection.

Complication

On f&rther ;&estioning, after several years of illness, she also

had history of hemat&ria, frothy &rine and generali>ed s)elling.

Renal iopsy done and it )as con9rmed that she has l&p&s

nephritis. Her med )as then changed to

cyclophosphamide


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&mrella, thick s&nlock )ith #PF 8, and she re;&ires

tinted screen for her car eca&se she )ill develop

photosensitivity.")Emotion

Initially it )as very to&gh for her to accept the illness.

Ho)ever as time goes y, she is no) positive )ith goodmoral s&pport from her mothers and her s&pport gro&p.

$)inancialIn terms of 9nancial, she receives s&pport from



Summar

&)Acute

(iss 5eelafo, a -* year+old singer )as admitted to H# -

)eeks ago follo)ing episodes of fever and m&ltiple 1oint

pain 0 )eek prior to admission, associated )ith malar rash,

photosensitivity, painless oral &lcer. Imm&nological antiody

)ork o&t )as done and she )as con9rmed )ith #"E.

C&rrently she is doing )ell )ith mild


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#he is doing )ell )ith mild


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/OUT ARTHRITIS

Opening statement

(r(&shidi, a 80AyearAold (alay gentleman, )ho has an

&nderlying hypertension, hypercholesterolemia, and go&ty

arthritis for 0 years, complicated )ith chronic kidney disease,and chronic gastritis )as admitted to H# ? months ago follo)ing

episodes of fever and m&ltiple 1oint pain 0 )eek prior to

admission.

HO'I

0'Explore

He )as other)ise )ell &ntil 0 )eek prior to admission )henshe developed fever )hich )as grad&al in onset,

intermittent in nat&re, )ith no chills or rigors, )arm to to&ch

&t no doc&mented temperat&re, relieved temporarily y

paracetamol.

? days follo)ing the onset of fever, she developed pain over

small 1oints of oth hands and not migrating. 3he pain )as

constant, d&ll aching in nat&re, It )as severe )ith the score

7


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1&ngle trekking, s)imming. #he also does not live in

deng&e+prone area. #he denied any history of tra&ma.

%r&le o&t R!, go&t, septic arthritis, deng&e, P#!'

-'!dmission

For the past - )eeks in Hospital #elayang, severalinvestigations )ere done )hich incl&de lood investigations

like antiody testing and radiological investigation. !fter

one )eek of admission, she )as con9rmed to have #"E and

)as started on oral prednisolone talets x 8 mg and

topical hydrocortisone. #he )as also seen y dermatologist.?'C&rrent condition

C&rrently, patient is aferile )ith minimal 1oint pain andresolving malar rash.Other)ise, the systemic revie) is &nremarkale.

Initial presentation

#he presented 0? years ago )ith - months history of painf&l

s)elling of right )rist. 3he pain )as descried as throing in

nat&re, severe, )orse in the morning and relieved at the end of the day. #he )akes &p very stiQ, and the stiQness lasted for fe)

ho&rs after doing some activity. 3he )rist 1oint )as )arm to

to&ch )ith no skin changes. Pain )as not ind&ced y any

medications or food intake. #&se;&ently, fe) days


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0'ollo! ups#ince then she &ndergoes reg&lar follo) &p - monthly )ith

rhe&matology o&tpatient department of H", physiotherapy

every month for the 9rst - years of diagnosis and

ophthalmology ann&ally.

")Change in me#s 3here )as several change of medications for the past 0?

years. #he has &ndergone trial of penicillamine

%myelos&ppression, oral &lcer, and fatigaility',

s&lfasala>ine %rash, na&sea, myelos&ppression, oral &lcer',

hydroxychloro;&ine %retinopathy, rash' and methotrexate

%oral &lcer, na&sea, myelos&ppression, hepatotoxicity,

pne&monitis', le4&nomide %arava' %na&sea, rash, diarrhea,myelos&ppression', a>athioprine %myelos&ppresion, na&sea,

hepatotoxicity', cyclosporin %g&m hypertrophy, na&sea,

myelos&ppression, renal impairment'.$)Compliance

C&rrently she is on +++++, folic acid, calci&m talet and

vitamin 2. #he is compliant to medications and is on reg&lar

lood test. #he denied any side eQects of medications < shedeveloped +++ and )as told that she had developed several

side eQects related to the medications incl&ding +++.%)A#mission relate# to illness

Over the past 0? years, she has een admitted ao&t -

times d&e to 0' 4are &p of R! and -' change of medication

?' side eQects of medications *' rec&rrent infection. 3he last

admission )as one month ago )ith similar presentation %

other infections' and she )as discharged )ell.

Complication

On f&rther ;&estioning, after several years of illness, she denies

of having < she also had history of chronic dry co&gh and

occasional shortness of reath and chest pain. #he &nder)ent

%high resol&tion' C3 scan, l&ng f&nction tests and )as told that

the illness has no) involved her l&ngs.

-J


28/39

#he also complains of dryness and redness of eyes, and dryness

of the mo&th, and therefore )as prescried )ith arti9cial tears.

#he has rec&rrent fever and history of easy r&ising, she also

complains of early satiety and adominal discomfort.

Ho)ever, no )eakness or n&mness over the lims, loss of sensation, neck pain, and o)el or ladder incontinence.

unction

%)'hsicalFor the past 0? years, this disease has limited her daily

activities, )herey she )as not ale to go o&tside eca&se

she 9nds diGc&lty in climing &p the stairs. #he cannots;&at and re;&ired sitting toilet. !s she )orks as a

hairdresser, she 9nds slight diGc&lty in doing her 1o. #he is

independent in terms of activity of daily living.0)Emotion

Initially it )as diGc&lt for her to accept the illness. Ho)ever

as time goes y, she is no) positive )ith good moral

s&pport from her mothers and her reg&lar c&stomers.1)inancialIn terms of 9nancial, she receives s&pport from



Summar

(adam "im, a *- years old hairdresser )ith &nderlying

rhe&matoid arthritis complicated )ith #1ogren/s syndrome,

peripheral ne&ropathy, p&lmonary 9rosis, anemia, felty/s

syndrome and she is on le4&nomide. C&rrently she is doing )ell

)ith mild


29/39

P#$CHI!3R$ene%alie* n+iet, Diso%*e%

, -7 years old male, an exec&tive oGcer is here today for examp&rposes. He has history of having excessive )orry ao&t daily

living things over the past 0 year d&ration and is &nder ro&tine

follo) &p )ith H#". C&rrently, he has no active complaints

, is an exec&tive oGcer of his o)n company, a perfectionist

%predisposingL' )ho get married at the age of - years old.

Ho)ever, he )as divorced %precipitating' 0 years ago andaccording to him, this is )hen the prolem started.

complaint to have excessive )orry ao&t daily living things.

He is not s&re ao&t the exact detail that ca&sing him to e

)orry %free 4oating', &t it is hard to control the feeling.

F&l9ll D E#I( %? and aove'

lank mind


30/39

3his prolem goes on for ao&t x months %x months', )hen

9nally seek medical attention at H#" in %)henD estimate'.

#everal ix )as done, and he )as told to have anxiety disorder.

He )as referred to psychiatrist H#". He )as then started on

SSmedsSS, and c&rrently he is on SSmedsSS x dosageed!nxiety 2isorder. He is c&rrently on %)hat medication', and thesymptoms is )ell


31/39

panic attack


32/39

feel that the escape might e diGc&lt, or help is not readily

availale if anything happen.

Or

denies of having any fear of eing in certain place alone or at

the place )here escape might e diGc&lt like in the &s or incro)ds.

Other)ise, did not have any dist&rance in sleep, no change in

concentration, no irritale mood, and eing easily fatig&e %@!2'.

3here is no past history of tra&matic event %P3#2', no rec&rrent

intr&sive tho&ght or ehavio&r in response to the tho&ght %OC2'.

He did not have any sx s&ggestive of pyschosis, no 0

st

rank sx,no manic sx and depressive sx. He did not have hx of s&stance

a&se.

3here )as no sx s&ggestive of hyperthyroidism like heat

intolerance, increase appetite &t )eight loss and diarrhea.5ohx

of excessive s)eating, h&nger, do)siness, sei>&re and loss of

conscio&sness.

3his prolem goes on for ao&t ? months, )hen 9nally seek

medical attention at H#".

#everal ix )as done, and he )as told to have anxiety disorder.

He )as referred to psychiatrist in !&g&st -0-. He )as then

started on SSmedsSS, and c&rrently he is on SSmedsSS x

dosage


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)ith agoraphoia< )itho&t agoraphoia )hich f&l9l 2#( *criteria for Panic 2isorder )ith


34/39

He kno)s that the tho&ght came from his minds, and he tries to

stop it ho)ever failed. 3his prolem ca&se signi9cant

impairment in normal ro&tine, social, occ&pational f&nctioning

)here heSSS. 3his also aQect his relationship )here he SSSS.

Other)ise, did not have any dist&rance in sleep, no change inconcentration, no irritale mood, and eing easily fatig&e %@!2'.

3here is no past history of tra&matic event %P3#2', no rec&rrent

intense fear or anxio&sness %Panic d


35/39

f&nction


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said that his )ife has m&ltiple sex&al partners, even d&ring their

marriage.

H also elieve that he is the descendant of people )ho is given

ma/rifat to take care of certain treas&re &ntil ?7 descendant. 3he

ma/rifat also take years of his memory )hich ca&se him cannotrememer m&ch of the details of his life that occ&r efore this.

3his is s&ggestive of grandio&se del&sion.

H ho)ever denies any history s&ggestive of disorgani>ed

speech. H never ca&sed any tro&le to anyone, did not ca&sed

harm and no past hx of s&icide attempt or ideation.

His )eird ehavio&r and tho&ght attract p&lic attention andca&sing diGc&lty among his family memers.3his prolem ca&se

signi9cant impairment in normal ro&tine, social, occ&pational

f&nctioning )here he cannot take care of himself, and need help

from his sister. 3his also aQect his relationship )here he SSSS.

H has the history of a&sing heroin, ho)ever he cannot

rememer the exact timeline, and claimed that it only lasted for

fe) years and he is no) completely cleaned from the dr&gs. Hother)ise did not have symptoms s&ggestive of depressive d


37/39

)ith persec&tory del&sion, tho&ght roadcasting, made aQect

and made volition . 3hese symptoms f&l9l the criteria for 2#( *

for schi>ophrenia. He is c&rrently on %)hat medication', and the

symptoms is )ell


38/39

talks ao&t her oyfriends. 5 claimed that she has m&ltiple

special oyfriend, )ho are all nice to her. (any of them )ere in

love )ith her %grandio&re'. 3here )as history )here 5 sold her

1e)ellery so that she can give the money to her oyfriend

%tho&ghtlessness'. Ho)ever, her sister reali>ed her act and

started to have talk )ith her. !ccording to 5, her sister )as 1ealo&s )ith her )ho has a lot of oyfriends. 5 other)ise denies

any lack of concentration and is not easily distracted.

2I@#P!CE

On f&rther ;&estioning, 5 also feel that there are certain times

)here she have lo) mood, and decreased interest to do things

that she likes )hich are cleaning the ho&se, and take some )alko&tside the ho&se. In those moment of time, she has lack of

energy, &nale to sleep and feel g&ilty ao&t her reckless

ehavio&r )hich ca&se tro&le to her sister and her family. #he

also feel that her presence is not more than a n&isance.

Ho)ever, she still has normal appetite, )ith intact

concentration.

5 also said that she once seen a man )ith )hite roe )aited for

her from o&tside the ho&se. 3he man )as skinny, )ith )hite

eard, saying something that she cannot hear, &t she can tell

that the man )as asking her to come o&t from the ho&se. 3hat

)as the reasons )hy she al)ays going o&t the ho&se )itho&t

telling her sister or her mother. Ho)ever, according to her, none

of her family memers have ever met or kne) that man.Over the past J years, there is m&ltiple admission to the

psychiatric )ard, most of the times is vol&ntary admission as 5

herself kno) )hen is the time that she is not ehaving )ell and

needs help. #he )as prescried )ith medication like those to

control her mood and to help her sleep. #he is compliance to

medication as she said that her sister )ill al)ays look after her

medication.

?


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Her recent episode of mood symptoms lasted for more than a

)eek, )hich involve irritale mood, decrease need for sleep,

talkative, 4ight of ideas and increase in goal directed activity

)here she has a lots of ook that she )o&ld like to 9nish in a

day. #he o&ght the ook y herself, and according to her, &p till

no), she is ale to 9nish ao&t 8 non+9ction novels in a day.

Other)ise, she is doing )ell at home. #he did not have any

mood symptoms, does not ca&se any tro&le, does not involve

in harmf&l activity, no s&icidal ideation and no s&icide attempt.

#he is ale to sociali>e )ith neigho&rs, ale to take care of her

niece, and manage daily ho&sechores )itho&t fail.

5, a *7 years old single, &nemployed lady came today )ith Jyears history of mental illness that s&ggestive of ipolar I

disorder. Her recent mood disorder s&ggestive of manic episode

)herey she complaint of having irritale mood, decrease need

for sleep, talkative, 4ight of ideas and increase in goal directed

activity )hich lasted for more than a )eek. 3his criteriaf&l9l 2#(

* for ipolar I disorder, recent episode manic. Other)ise, she is

c&rrenly )ell, )ith no mood symptoms and good f&nctioning.

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