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Demographic Information. RY 40/M Single Works in the family business Cabanatuan City, Nueva Ecija Roman Catholic Accompanied by sister. Chief Complaint . “May naririnig na boses ”. HPI. 6 years PTA Symptoms: Auditory/Motion-Space hallucinations Ideas of reference (TV)
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Demographic Information • RY • 40/M • Single • Works in the family business • Cabanatuan City, Nueva Ecija • Roman Catholic • Accompanied by sister
Chief Complaint • “May naririnignaboses”
HPI • 6 years PTA • Symptoms: • Auditory/Motion-Space hallucinations • Ideas of reference (TV) • Delusions of persecution • Resulted in sleep problems, inability to work • Consulted with various doctors psychiatrist • Prescribed Fluoxetine (no relief)
HPI • 6 years PTA • Consulted with another psychiatrist • Admission, discharged after one month • Meds: Risperidone 2mg tab OD • After discharge, discontinued meds • Symptoms returned within a month • Readmitted
HPI • 3 years PTA • Non-compliance with meds for 4 months • Symptoms • Ideas of reference • Delusions of persecution • Disturbing dreams • Readmitted
HPI • 1 month PTA • Good compliance with meds and follow-up • Symptoms • Ideas of reference • Delusions of persecution • (-) Hallucinations, sleep, mood problems • Rx: Risperidone 4 mg tab OD, Levomopromazine OD • Advised admission at next follow up
Family History • Youngest of 6 • 3 girls, 3 boys • Was close to his father and brother (5th) • Psychiatric? • Had an aunt who stayed in bed for a long time, eventually managed (unknown diagnosis) • (+) CVA • Mother died in 1997 • Father died in 2001 deeply saddened
Anamnesis • Early childhood (b- 3) • Born full-term via NSD • Had neonatal pneumonia • Denies thumb-sucking, nail biting or object constancy
Anamnesis • Middle childhood (3 – 11) • Earliest childhood memory 6 years • Had a few constant playmates • Went to Chiang Kai Shek College • Had a few friends • Timid • No behavioral problems • Parents were busy, raised by nanny
Anamnesis • Middle childhood (3 – 11) • Religion • Father never went to church, mother occasionally took kids to church • Not very devout • Respects Catholic teachings
Anamnesis • Later childhood (prepuberty – adolescence) • A few friends , neither a leader nor a follower • Not aggressive • No particular favorite subject, no extracurricular activities, no sport • “Normal” grades
Anamnesis • Later childhood (prepuberty – adolescence) • 3rd Year HS: Chiang Kai Shek CollegeCollege of the Immaculate Conception (Cabanatuan) • To help in family business • Fewer friends; acquaintances • Attended prom: stag, but danced w/ a few girls • Tried beer and gin but didn’t liked it • Never smoked • Never used illicit drugs • Always remembers his father’s advice about gambling and vices
Anamnesis • Later childhood (prepuberty – adolescence) • Psychosexual • 1st exposure at 14 – pornographic videos • No significant crushes, never courted a girl • Never had a girlfriend • Respects church teaching: man-woman • Enjoyed watching the show 700 Club
Anamnesis • Went to De La Salle University for college education • Engineering Commerce • Accounting • Beneficial for family business • Had a few friends; didn’t go out very much • Had an “MU” but didn’t do anything about it
Anamnesis • Adulthood • Lost contact with old friends • Always in the company of his brothers • Family business • Father’s advice • Satisfied, likes his life, “no obligations” • Deeply saddened by father’s death in 2001 • Affected his faith • No partner, prefers to stay that way • Sex = obligation • Children = gift, but obligation
Anamnesis • Adulthood • Loves to travel (Europe) • Architecture • Prefers to be in the company of older people • 2004: Paris, Italy • After 1st confinement • (+) auditory hallucinations; didn’t take medications • Confined upon arrival • 2006: Russia, Scandinavia • 2008: Spain, Portugal, Monte Carlo Risperidone • 2010: Eastern Europe • Recently applied for UK visa, denied