1 / 42

General Data

General Data. CR 22 year old female Christian Resides in Pasay Housewife Date of birth: December 20, 1988. Chief complaint. According to the patient: “I can’t sleep” According to the son Natruama sa nakita ”. 1.

totie
Download Presentation

General Data

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. General Data • CR • 22 year old female • Christian • Resides in Pasay • Housewife • Date of birth: December 20, 1988

  2. Chief complaint • According to the patient: “I can’t sleep” • According to the son Natruamasanakita”

  3. 1 Patient witnessed stabbing of her brother and shooting of brother’s girlfriend Patient was not harmed during the incident but reports feeling like she was followed 4 days PTA

  4. 1 Difficulty sleeping Anorexia Recurrent thoughts about the event Fears for her life and her siblings lives “Di tayopwedengmagkitabakasinusundan kayo”

  5. 1 Refuses to leave her house or return to the scene of crime Poorly kempt Chest pain and heaviness Epigastric pain “Natutulala”

  6. 1 Brother who was also implicated in the murder was arrested and detained 1 days PTA

  7. 1 On the day of consult Persistence of symptoms led mother to bring CR to the TMC Psychiatric Unit ADMISSION

  8. 1 Review of Systems • General. (-) weight loss, (-) night sweats, (-) changes in appetite CNS (-) headache, dizziness, neck pain, (-) back pain Respiratory-(-) Difficulty of breathing, (-) Shortness of breath, Cardiovascular – (-) No palpitations, (-) easy fatigability

  9. Gastrointestinal: (-) abdominal pain, vomiting • Genitourinary. (-), dysuria, (-) frequency, (-) hematuria • Endocrine: (-) polyuria, polydipsia, polyphagia, (-) heat/cold intolerance • Extremities: (-) edema, joint pains, stiffness

  10. Past Psychiatric History No previous psychiatric consult

  11. Past Medical History • No other diagnosed medical illnesses • No previous hospitalizations • No previous surgeries • No known history of allergies to food or drugs

  12. Alcohol and other substances • Tried smoking • Started this month • Smoked a total of 6 cigarettes • Heavy alcohol beverage drinker • Started last few years of college • 6-7 bottles of beer per session • 3-4 times a week • Took Bangkok Pills erratically for 6 months three years PTC

  13. Family history Diabetes– Mother Schizoaffective Disorder – Mother Depression – sister Hypertension – Father Stroke - Father

  14. Anamnesis

  15. Perinatal History • Patient born full term via NSD in San Juan De Dios • No perinatalcomplications • Planned pregnancy • 2nd out of 9 siblings • Mother was a housewife • Father was an actor and businessman

  16. Infancy and Early Childhood • Patient was close to both parents • No problems with feeding and sleeping • Mother is the primary caregiver • No unusual behaviors were noted

  17. Middle Childhood • Took up elementary at Southville International School • Claimed to have been a quiet and shy child • Honor student • Had many extra curricular activities

  18. Adolescent • Took up college in De La Salle • BS Political Science but later shifted • Remained shy and only went out during her last years in college • Deans lister

  19. Young Adulthood • Met Turkish husband through the internet • Husband was her first boyfriend • Married by age 21 after knowing her husband for 2-3 years • Has been married for 3 years • No children • No previous pregnancies or abortions • Moved to Turkey with her husband and only goes home for 2-3 months a year

  20. Mental Status Examination

  21. Appearance • Patient was seen supine. Well kempt and appropriately dressed. Fair skinned. Tall, average build and attractive.

  22. Attitude towards examiner • cooperative

  23. Speech • Normoproductive • Spontaneous • Goal directed

  24. Mood and Affect • Anxious • Euthymic • Appropriate affect

  25. Thinking • Normal thought process • (-) blocking, tangentiality, no looseness of association, neologisms • (-) delusions, obsessions or compulsions • Still with recurrent thoughts of event and currently still fears for her life

  26. Sensorium • Alert • Oriented to person, place, time • Memory: immediate, recent, recent past, remote memory intact

  27. Insight • Had poor insight regarding her condition

  28. 1 Physical Exam HEENT: (-) anictericsclerae, (-) nasal discharge, no hyperemic tonsils, no neck mass, no palpable nodes,

  29. 1 On Physical Exam Cardiopulmonary: symmetric chest expansion, clear breath sounds NRRR, (-) murmur abdomen: flat, normoactive bowel sounds, non-tender Extremities: full and equal pulses, good color and turgor, spasticity noted both lower extremities

  30. Sensory • No gross sensory deficit on both upper and lower extremities

  31. Salient features • 22M, married, Christian, housewife • (+) witnessed a murder • (+) anorexia • (+) chest pain and heaviness • (+) anxiety • No previous psychiatric history

  32. 1 Diagnosis Axis I: Acute Stress Disorder Axis II: Defered Axis III: None Axis IV: Family Stress Axis V: 61 - 70

  33. Differential Diagnosis: Acute Stress Disorder • (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others  • (2) the person's response involved intense fear, helplessness, or horror 

  34. Differential Diagnosis: Acute Stress Disorder • B. Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:  • (1) a subjective sense of numbing, detachment, or absence of emotional responsiveness  • (2) a reduction in awareness of his or her surroundings (e.g., "being in a daze")  • (3) derealization • (4) depersonalization • (5) dissociativeamnesia

  35. Differential Diagnosis: Acute Stress Disorder • C. The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.  • D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people).  • E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness). 

  36. Differential Diagnosis: Acute Stress Disorder • F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.  • G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event.

  37. Differential Diagnosis: Acute Stress Disorder • H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

  38. Differential Diagnosis: Brief Psychotic Disorder • A. Presence of one (or more) of the following symptoms:  • (1) delusions(2) hallucinations(3) disorganized speech (e.g., frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior  

  39. Differential Diagnosis: Brief Psychotic Disorder • B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.  • C. The disturbance is not better accounted for by a Mood Disorder With Psychotic Features, Schizoaffective Disorder, or Schizophrenia and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. Specify if: With Marked Stressor(s) (brief reactive psychosis): if symptoms occur shortly after and apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture 

  40. Management • Admit patient to psych unit • 1 watcher

  41. Diagnostic Plan • Diagnosis mainly clinical • Routine Labs: • CBC, urinalysis, FBS, cholesterol, SGOT, SGPT, alkaline phosphatase, BUN, Crea, FT3, FT4, TSH, Na, K • Chest x-ray, ECG

  42. Treatment • Clonazepam 2mg tab, ½ tab twice a day • Escitalopram 1 mg tab, 1 tab twice a day

More Related