FAMILIAL DI-STRESS: A Family Medicine Approach to an Acute Psychiatrically-ill Patient

1. FAMILIAL DI-STRESS: A Family Medicine Approach to an Acute Psychiatrically-ill Patient Aranjuez, Agustin, Maglaque, Ocampo, Parco, Regalado, Serrano, Tan, Tanbonliong

2. PATIENT INFORMATION • 25 year-old female • Chief complaint: difficulty in sleeping

3. HISTORY OF PRESENT ILLNESS 4 days PTA • witnessed a vehicular accident • involving her brother • resulted in his demise • she was allegedly present during the accident  unharmed • formal police investigation • chest heaviness and epigastric pain  prevented her from fully sharing the incident

4. HISTORY OF PRESENT ILLNESS Interim Admission • difficulty in sleeping (average of 6 hours to around 2-3 hours per day) • decrease in her appetite • attributed to recurrent thoughts of the event • family tried to spend time with each other • CR still remained highly affected  stare blankly into space • neglect her daily • siblings (first family)  own family meetings  further adding to the patient’s stress

5. PAST MEDICAL HISTORY • Unremarkable

6. FAMILY HISTORY • mother  Schizoaffective Disorder • older sister  depression.

7. PERSONAL AND SOCIAL HISTORY • heavy alcohol use • college years • 6-7 bottles 3-4 times per week. • Bangkok pills for weight loss 3 years PTA

8. ANAMNESIS • extended family • father is polygamous • patient’s mother still wanted her children to be close to the father • father formally lives with his primary family • patient’s mother basically functioned as a single parent • much of the family’s finances were still being shouldered by the father. • patient’s schooling was relatively unremarkable, • Husband (Turkish) via the Internet • an online relationship for around 2-3 years  marriage • father did not support

9. BIOMEDICAL ASSESSMENT AND INTERVENTIONS

10. physical and neurological examinations were unremarkable • mental status examination • supine, well-kempt and appropriately dressed for sleeping • tall, with average build and fair-skin • no mannerisms or postural deviations observed • cooperative during the interview • talked in a slow and soft/ whispered voice • speech was spontaneous and normoproductive

11. goal-directed answers • patient’s mood appeared to be anxious, with appropriate affect • denies any perceptual disturbances and suicidal ideation; however, her thoughts are mostly pre-occupied by her brother’s death as she admitted that the scenes were always replaying in her head, especially at night when she is alone

12. fears for her safety as the perpetrators may be following them • patient was alert, oriented to time, place and person • remote, recent past and recent memory was intact • insight regarding her condition was poor as she said that she was in the psychiatry unit for difficulty sleeping • calculation, judgment, fund of knowledge, abstract reasoning was relatively unremarkable as well.

13. Axis I: Acute Stress Disorder • Axis II: Deferred • Axis III: none • Axis IV: murder of brother, family stressors • Axis V: 61-70

14. PLAN • For admission • For psychiatric counseling and therapeutic management