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    Morpot 21 Sept

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    Tasia Deastuti
    Mrs. T, a 46-year-old male construction worker, was brought to the emergency room displaying symptoms of uncontrolled anger including breaking his neighbor's window and threatening to kill him with a parang. He had been experiencing lack of sleep, wandering, and talking to himself for unknown reasons over the past 3 weeks. His symptoms were exacerbated by a recent fight with his father-in-law and discontinuing his medications regularly. Upon examination, he displayed mood disturbances, auditory and visual hallucinations, and delusions of envy, mysticism, and suspicion. He was diagnosed with paranoid schizophrenia and admitted to the inpatient unit for stabilization and treatment.

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    Morpot 21 Sept

    Uploaded by

    Tasia Deastuti
    31 views41 pages
    Mrs. T, a 46-year-old male construction worker, was brought to the emergency room displaying symptoms of uncontrolled anger including breaking his neighbor's window and threatening to kill him with a parang. He had been experiencing lack of sleep, wandering, and talking to himself for unknown reasons over the past 3 weeks. His symptoms were exacerbated by a recent fight with his father-in-law and discontinuing his medications regularly. Upon examination, he displayed mood disturbances, auditory and visual hallucinations, and delusions of envy, mysticism, and suspicion. He was diagnosed with paranoid schizophrenia and admitted to the inpatient unit for stabilization and treatment.

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    morning report

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    Mrs. T, a 46-year-old male construction worker, was brought to the emergency room displaying symptoms of uncontrolled anger including breaking his neighbor's window and threatening to kill him with a parang. He had been experiencing lack of sleep, wandering, and talking to himself for unknown reasons over the past 3 weeks. His symptoms were exacerbated by a recent fight with his father-in-law and discontinuing his medications regularly. Upon examination, he displayed mood disturbances, auditory and visual hallucinations, and delusions of envy, mysticism, and suspicion. He was diagnosed with paranoid schizophrenia and admitted to the inpatient unit for stabilization and treatment.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    31 views41 pages

    Morpot 21 Sept

    Uploaded by

    Tasia Deastuti
    Mrs. T, a 46-year-old male construction worker, was brought to the emergency room displaying symptoms of uncontrolled anger including breaking his neighbor's window and threatening to kill him with a parang. He had been experiencing lack of sleep, wandering, and talking to himself for unknown reasons over the past 3 weeks. His symptoms were exacerbated by a recent fight with his father-in-law and discontinuing his medications regularly. Upon examination, he displayed mood disturbances, auditory and visual hallucinations, and delusions of envy, mysticism, and suspicion. He was diagnosed with paranoid schizophrenia and admitted to the inpatient unit for stabilization and treatment.

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    You are on page 1of 41

    sunday night shift, 21th September

    2014

    MORNING
    Supervisor
    : dr. Sabar P. Siregar,
    REPORT
    Sp.KJ

    PATIENTs IDENTITY
    Name
    Sex
    Age
    Address
    Occupation
    Marital State

    : Mrs.T
    : Male
    : 46 years old
    : Magelang
    : Construction Worker
    : Married

    RELATIVEs
    IDENTITY
    Name
    :
    Sex
    :
    Age
    :
    old
    Relation :

    Mr.I
    Male
    35 years
    Wife

    Reason patient was brought to


    emergency room

    Patient had symptoms of uncontrolled anger, solve the window of his


    neighbor and takes Parang then said want to kill his neighbor
    Rampage, talking and laughing for unknown reasons, Lack of sleep,
    Wandering around, since 3 week ago

    STRESSOR

    He fight with his father in


    law and
    didnt take the medicines
    regulary

    PRESENT HISTORY
    3 years ago
    May 2012
    Easily to get
    angry
    Suspicious
    to others
    Because
    fight with
    father in law

    Patient
    brought to
    RSJ
    Magelang
    then
    hospitalized
    for a month

    The symptom
    decreased,
    patient could
    work as usual

    PRESENT HISTORY
    2 Years Ago
    (March 2013)
    Patient easily
    to
    get
    anger
    again he want to
    strangle her wife

    Distrubing
    others
    Talked
    by
    herself
    He didnt take
    the
    Rampage
    medicines
    regularly

    Patient brought
    to RSJ
    Magelang then
    hospitalized for
    a month

    PRESENT HISTORY
    2 weeks ago

    6 month
    ago
    He fight
    with his
    father in
    law and
    didnt take
    the
    medicines
    regulary

    Patient easily to
    get anger again
    Distrubing
    his
    neighbour
    and
    others
    Talked
    by
    herself
    Rampage
    Lack of sleep

    Wandering
    around

    DAY OF ADMISSION
    21th

    September 2014

    Brought to
    hospital by his
    wife

    Easily angry
    Talked by herself
    Lack of sleep
    He solve the window
    by him neighboar and
    take parang to killing
    him
    Suspicious his wife
    have affarair
    Wandering around
    His self care is poor

    EARLY CHILDHOOD PHASE (0-3 YEARS


    OLD)

    Psychomotoric (No Valid Data)


    - there were no valid data on which age patient
    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 (No Valid Data)


    - 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 (NO VALID DATA)


    - there were no valid data on when patient started bubbling. (6-9
    months)
    Emotion (NO VALID DATA)
    - there were no valid data of patients reaction when playing,
    frightened by strangers, when starting to show jealousy or
    competitiveness towards other and toilet training.
    Cognitive (NO VALID DATA)
    - there were no valid data on which age the patient can follow
    objects, recognizing his mother, recognize his 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)
    No valid data on when patients 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)
    No valid data on patients emotional.
    Cognitive
    No valid data on patients cognitive.

    LATE CHILDHOOD & TEENAGE


    PHASE
    Sexual development signs & activity
    No valid data on patients sexual development
    Psychomotor
    No data if patient had any
    patient involved in any kind of

    favourite hobbies or games, if


    sports.

    Psychosocial
    No valid data regarding patient psychosocial.
    Emotional history
    No valid data on patients emotional history.
    Communication
    No valid data regarding patient ability to make friends at school
    and how many friends patient have during his school period.

    ADULTHOOD
    Educational History
    he graduated in
    elementary school
    and did not continue
    his study to junior
    high school
    Occupational history
    He is a Construction
    Worker
    Marital status is
    Married

    Criminal History
    No criminal history
    Social Activity
    He is an extrovert
    person and has a
    lot of friends.
    Current Situation
    He lives with wife
    and 2 children but
    when he rampage
    he live with his
    sister

    Eriksons 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

    FAMILY HISTORY
    The patient is the 2nd and has a 3 siblings
    Psychiatry history in the family (-)

    GENOGRAM

    Femal
    e
    Male

    Dead
    Patient

    Divorced
    Live in one
    house

    PSYCHOSEXUAL
    HISTORY
    Patient realizes that he is
    male
    Has interests to male
    His attitude is appropriate as
    a male

    Progression of Disorder
    Symptom
    May,
    2012

    Role Function

    March,
    2013

    Now

    Mental State
    21th September 2014

    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
    Indifferent
    Apathy
    Tension
    Dependent
    Passive

    Infantile
    Distrust
    Labile
    Rigid
    Passive negativism
    Catalepsy
    Cerea flexibility
    Excited

    Emotion

    Disturbance of Perception

    Depersonalization (-)

    Derealization (-)

    Thought Progression

    Content of Thought

    Idea of Reference

    Delusion of grandiose

    Idea of Guilt

    Delusion of Control

    Preoccupation

    Delusion of Influence

    Obsession

    Delusion of Passivity

    Delusion of Persecution

    Delusion of Perception

    Delusion of Reference

    Delusion of Suspicious

    Delusion of Envious

    Thought of Echo

    Delusion of Hipochondry

    Thought of Insertion &

    Delusion of magic-mystic

    withdrawal
    Thought of Broadcasting

    Form of Thought
    Non Realistic
    Dereistic
    Autistic
    Cannot be evaluated

    Sensorium and Cognition


    Level of education
    : Elementary school
    General knowledge
    : not assessed
    Orientation of time
    : Bad
    Orientations of place
    : Good
    Orientations of people
    : Bad
    Orientations of situation : Good
    Working/short/long memory: Not assessed
    Writing and reading skills
    : Not
    assessed
    Visuospatial
    : Not accessed
    Abstract thinking
    : Not accessed
    Ability to self care
    : Poor

    Physical State
    Consciousnes

    : compos mentis

    Vital

    sign :
    Blood pressure
    mmHg
    Pulse rate
    Temperature
    RR

    : 110/80
    :
    :
    :

    91 x/mnt
    36.5
    18 x/mnt

    REVIEW SYSTEM

    Head

    : normocephali, mouth deviation (-)

    Eyes

    : anemic conjungtiva (-), icteric sclera (-), pupil

    isocore

    Neck

    Thorax

    : normal, no rigidity, no palpable lymph nodes

    Cor

    : S 1,2 regular

    Lung

    : vesicular sound, wheezing -/-, ronchi-/-

    Abdomen : Pain (-) , normal peristaltic, tympany sound

    Extremity : Warm acral, capp refill <2

    Neurological exam : not examined

    RESUME
    A man, 48 years old, appropriate
    according to his age
    Reason to be brought to hospital are:
    Easily angry
    Talked by herself
    Lack of sleep
    Suspicious
    Wandering around

    Mental
    Status

    Lack of
    sleep
    Talked by
    herself
    Easily get
    angry
    Suspicious
    Wandering
    around

    -Mood: Disforik
    - Perception: auditoric
    hallucination (+) Visual
    hallucination (+)
    Content of Thought
    Delusion of Envious,
    magic-mystic and
    Suspicious, Thought of
    Insertion
    Form of thought: nonrealistic

    Impairment

    He was not able to


    do daily activities
    and had difficulty in
    sleep. He didnt
    socialize with
    others and still had
    decreased appetite

    Differential Diagnosis
    F20.0 Paranoid Schizophrenia
    F25.1 Schizoaffective Disorder
    Depressif type
    F20.5 Skizofrenia Residual

    Multiaxial Diagnosis
    Axis
    Axis
    Axis
    Axis

    I
    : F20.0 Paranoid Schizophrenia
    II
    : Z03.2 No diagnosis
    III
    : No diagnosis
    IV
    : Problems with the primary
    support group (family)
    Axis V
    : GAF on admission 21-11

    PLANNING
    MANAGEMENT
    Inpatient (hospitalization)
    Patients had Uncontrolled anger, rampage,
    more talking and laughing for unknown
    reasons. He was not able to do daily
    activities and had difficulty in sleep. He
    didnt socialize with others and still had
    decreased appetite since 2 week ago.

    RESPONSE PHASE
    Target therapy : 50% decrease of symptoms
    Emergency department

    Haloperidol
    5mg i.m
    Diazepam
    10 mg i.v (sedative and muscle
    relaxant effects)
    Maintance
    Haloperidol 2x5mg
    Re-assess patient

    REMISSION PHASE
    Target therapy :
    100% remission of symptom
    Inpatient management
    Continue pharmacotherapy: Haloperidol 2x5mg
    Improving the patient quality of life :
    Teach patient about his social & environment
    (interact with his relatives, socialize with his
    neighbors, get a new job, find a hobby to do his spare
    time)
    Outpatient management
    1.Pharmacotherapy : Haloperidol 2x5mg
    2.Psychosocial therapy

    RECOVERY PHASE
    - Continue the medication, control to
    psychiatric
    -Rehabilitation : help patient to find a hobby,
    help patient to interact normally with his
    family and neighbor
    Family education :
    -Explain to his family about patients mental
    disorder and his treatment.
    -Educate his family to support not to exile
    the patient.
    -Ask his family to monitor patients progress
    and make sure the patient takes medicine as
    prescribed.
    Target
    therapy : 100% remission of

    symptom within 1 year.

    THANK
    YOU

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