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CASE PRESENTATBY MEENAKSHI ANANDI KRISHNAN

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PRELIMINARY DATA

Name: C. W. L

Age: 32 year

Race: Chinese

Sex: Male

Social Status: MarriedResidence: Cheras

Brought in by his brother and wife.

Languages known : English and Malay

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CHIEF COMPLAINT

Couldntsleep for the last one week.

Raised his voice against his brother and wife for not giving money on the 31October.

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HISTORY OF PRESENTINGILLNESS

He says he has been unable to sleep for the past one week. He sleeps onhours per day and claims that it is sufficient for him.

When awake, he keeps thinking of his unaccomplished mission.

He wants to invest in business and learn new languages. 3 years back withearned through gambling in Australia( rm.70,000), he spent it in japan to le6 months.

Likes to spend money. He claims that the money he earns he gives it to his

for his daughter. But gets money from her when he needs it.

He also likes spending his money on entertainment like gambling and alsHe kept asking for more money from his brother and wife. When they refumoney, he lost his temper, raised his voice against his wife and brother. Thibring him to the emergency department of HKL.

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PAST PSYCHIATRIC HISTORY

Has been admitted to the hospital at least 10 times. The last one was in ear2014.

He has been always admitted to HKL and once in hospital cheras.

Does not like taking the medicines, as he ends up bedwetting. He has askethe doctor to change the dose or change the medicine.

Forensic history:

Arrested once by police for touching a woman inappropriately. He said he wanted steal rm.10 from the lady, but he was arrested for touching her. He said it happenlong time ago.

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Past medical history

Nil.

Medications and allergies

Cant remember the medicationname. stopped recently, as themedicines caused bedwetting andhe dint like it.

No allergies were reported.

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Sleeping habits:

Usually gets 6-7 hours of sleep during his early days.

But currently he is unable to sleep at night. He sleeps at 12-1am and wakes u

says he cant sleep because his missions haven't been accomplished. I need husband and a good father.

Appetite:

He has a good appetite.

Toilet habits:

Bed wetting because of the medication he was taking. Increased urinary frequenc

symptoms.

Bowel movements normal.

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FAMILY HISTORY

Father was a construction worker and passed away at the age of 55 due toheart attack when he was 20 yrs. old.

Mother was a housewife.

Has a younger brother who is 30 years old and is working.

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PERSONAL HISTORYBirth:

Born via spontaneous vaginal delivery on the 16.10.1982.

Milestones- normal.

School- was a cheerful child.

School drop out at the age of 13, form 2.

Work history:

Worked in japan 3 months- hard core laborer.

Australia- machinery helper.

2014- Thailand 10 days trip HRM.

Religion:

He believes in god but he says it is not necessary to go to temple to pray.

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DRUGS AND ALCOHOLStarted smoking at the age of 13. Started with one pack per day( 7 stickCurrently smokes 20 sticks per day. If stressful smokes 40 sticks per day.

Started drinking alcohol at the age of 13. he was introduced by his fathwith a glass of beer.

Currently drinks 4-5 big cans of beer or 5-7 shots of whisky. If he has mone

he goes to a bar and drink or else drinks at home. Drinks mostly alone.

Started smoking ganja at the age of 13 under the influence of his schofriends. But now, he takes it once in a while, when lonely.

He doesn't feel guilty about drinking and never felt like drinking it as an ey

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MARITAL AND SEXUAL HISTOR

Married 3 months ago. He claims that his wife is a Vietnamese whom he mat a pub.

She is currently pregnant. He is happy in his marriage.

Has previous history of multiple sexual partners.

Japanese, Australian girl friends etc. claims that Malaysian girls don

provide the service he pays for.

Currently no other partner.

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PREMORBID PERSONALITY

Jovial and cheerful person

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PSYCHIATRIC EXAMINATION

He is well oriented to person, place and time.

Memory:

Five minute memory test: the five words given were

(bed/tree/bucket/plate/car)

His recent memory was good. He was able to recollect all the five words.

After 5 minutes, he was able to recollect 4/5.

Able to do simple calculations like 2+2

Intelligence:

It was fair

He was able to answer when asked about the current prime minister of Malays

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Attention and concentration:

When asked to do the serial seven test, he was able to do the first calculation (17=92) and refused to do after that.

He did well in the digit span test.

Judgment: Good.

House on fire scenario: He would run out of the house to safe his life.

Insight:

Partial

He says his problem is unable to sleep and taking the medication helps him sleep

Abstraction:

It was good.

The proverb nopain, no gainwas asked and he was able to answer.

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TREATMENT PROVIDEDT.epilim 600mg

T.risperidone2mg BD

T.clonazepam 1mg ON

T.artane 2mg ON

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Precipitating factor- school dropout/ early onset smoking/alcohol/drug

Predisposing factor- fathers death

Perpetuating factor- alcohol n drug abuse

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DIFFERENTIAL DIAGNOSIS

Bipolar disorder : type 1

Schizoaffective disorder

Substance induced psychosis

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DSM IV TR MULTI AXIALCLASSIFICATION

AXIS I:

AXIS II: Nil

AXIS III: Nil

AXIS IV: Nil

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THANK YOU!!!!