University of Northern Philippines

Tamag, Vigan City, Ilocos Sur

College of Medicine

Psychiatry

The Case of A. G.

Prepared by:
Stephen A. Ujano
II B

Prepared for:
Dr. Johann Yee

March 20, 2016

I. PSYCHIATRIC HISTORY
Date/Time: March 15, 2016 3:20pm
Date of Admission: March 15, 2012
Identifying Data
Patient A.G. is a 26 year-old female, Pastoral Ministry student admitted for the first time
at Tan-Yee Therapeutic Home Care, Psychiatric and Rehabilitation Center. She was born in
Benito Soliven, Isabela on August 22, 1989. She is a Filipino, single, and an affiliate of Born
Again Religion. She currently resides in Vintar, Ilocos Norte.
Referral / Informants: Patient
Chief Complaint:
Agriyawriyaw, haan nak makaturog, haan nak makakakaan, ken kanayon nak madandanagan
as verbalized by the patient
History of Present Illness
15 days prior to admission (February 28, 2012) patient was admitted at Gabriella Silang
General Hospital due to Dengue and Pneumonia.
11 days prior to admission, while resting in her bed at the Medical Ward of the same
hospital, a news came that there is a bomb inside the institution and that all should evacuate
immediately. The patient claimed everybody inside the ward was in disbelief, panicking and
screaming so is she. She was so scared and panicked as well while screaming and running
towards the outside of the hospital. She claimed she thought she was about to die that even as
they already went out, she is still shaking and very afraid.
Since the incident happened, her parents noticed that her behaviour has changed. She
became so vigilant, quieter but often screams without any reason, prefers to stay in her bed,
doesnt like to eat or take a bath, became aggressive, has difficulty in sleeping and goes out of
the house to go to their church to pray in the middle of the afternoon. She also doesnt want to
talk to anyone but mumbles and talks alone sometimes. Her relationship with her family was
very affected because of her behaviours. She was given with a medication (name unrecalled) to
promote sleep but afforded only minimal relief. She shows the same behaviour as soon as she
wakes up. She then wasnt able to do her common activities of daily living and wasnt able to
attend her classes anymore.
Her condition and behaviour remained the same every day that on March 15, 2012, her
parents decided to seek for psychiatric evaluation, and was she subsequently admitted.
She didnt have any prior experience of a traumatic event.
She claims that she doesnt want to go back to Gabriela Silang General Hospital again.
Past History
a. Psychiatric:
No history of previous contact with psychiatric and other services for mental hhealth
problems.
b. Medical:
Admitted at Gabriela Silang General Hospital last February 28, 2012 due to to dengue
and pneumonia. Treatment given was unrecalled.
No history of pregnancy, epilepsy, head injury, or central nervous system infection.
c. Alcohol and Substance:
The patient denies alcohol drinking or any illicit drugs use.

Family History:
No family history of psychiatric illnesses, neurological disorders, suicides, criminal
behaviours, abuse, alcoholism and depression.
Personal and Social History (Anamnesis):
1. Prenatal and Perinatal:
Patient was born premature (7 mos) via normal spontaneous delivery at their home
attended by a midwife. She claims that her mother did not take any teratogenic agents. No birth
complication or congenital defects.
2. Early childhood (Birth through age 3):
Patient was purely breastfed up to 6 months of age and had no feeding or sleep
disturbances. Patient is a very energetic and playful yet quiet girl and had no behavioural or
developmental problems. She is solely taken cared by her mother.
3. Middle childhood (ages 3 to 11):
She is a timid girl but friendly type of person in preschool. She prefers to stay at home
when she has no classes to study. Plays with peers well and has no history of behavioural
problems.
She has no learning difficulties and was a top performing student in the class during her
primary school. Though she claims she was an inconsistent honor student because she lost her
focus in her studies during her intermediate school because she has to work and help at home.
She admits that her parents are strict when it comes to discipline. They were disciplined
through verbal punishments and reprimands or through physical punishments like being slapped
when they do something wrong.
She claims she is afraid of snakes and God.
4. Late childhood (puberty through adolescence):
She had her menarche at the age of 12, regular and consumes about 8-10 pads with 7
days duration. She had no developmental difficulties during her puberty.
She was an inconsistent honor student because of the same reason stated above. She
ranks 2nd when she was 2nd year high school but graduated without honors.
Her friends are mostly girls. She is avoidant when asked about her sexual history and
she said she is shy and refused to talk about it but admitted she had a boyfriend when she was
17 years old.
She often joins pastoral activities of their church and goes to Church every Sunday.
She denies use of alcohol, illicit drugs or cigarettes.
5. Adulthood:
She has been a pastoral minister at their church and still finishing up her degree in
Pastoral Ministry at Bible Truth Institute in Raois, Vigan City Ilocos Sur.
She is still single and is currently not in any mutual relationship.
She is staying at her aunts house in Bantay, Ilocos Sur while taking her degree in
Pastoral Ministry.
She is an active member of the Born Again Religion and serves as a pastor counsel at
their church.
She seldom goes out with friends during weekends and goes home to their house at
Vintar when she has a long vacation but spends most of her time during weekends doing
pastoral duties at their church.
She is avoidant when asked about her sexual history and she said she is shy and
refused to talk about it but admitted she had a boyfriend when she was 17 years old.
She has not been submitted into any legal actions nor done any illegal activities.
She dreams about going home already and make a living. She wants to be engaged
again in their church as pastoral leader but on part time basis. She wants to continue her
studies in pastoral ministry.
She prioritizes her needs first rather that wants. She always put Gods first and a thrifty
type of person.
Current Social Circumstances

Patient stays at Tan-Yee hospital for about 4 years already. She said she currently a
working patient and helps doing some hospital chores like cooking, washing clothes and dishes
and cleaning the hospital surroundings. She spends her spare time making hairbands and sells
it to the students, nurses working in the hospital or relatives of the patients at which is her
source of income while in the hospital. She said she lives in a well-ventilated, clean and sound
room outside of the hospital wards.
Her familys source of income is through farming. Her siblings are currently taken cared
by their parents at home.
She is seldom visited by her relatives at about once every month.
Premorbid Personality
Prior to illness, patient claimed she was an active pastoral ministry leader of their
church. She does household chores, and talks often to her friends and family. She was even
doing well at her school. Although a bit timid type of girl, she has a lot of friends. She is not
aggressive and very polite instead.
II. MENTAL STATUS EXAMINATION (MSE)
General Description
Patient A. G. is an active, coherent and alert 26 year old female, which appears to be
physically fit and healthy. She stands and sits with proper posture, and has medium-built body.
She is well-groomed and with fair complexion. She is also cooperative, talkative and answers all
the questions with ease. She smiles often and doesnt appear to be in distress or anxiety.
Mood and Affect
The patient appears to be not in stress or anxiety. She spontaneously smiles and very
optimistic. Her facial expressions correspond well with her responses. The patient is euthymic.
Speech
The patient speaks in a medium tone of voice and well-modulated. She is talkative and
responds spontaneously to questions with proper answers and is substantial. She is seldom
hesitant, with speech speed at about 2-3 words per second. She speaks with proper accent and
intonation.
Thinking
Patients thought are of the right amount based on answering the questions correctly,
direct to the point and is relevant to the subject. She thinks rapidly but is seldom hesitant.
Perceptions
The patient does not appear to display any behaviours based on actions and speech
indicating hallucinations, illusions, and feelings if depersonalization.
Sensorium and Cognition
Patient is alert and awake. She is oriented to time, place, person, day, year and date.
She spelled the word WORLD forward and backward with ease and performs good in Serial 7s
with 2 mistakes and 7 correct answers. She has a good attention and memory as manifested by
being able to recall the objects presented at 0,3 and 5 minutes interval.
She remembered all of the school she attended before, places she lived in and the
names of her other family members. She performed well ble to answer word problems /
calculations, fund of knowledge. She has an intact abstract thinking.
Scores 27/30 in the Mini Mental Status Exam.
Insight
Patient is now aware that she was admitted because she had a problem with her mental
health. She is not blaming anyone because of her current situation but claims everything
changed as to what she couldve accomplished if she did not get sick because of the bomb
threat she had experienced. She said her parents opted to seek medical consult of her condition
because she wasnt the same girl that they know before, as her behaviour changed drastically.
Nonetheless, the patient is optimistic enough and said she will try to repay what her parents
have sacrificed for her to be cured when she will go home.
Judgement

The patients now understands well the outcomes of the prior changes in behaviours and
its consequences that she is planning to make a living for good once she gets back home. She
has an intact and practical judgement and reasoning.
MULTIAXIAL DIAGNOSIS:
AXIS I: 308.3 Acute Stress Disorder
309.81 Posttraumatic Stress Disorder
AXIS II: V71.09 No diagnosis
AXIS III: None
AXIS IV: Bomb threat experience
AXIS V: GAF = 85 (Current)

MOST PROBABLE DIAGNOSIS:

Acute Stress Disorder
ALTERNATIVE DIAGNOSIS:
Posttraumatic Stress Disorder
MUST-NOT-MISS DIAGNOSIS:
A. Generalized Anxiety Disorder
B. Panic Disorder

TREATMENT OF PROBABLE DIAGNOSIS:

Trauma-focused cognitive-behavioral therapy

-

Family therapy
-

Involves carefully and gradually "exposing" yourself to thoughts, feelings, and

situations that reminds of the trauma. Therapy also involves identifying upsetting
thoughts about the traumatic eventparticularly thoughts that are distorted and
irrationaland replacing them with more balanced picture.

Helps everyone in the family communicate better and work through relationship
problems caused by PTSD symptoms.

Medication
-

To relieve secondary symptoms of depression or anxiety.

Serotonergic antidepressants (SSRIs), like fluoxetine (Prozac), sertraline (Zoloft),
and paroxetine (Paxil).
Mood stabilizers like lamotrigine (Lamictal), tiagabine (Gabitril), and divalproex
sodium (Depakote), as well as mood stabilizers that are also antipsychotics, like
risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole
(Abilify), asenapine (Saphris), and paliperidone (Invega) are useful for those who
suffer from agitation, dissociation, hypervigilance, intense suspiciousness
(paranoia), or brief breaks in being in touch with reality (brief psychotic
reactions).

EMDR (Eye Movement Desensitization and Reprocessing)

Incorporates elements of cognitive-behavioral therapy with eye movements or

other forms of rhythmic, left-right stimulation, such as hand taps or sounds.
These work by "unfreezing" the brains information processing system, which is
interrupted in times of extreme stress.