Identifying Data

61 year old Clarine Hall resides at 22 Walker Terrace Castello Housing Scheme. She is an unmarried Afro-Guyanese. s. Hall is a s!iritualist"#e$erent %$angelist other and is unem!loyed.

Chief complaint:
Com!lains of hearing $oices outside her head in 1&'&

History of Present Illness:

s. Hall com!lains of hearing $oices and reali(ed it )as serious in 1&'&. These $oices )ere outside her head and )ere religious ones. They seem to *e gi$ing her s!iritual ins!iration and in some cases )ere !ro!hetic. The $oices )ould identify themsel$es to her and then gi$e her the message since she recalled a !articular $oice told her a fe) things a*out her daughter and )hen she confronted her daughter it )as true and another $oice kno)n to her also told her the )ay her uncle )ould die and he suffer his fate the e+act )ay the $oice told her. s. Hall *elie$es these $oices are real and ins!irational *ut sometimes thinks it is e+cessi$e. She recall in 1&', after attending the Assem*ly of God church three -./ )eeks consecuti$ely she heard the $oices clearer and more distinct. She )ould also feel )eak and tired and to relief this feeling she )ould ha$e to sto! going to church. Ho)e$er0 if she attends the same church for one )eek or e$en t)o she does not feel sick it only ha!!ens if she attends three )eeks consecuti$ely. Also *ecause of the )ay she felt it has !rohi*ited her from )orking or maintaining a sta*le 1o* for se$eral years. As of 222, Clarine reali(ed that she )as a*out to communicate )ith other !eo!le non$er*ally. She said that sometimes )hen she is !assing someone they might communicate and she )ould re!ly. She *elie$es that this kind of communication is natural. 3n that $ery year she *egan hearing from animals as )ell. She recalled going to !reach )ith her church grou! and remem*ered a dog saying0 4Good morning ladies05 and she re!lied0 4 Good morning r. 6og.5 Clarine also *elie$es the animals are a *lessing to her as she recalled one time that a 7co) fly8 )as on her )indo) !ane and a fe) days later she got money. Another time another 7co) fly8 )as on her hand and she recalled it telling her not to *rush it off0 she did not and a fe) hours later her daughter *rought money for her. She also communicated )ith a donkey that she domesticated and it )as called 7go do)n.8 She told me one time )hen she )as attending to the donkey it told her that it does not like that name and she )as not call it that. She *elie$es that the donkey died 1ust as it )as called *ecause some*ody cho!!ed it and it )ent do)n. s. H feels )eak and sick occasionally es!ecially )hen she is not taking her medication and in this state she )ould hear the $oices $ery distinctly. Also she thinks )hen she is

feeling sick she *etter a*out to !reach and !ray to God. She *elie$es she hears from God more and is a*le to deli$er her message to the congregation *etter and more effecti$ely.

Past Medical/ Personal History:

s. H )as a full term *a*y she had not suffered any serious medical illness in her childhood. She has arthritis and has *een diagnosed )ith this earlier in life0 she is also hy!ertensi$e. She )as anemic during e$eryone one of her !regnancies and had surgery for an o$arian cyst. Clarine has fi$e children each for a different !erson. She has three girl and t)o *oys. She also has ten grandchildren and t)o great grandchildren.

Social History:
She ne$er had a lot of friends )hen she )as young and occasionally )ould go out )ith her sister to a 7dance.8 She !resently does not ha$e many friends and s!ends her time )ith her daughter- in- la) and grandchildren. She ne$er smoked and only consumes alcohol occasionally. As a child she )as an Anglican and attended the St. George8s Cathedral. 9resently she attends the House of #uth: a s!iritual church. Clarine attended nursery and St. Ste$ens 9rimary School. She )as una*le to attend secondary school *ecause of financial reasons *ut )as thought *y her aunt. She has not further de$elo!ment herself in any other field and learnt any skill. When she )as in her t)enties she )orked at a !rintery and later in her life a domestic )orker. She )as also a security guard *ut !resently does not )ork *ecause of the arthritic !ains.

Family History:
Clarine )as the .rd of fi$e children. All her si*lings are ali$e and they communicate occasionally. ;one of her si*lings ha$e any mental illness. Her !arents )ere *oth hy!ertensi$e *efore they died. Her grandmother suffered from arthritis. There )as an aunt )ho )as admitted at the <er*ice 9sychiatric institution. That aunt )as the only other family that Clarine kne) )ith similar mental illness to hers0 ho)e$er0 the aunt died in 1&&1.

Mental Status Examination:

s. H )as clean and )ell ke!t: she )as coo!erati$e and many times $olunteered information. Her !sychomotor acti$ity )as normal. She s!oke normal and logical and )as $ery attenti$e. She listened keenly to my =uestions and res!onded a!!ro!riately. Clarine same ha!!y ho)e$er her thought content is *i(arre and had suicidal ideations. When she )as 16 years old she tried to kill herself *ecause she )as ha$ing !ro*lems )ith her mother. These !ro*lems only seem to occur after her mother ga$e *irth to her t)o younger si*lings. 3n her t)enties )hen she )as !regnant )ith her son she attem!ted suicide *y drinking kerosene oil. She later attem!ted again after she found out that her son8s father )as dating another )omen and she *ecame )ithdra)n. 222> )as the last time she attem!ted to commit suicide. Ho)e$er0 !resently she *elie$es God has a !ur!ose for her since she ne$er died after trying to commit suicide and thinks life is )orth li$ing no). Her thought !rocess )as coherent. She has auditory hallucinations and grandiose delusions. Her 1udgment is good. She is )ell oriented and has good memory since she remem*ers the e+actly time and date things ha!!ened in the !ast. Her intelligence is a$erage.

Diagnosis:
Schi ophrenia

!reatment:
Ta*lets Sodium ?al!roate >@2mg at nights Ta*lets ellaril @2mg once daily at nights

?itamin <1 ta*lets once daily