Davao Medical School Foundation Inc.

,
Medical Drive Bajada, Davao City
College of Nursing

A Case Study On

SCHIZOPHRENIA, PARANOID TYPE
In Partial Fulfillment of the Requirements
In
NCM 105- RLE
Psychiatric Nursing Rotation
INTRODUCTION


Every person created by God are equal; no matter who you are,
what you are, where you from. Having an illness is not a reason
of being discriminated. Everyone must be treated equal.

We are living in a world that is full of unexpected events or
surprises. There are events that everyone is prepared to deal with
it but there are more events that we do not expect to happen.
There are truths that can be found behind everything happened.
Only few people wants to discover what is the truth behind an
event because knowingly, we are afraid of what lies behind us
the sanity of our own insight, about the world we were living in.
Too soon or later, we will discover the truth.




The conceptual framework of our case study focuses on
the investigation of anonymity of our client who had
schizophrenia. Given four (4) days of interaction with
our client, as a responsible nursing student of Davao
Medical School Foundation, this concept will help us to
expand our knowledge and comprehend the different
important facts.


Schizophrenia is a severe mental disorder, characterized by
profound disruptions in thinking, affecting language, perception,
and the sense of self. It often includes psychotic experiences,
such as hearing voices or delusions. It can impair functioning
through the loss of an acquired capability to earn a livelihood, or
the disruption of studies. This is a severe form of mental illness
affecting about 7 per thousand of the adult population, mostly in
the age group 15-35 years. Though the incidence is low (3-1000),
the prevalence is still high due to chronicity. It affects about 24
million people worldwide. Typically, it begins in early adulthood,
between the ages of 15 and 25. Men tend to develop
schizophrenia slightly earlier than women, whereas most males
become ill between 16 and 25 years old, most females develop
symptoms several years later, and the incidence in women is
noticeably higher in women after age 30.


The average age of onset is 18 in men and 25 in women. The
onset is quite rare for people under 10 years of age, or over 40
years of age. The prevalence rate for schizophrenia is
approximately 1.1% of the population over the age of 18 or, in
other words, at any one time as many as 51 million people
worldwide suffer from schizophrenia and it ranked among the top
10 causes of disability in developed countries worldwide.
We accepted the case of JL as our respondent of care for the
reason that his case was challenging and interesting. The
implications of this case study in the three domains of nursing
field, namely: education, research, and practice are wide and
varied.
In nursing education, this case study broadens our knowledge,
specifically of this rotation as regards the maladaptive concept. It
improves our rational capabilities as regards the nature of
psychiatric circumstance and the extra information we had gained
in the period of making this case study.
In the nursing research, this case study is an essential tool for the
succeeding generations of upcoming student nurses, researchers
of psychological and mental illness and the clinical instructors in
order for them to probe upon the nature of the mental illness
and strengthen their knowledge with supportive inputs this has to
offer. This case study can be used as comparison with other case
study to be able to give support in the construction of more
truthful and consistent information.

In the nursing practice, this case study presents ways to manage,
care, and diagnose for clients with this diagnosis. To become an
effective nurse, the knowledge must be used and practiced for the
betterment of a client. In this case study, the use of assessment
tools are covered; Mental Status Examination which is one of the
major tools in psychiatry. It help us to know more the use and
significant of such tool. Using the different tools, it helps us to
know what would be the diagnosis of the client and identify what
kind of behavior is our client manifested. In gathering the
information for this case study, the therapeutic communication
was used, both verbal and non-verbal.
Lastly, the whole experience of Psychiatric Nursing has outfitted
us with skills and knowledge in order to develop into an effective
future nurses, advocating and uplifting the rights and dignity of
those who are mentally and psychologically challenge.

OBJECTIVES
This case study aims to make student nurses gain new
and profound understanding about the process and
impact of mental illness on an individuals health and in
functioning, as well as its management, through the
substantial and comprehensive study. Using the nursing
process as our framework we will be able to make a plan
of care for our chosen client in our four (5) days
interaction with our client.
GENERAL OBJECTIVES
To achieve the above general objective, we formulated the following specific:

1.Establish a helping-trusting relationship with the client and her significant
others;
2.obtain pertinent data from the patient, patients records, family and
informants;
3.set out the family tree, a third generational kind, of our client and
inquisitively point some significant factors that correspond to the existence of
the disease;
4.trace clients health history, which includes the past and the present history
that could have predisposed the client to such condition;
5.conduct a thorough Mental Status Examination of the client to serve as
basis for planning nursing care;
6.present and discuss the clients course in the hospital through presenting
progress notes based on the clients daily activities;



SPECIFIC OBJECTIVES
7.present and discuss several complete definitions of the
diagnosis from different sources;
8.present the actual medical procedures done on the client and
some possible procedures to be done;
9.determine the drug administered to or used by the client, their
actions, side effects, and nursing responsibilities;
10.bring about a differential diagnosis from the observation from
our client and affiliate it with him;
11.impart Nursing Care Plans applicable for the patient;
12.lay out and contend the prognosis of our patient comparing it
with his conditions









SCOPE AND LIMITATION

This study was conducted on March 11-14/ 18-21, 2013, during
our Psychiatric Nursing exposure at SPMC Behavioral Medicine
located at J. P Laurel Avenue, Davao City. We have one subject
for this case study from the Crisis Intervention Unit (CIU) of the
said place. This Nursing Case Study was focused on one patient
residing at F. Torres St., Brgy. 9-A Poblacion, Davao City.
Interaction with the client and his family was limited to three
days. Home visitations were done for three days at F. Torres St.,
Brgy. 9-A Poblacion, Davao City. With a minimum of 30 45
minutes in each interview with the client and 1hour to 1hour and
30 minutes in each interview with the informants. At least 10
informants were interviewed for the said case study, including his
mother and his 2 younger brothers and his neighbors.



The patient was lately diagnosed with Schizophrenia, Paranoid
Type VS. Bipolar 1 manic phase with psychotic features and was
admitted at male ward last March 11, 2013. The information
gathered from both the interview and patients chart included the
patients history of past and present illness, family genogram,
medical management and other. The sources of all this
information in this case study were gathered by means of listed
informants on the succeeding pages.

PERSONAL DATA
Name: JL
Age: 38 years old
Birthday: March 13, 1975
Birth place: Tagbilaran Bohol
Sex: Male
Address: F. Torres Street Barangay 9-A Dvo City
Religion: Jehovahs witness
Ordinal Position: 1
st
/ eldest
Civil Status: Single
Educational Attainment: Vocational Courses
Nationality: Filipino

Fathers Name: Ambostero L.
Occupation: OFW
Educational Attainment: College Level
Mother: Florencia L.
Occupation: Housewife
Educational Attainment: College Level

Siblings:
Jessa Mae
Elsie
Hern
Joey

PATIENTS PROFILE
PATIENTS PROFILE

Hospital Code: 0000509 Hospital Number: 0000001520

Patients Name: J.L.
Permanent Address: F. Torres St., Barangay 9- A Poblacion, Davao City
Birth Date: March 19, 1975
Age: 38 years old
Birth Place: Bohol
Nationality: Filipino
Religion: Jehovahs Witness
Fathers Name: Ambostero
Mothers Name: Florencia
Date of latest Admission and Time: February 24, 2013 / 7: 30 PM
Admitting Physician: Dr. Lacno
Impression: Schizophrenia, Paranoid Type
Admission Diagnosis: Schizophrenic Type VS Bipolar 1 Manic phase with
Psychotic features


OUTLINE PSYCHIATRIC HISTORY
First Admission

Date: 11/21/2005
Time: 4:30pm
Principal Diagnosis: Schizophrenia Undifferentiated
Admitting Physician: Marius Orlando A. Oco, MD
Patient Words: naga libog akong huna-huna
Companions Words: namuak man gud siya ug baso ug salamin
Premorbid Personality:
Patient is a shy type home buddy person. Patient had few several friends and goes out sometimes
alone. Patient took several courses in college but finished only a 2 year course.
Discharge: 12/02/05
Present illness:
Patient was admitted in this institution last 2002 and discharged thereafter with home meds given.
Patient had regular follow up checkup. Patient sometimes claims that he hear voices disturbing his mind. This
was always his complaints and that he has cleared appetite and disturbed sleep. This behavior became
persistent for the past years.
Present condition started about few days PTA when patient was noted to be anxious, always with
disturbed sleep and had auditory/ visual hallucinations. No consult was done until morning PTA patient broke
the mirror in their house and break things such as glasses. Thus patient was brought in the institution for
further evaluation and management
Past Illness: +psychiatric illness
Non- psychiatric illness: no previous hospitalization


Second Admission

Date: 08/23/2006
Time: 6:00 pm
Principal Diagnosis: Schizophrenia Paranoid Type
Admitting Physician: Esper Ann J. Castaneda, M.D
Patient Words: nay naga communicate sa akoa- si RONA
Companions Words: Naa daw nagahunghung sa iya. isog siya tapos dili
mag-inom og tambal.
Premorbid Personality:
-Silent type
-Never been married
-Dili pala barkada
Discharge: 08/31/2006
Time: 3:00pm
Total of Days: 8days

Present illness

Last admitted to this institution last year (2005). Apparently well,
until 1week PTA, when patient had poor compliance to
levopromazine and mother noted changes of patient behavior,
like inability to sleep and started to talk to himself. Also noted to
have auditory hallucinations like commanding him to slap/stab
someone, also hallucinates about RONA, a college batchmate.
4hours PTA, patient still have the above symptoms, patient
became hostile (shouting very loud and throws punches on the
wall)
2 days PTA, patient still have the above symptoms with angry
mood, always mumble bible texts
Past illness: + psychiatric illness admitted last 2005
Non- psychiatric Illness: no previous hospitalization
Third Admission

Date: 07/19/2012
Time: 11:10 am
Principal Diagnosis: Schizophrenia Paranoid
Admitting Physician: Giola Fe D. Ginglasan
Patient Words: Ngano inyo ko gi dala diri, dili man ko buang.

Companions Words: Mag-syagit, dili matulog.
Premorbid Personality: Silent Type; Introvert keeps to himself; Stays at home
Discharge: 7/24/2012
Time: 5:50 pm
Total of Days: 5

Present Illness:
Patient brought in because of lack of sleep; presence of visual and auditory
hallucination. Patient seen talking to himself. Condition noted about a week patient as
behavioral changes characterized by your sleep, mother claims patient was shouting,
singing by himself, poor appetite, and persistence of condition. Prompted parents to
bring patient to the constitution.
Past Illness: + psychiatric illness admitted last 2005
Non- psychiatric Illness: no previous hospitalization

4th Admission

Date of Admission: September 26, 2012
Time of Admission: 8:00 am
Discharge Date: October 9, 2012
Time Discharged: 2:25 pm
Days at Hospital: 13 Days
Admitting Diagnosis: Schizophrenia, Paranoid Type
Companions Words: Nag wild siya

Present Illness:
2 months prior to admission, the pt. was admitted in this institution for
behavioral changes and was discharged improved with risperidone 2mg/ 1 tab, two
times a day. However complied only for a week.
After stopping the medication the patient was again noted to have
behavioral changes like shouting at the people; talking to himself and was also
noted to have decreased sleep with good appetite.
Condition persisted and worsened until the day of admission when the
pt was noted to have hostile episode (hit his uncle without any reason) hence was
brought into this constitution for admission.

Date of Admission and Time: February 24, 2013 / 7: 30pm
Brief History:
Pt. was admitted last February 24, 2013 because of his combative,
hostile behavior, destroying things at home and his attempt to hurt others in the
house.
Impression:
Schizophrenia, Paranoid Type
Patients Words: Nag-agawan lang man gud mi
Companions Words: kung Makita niya iyang igsoon mo siyagit man siya
Premorbid Personality: Pt. was helpful and not involved to any riot in the family
and in the community
Present Illness:
Condition started last 2001; patient had episode of talking to himself,
hallucinations, pt. became paranoid to his environment and episode are on and
off, pt. was brought to this institution for further management and because pt.
was combative, hostile, delusions, hitting others in their house, Pt. was admitted
here 5X due to current behavior.
Past Illness:
Admitted 5X due to psychotic illness.

ANAMNESIS
Informant # 1

Name: Ms. Flor
Address: F. Torres St. Brgy. 9-A Poblacion, Davao City
Age:63/F
Educational Attainment:College Level
Occupation:Housewife
Relationship to patient: Mother
Length of time known to patient: Since birth

INFORMANTS
Apparent understanding of present illness of patient:
Mrs. Flor told us that J.L is a silent type and behave son. J.L was also
described by her mother as a shy yet obedient son. According to her, J.L was
active in their church and he was able to memorize a number of texts and
verses in the bible. She also verbalized that J.L and his siblings were not that
close.

They have this jealousy towards him. According to her, among the 5 siblings, J.L
was the eldest and the closest one to her. She also said that J.L was not engaged
into any vices then until he was in 3
rd
year high school. When J.L was 16 years
old, he was the baker of their bakeshop back in the days. When he was 18 years
old, he already stopped schooling. He had then his own business which is
selling chorizo and while hes lending his product to his costumers houses, at
times he was invited by his friends to have a drink. According to Mrs. Flor, J.L
went to Bohol and then Manila afterwards. After Manila he went back to Bohol.
She also told us that when J.L arrived from Bohol, he was acting strange. He hit
his head with an alho ( the one used to manually pound rice grains ). She said
that J.L hears someone whispering to him that they will beat him. There are
instances that he and his youngest sibling fight. She also told us that J.L was
once sent to jail rather than in the mental institution because they feel
embarrassed when they have a family member who is in a mental institution.


She also said that J.L was taking his medication for about 2 years
without him knowing that he was taking this medication. One day,
according to her, J.L found out that he was taking this medication when
the tablet wasnt properly dissolved in the milk. After he knew it, he
slapped his mothers face. J.L also tends to hurt others. Theres an
instance when he had a fight with his uncle when he punched his
uncles face.


Other characteristics and attitude of informant:

We noticed that Mrs. Simbajon is very accommodating towards
us. She had eye contact with us when answering our questions. She is
also open with the information were asking. We also felt that she really
cares for her son and she feels sad and sorry for the condition of his
son.


Informant #2

Name: Ms. JL
Age: 35/F
Address: Barangay 9A-1 Torres Street, Davao City
Status: Married
Educational Attainment: College Level
Occupation: Housewife
Relationship: Childhood friend/ Neighbor
Length of years know to the patient: 30 years
Date of interview: March 12, 2013

Apparent understanding of present illness to the patient:

According to our informant she knew the patient for a long
time. She said that the patients family is anti social because of
their religion (Jehovahs Witness). She also stated that patient X
was comparable to a normal average person if only he complies
regularly with his medicine. Napasmuhan is the term she
quotes when she asked if she knows the real reasons why patient
X confined erratically at Davao Mental Hospital. At times when
he neglects to take medicine, he starts shouting at their house,
uttering Biblical words and became violent. In their
neighbourhood when the patient is in his normal state of mind
he is approachable and easily to talk with
Attitude and Characteristics of the informant:
During the interview, the informant was never reluctant to answer
the questions that we have asked her. The answers were genuine
and straightforward. She described the patient the way she sees it
whether in hostile behaviour or in his normal state of mind.
Through her depiction of our patient, we knew the positive and
negative traits of the patient.

Informant#3

Name: Ms. A.
Age: 45 years old
Sex: Female
Address: F. Torres St., Brgy. 9-A Poblacion, Davao City
Relationship to the Patient: Neighbor
Length of time known: 30 years

Apparent Understanding to the Present Illness of the Patient:
Miss A. was aware that J.L. was admitted at SPMC Psychiatric ward. She
described J.L as a serious type person and she added that J.L did not want to be
with others and preferred to be alone. Dili siya hilig makihalobilo sa uban
verbalized by Ms. A..Ms. A said that the last time I saw J.L, he was shouting at his
younger brother because J.L believed that his younger brother doing tsimis to
him together with his friends.
Characteristics and Attitude of the Informant:
At the time we saw Ms. A, she was sitting outside their house. As we approach her
she was smiling. She was very open on everything she knew about J.L. She
appropriately answered our inquiries. She was kind and polite.

Informant # 4

Name: Mr. J
Age:
Sex: Male
Status: Single
Address: F. Torres street, Brgy. 9-A Poblacion, Davao City
Relationship to the patient: Younger Brother
Length of time known: Since birth

Apparent understanding of present illness to the patient:

Mr. J is aware that JL was confined at SPMC-Psychiatric Ward. He described Mr.
JL as a loner person. He doesnt like to mingle with other people. He said that Mr.JL
doesnt have friends. naay sariling mundo man nang tawhana gud quoted by Mr.J
when we asked why Mr. JL doesnt have friends, and he added that Mr. JL went to
Taguig, Manila and when hes back home, Mr. J noticed that Mr. JL was acting strange
when he was very violent and keeps on shouting. Mr. J quoted sa uyab-uyab didto nag
sugod na, sige rag hinuktok. He also observed that Mr. JL was talking alone saying
ayaw ko bulagi, muhilak ko, mgpakamatay ko. He keeps on talking whole day and
whole night without sleep for 1 week and keeps on shouting and then laughs. Mr. J
stated that Mr. JL was a spoiled son, and he was able to finish all his five courses. He
also stated that Mr. JL was intelligent. He reads dictionary and bible.

Characteristics and attitude of the informant:

When we asked permission to get some information about Mr. JL, Mr. J
was very
approachable and accommodating. He was very willing to cooperate and
answered all our questions. We observed that he is not withholding
information from us.





Informant # 5


Name: Q
Age: 31/F
Address: F. Torres street, Brgy 9-A, Poblacion, Davao City
Status:Single
Educational Attainment: College level
Occupation: Vendor
Relationship to the patient: Childhood friend
Length of time known to patient: 20 years

Apparent understand of the present illness:

Ms. Q verbalized that Sauna katong bata pa mi, seryoso na jud na sya nga pagkatao. Tagsa
ra man na sya mugawas, diha ra man sya permi sa ilang balay, tapos mag sigeg shagit. She also
told us that Kung naa gani magtapok-tapok nga mga tao, iyahang duulan ug singkahan kay abi
niya sya ang giistoryahan.

Other characteristics and attitudes of informant:

Ms. Q was a very approachable person, when we ask her about JL, she didnt hesitate to
answer our questions. She is also cooperative and very kind to us.


Informant # 6

Name: Ms. JL
Age: 35/F
Address: F. Torres St. Brgy. 9-A Poblacion, Davao City
Status: Married
Educational Attainment: College Level
Occupation: Housewife
Relationship: Childhood friend/ Neighbor
Length of years know to the patient: 30 years
Date of interview: March 12, 2013

Apparent understanding of present illness to the patient:
According to our informant she knew the patient for a long time. She
said that the Patients family is anti-social because of their religion (Jehovahs
Witness). She also stated that patient X was comparable to a normal average
person if only he complies regularly with his medicine. Napasmuhan is the
term she quotes when she asked if she knows the real reasons why patient X
confined erratically at Davao Mental Hospital. At times when he neglects to
take medicine, he starts shouting at their house, uttering Biblical words and
became violent. In their neighbourhood when the patient is in his normal
state of mind he is approachable and easily to talk with.

Attitude and Characteristics of the informant:
During the interview, the informant was never reluctant to answer the
questions that we have asked her. The answers were genuine and
straightforward. She described the patient the way she sees it whether in
hostile behaviour or in his normal state of mind. Through her depiction of
our patient, we knew the positive and negative traits of the patient.

Informant # 7

Name: Ms. SL
Age: 37/F
Address: F. Torres St. Brgy. 9-A Poblacion, Davao City
Status: Single
Educational Attainment: College Level
Occupation: None
Relationship: Cousin
Length of years know to the patient: 38 years
Date of interview: March 12, 2013

Apparent understanding of present illness to the patient:

Since childhood, we were playmates. Me, Jemuel and his brother Jessa
Mae. The whole duration of his childhood he was normal. It started when he
encountered a fight with his mother, and he eventually went to bohol. Bohol-
manila-bohol-manila. Some say he applied and worked for various jobs and
companies there, but he eventually went home to Davao then it all started.
Jemuel grew up without a father because his father is working abroad. He is
not also close with his siblings because Jemuel, being the eldest is mamas
boy. All their mothers attention were directed to jemuel which caused his
siblings to be jealous of him.

Attitude and Characteristics of the informant:
During the interview, the informant was never reluctant to answer the
questions that we have asked her. The answers were genuine and
straightforward. She described the patient the way she sees it whether in
hostile behaviour or in his normal state of mind.

Informant # 8


Name: AD
Age: 27 years old
Address: F. Torres St. Brgy. 9-A Poblacion, Davao City
Status: Married
Educational Attainment: College Level
Occupation:
Relationship: Neighbor
Length of years known:
Date Interviewed: March 12, 2013
Apparent understanding and attitude of the informant:

AD stated that the patient normally stayed at home; he was short
tempered, which caused him to become angry without any evident reason. He
could be asked to do favors and also informed us that he did not have any
enemies and in fact wanted friends. The informant also stated that his
condition would take over at anytime without apparent reason, causing him to
think that he was talked about, especially when he eyes a group in the middle
of a conversation. The patient would also act like he would hit a person.
AD alleged that he just wanted to be noticed.


Characteristics and attitude of the informant:

Throughout the whole interview with AD, he showed no sign of
disrespect or negation. He shared all information he could for this case study.
He was friendly and he never nagged or complained throughout the duration
of the interview.




Informant #9

Name: AB
Age: 40 years old
Address: F. Torres St. Brgy. 9-A Poblacion, Davao City
Status: Married
Educational Attainment: College Level
Occupation:
Relationship: Neighbor
Length of years known:
Date Interviewed: March 12, 2013


Apparent understanding and attitude of the informant:

AB stated that the patient was normal as a child, and that his symptoms
started to appear during his adolescent years. AB informed us that he was the only
one in the family with his condition. AB shared that he would throw tantrums;
screaming, shouting and he also hits family members. She also stated that the
patient would get agitated and angry upon seeing a group of people in
conversation. The informant also mentioned that his behavior and attitude
changed after he came back from Bohol. These observations gave her the
impression that the patient is presently ill because he might have been abusing
prohibited drugs or because of pasmo since he was working for a bakeshop.


Characteristics and attitude of the informant:

Throughout the whole interview with AD, she showed no sign of disrespect
nor did she disclose any nullification. No complaints, neither nagging nor
negative criticisms came from her. She was approachable and participative. She has
allotted information that contributed to this case study.

Informant#10

Name: ME
Age: 45 years old
Address: F. Torres St. Brgy. 9-A Poblacion, Davao City
Status: Married
Educational Attainment: College Level
Occupation:
Relationship: Neighbor
Length of years known:
Date Interviewed: March 12, 2013



Apparent understanding and attitude of the informant:

ME stated that the patient liked making friends, but there are situations
observed where at times he starts fights with other people. He affirmed that
the patient went to Manila and Bohol for a long period of time, had
relationships with women and came back to Davao as a different person. ME
also shared that the patient seemed to be short-tempered towards one of his
brothers. ME disclosed that the police once arrested the patient because he
had a violent tantrum on the street. He stated that the patient used to bake
bibingka and would take a shower right after, the aftermath: pasmo which
he assumed to be one of the causes of his situation. ME also suspects that the
abuse of prohibited drugs and depression led him astray and caused his
present condition.
Characteristics and attitude of the informant:

Throughout the whole interview with ME, he showed no sign of
behavior nor did he divulge null information. Complaints, neither nagging
nor negative criticisms came from him. He was approachable and participative.
He has allotted information that contributed to this case study.




Maternal and Paternal Lineage

The story of the parents of J.L happened in the year 1972. The sister of J.Ls
mother and the brother of his father were couple. Before his parents met, J.Ls
mother had a boyfriend at that time. Thus, his mothers attention was not in
his father. His father made efforts so that his mother could appreciate his
father. His father made an effort to plough the field and other household
chores. The parents and friends of J.Ls father extended their help just to make
her mother appreciate his father .After a number of efforts of courtship, the
mother of J.L. accepted his father. Three (3) months of being in a boyfriend
and girlfriend relationship the two decided to get married. A month after
their marriage her mother got pregnant with J.L.
During the course of pregnancy, her mother felt depressed about the situation
because she thinks that she was too young and she was not yet ready to have
that responsibility. But as time goes by she was able to accept and understand
the situation.


C. Siblings
Our patient,J.L. is the eldest among the Five (5) siblings. He had
three (3) brothers and one (1) sister. Among the five siblings, J.L was the
closest to his mother. Only Joey, his brother accommodated us for an
interview regarding his brothers case since his other siblings were living
outside Davao City.

D. Subjects History
Prenatal:
According to Flor, J.L.s mother had a complete prenatal but
then was not able to take enough her vitamins and supplements during
pregnancy. J.L was delivered at home by his grandmother, who was a
manghihilot. She went a normal pregnancy with J.L. and was delivered full
term without any complications.
Birth:
J.L. was born on March 13, 1975 via NSVD and was
delivered by a manghihilot, and was later attended by a midwife.


Psychosexual History:
J.L was circumcised at the age of 7 years old. He had his secondary sexual
characteristics by obviously by age of 16 when his height and his voice
changed.

Play Life:
During his childhood days, J.L is not fond playing with others because his
mother doesnt allow him that much. When J.L reached teenager he loved to
play basketball together with his friends.

School History:
J.L had been enrolled to Grade 1 at the age of 6. He studied at J.P Laurel
Elementary School from grade 1 to grade 6. During his elementary years he
got special award like most behave. According to Joey,