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Preliminary identification medical card was stolen along with her belongings and so she could not

Name: Selmah binti abdul ghani

Age: 49 years old This is apparently the patient's third admission to HHT and it is due to
worsening of symptoms due to her poor compliance. It all started about a
Race/religion :malay lady
week ago as patient was noted to become increasingly irritable by her
marital status: widowed 9 years ago
sister whom she visits every 2 weeks or so for money. She would get
Occupation: works as a cleaner at multiple places ( JKN, temple, bank), angry very fast if the sister refused to give her money and refused to stay
lives by herself around kt town and does not have a fixed accomodation. with her saying that she has important work to be done in town. Patient
D.O.A : 8/11/2015 ( 10 days ago) regards herself as an important person and claims that she is a minister's
adopted daughter ( Dato Toh) and that he willed a huge company that
D.O.C: 16/11/2015 ( on the 8th day )
profits millions each month to her and appointed her as the manager ever
Source of info: Patient herself and her case files
since she was 15 years old. However, the company was taken over by her
Reliability: quite reliable husband when she got married. But even then she claims that she hold an

Chief complaint : important post and handles outside dealings of the company and even now
they would contact her to sign checks and documents. She also said that
Patient was brought in by the police due to her persistently irritable mood
for more than a week which lead her to become a disturbance to the public the company gives her 6 thousand each month and that she staying at a big
and aggressive behaviour on the day of admission. villa in town .Pt also said that she was married at 17 years old to a rich
man whom gave 1 acre of land worth 30 thousand and a huge banglo as
dowry to marry her. During the time when she was married to her
Patient is a known case of mental illness for more than 20 years diagnosed husband, she claims that some people were jealous and tried to ruin their
in HSNZ and was prescribed with epilim 600mg and risperidone 2mg and marriage and this includes the husband's own brother who tried to kill her
was under follow up at HSNZ but defaulted her treatment since October by using black magic from thailand and even tried to get her husband
last year after her last admission to HHT. Her reason was because her married to someone else. After 23 years of marriage, the her husband

she still has delusions and some of the information she gave was she would sleep for 2 or 3 hours only daily but did not feel tired the next unreliable but she was very cooperative throughout the interview. But now that palpitation. patient has she claims that the policemen are ignorant of her complaints and are bad. being restless. feeling worthless. patient has been going around taking other people's stuff around town and hang out at restaurants. Apparently this has been going on for more many years and during this period when she experienced these symptoms. patient seem to have a strong belief that a group of history of head injury or seizure and denied taking any substance men has been targeting her and repeatedly stealing her belonging like throughout her life. change in bowel habit. however become more of a disturbance to the public as she would wander Due to this. scold random people passing by claiming that it's hers and this eventually lead her to be arrested this time and spit around. Patient also has been giving away On the day of clerking. she ran and react aggressively. husband is still alive and has gotten married to someone else.unremarkable denied having any special powers. handphone and other stuffs and treatened to harm her if she Eventhough. muscle tension. having a subjective feeling of thoughts racing. hot or cold intolerance. having tremor. inable to be ilicited from the patient or her sister who has been contacted thro concentrate. arrest her. Patient was diagnosed with mental illness more than 20 years ago however having loss of ability to feel pleasure from previously pleasurable activity. She was later sent to HSNZ hospital and was later referred to HHT. being easily distractible or being Past psychiatric hx involved in any goal directed activity. She also denied feeling depressed. the patient's condition appeared to be somewhat her money to children passing by and said that for the past 1 week plus stable . place her belonging outside people shop and has moreover as she stole a lady's handbag in front of a bank and when police tried to exhibited psychotic features as well due to her strongs beliefs.having slow thinking . She however Systemic review . being more talkative than usual. . handbag.passed away but the reason could not be elicited as she believes that the She also denied being overly anxious about anything. she is staying in town. Denied hearing voices or seeing abnormal figures. the details on the first episode and what precipitated the illness could not change of appetite or weight. having thoughts of phone and a full proper history has still not been obtained yet. suicide or attempts before. day and had normal energy to carry out her daily activities. fatigue . she was fairly able to take care of herself and go to work chases them.

Otherwise. Adolescent . there is no family history of mental illness. her siblings. substance She is currently staying alone by herself around town with no fixed abuse or suicide. She however does not smoke. learning. She however denies of experiencing any abuse or neglect at the relative's house. Health wise. remarried which eventually lead her to be brought up at her relative's house All of this had come as a rejection for her as her own mother has Past medical and surgical hx abandoned them. She started school at 7.She however has history of admission to HHT twice before. the 3 of them grew was widowed 9 years ago and since then she has lost contact with all her up at their relative's house. one in 2012 ( Past personal history 4 years ago) and another last year in 2014 for similar reasons. working as cleaner at a few places with a low-income of 10-20 ringgit from each place and even that is not stable and depends on how much work she gets. after her mother remarried. On both Infancy :She was born by normal delivery with no complications. good and she gets no support from them. her father died while she was still young and so stopped schooling at 15 years old after inheriting a big company which she she is not sure of the reason and later her mother remarried and left her and had to take care of. Family history Much of the adolescent history was unreliable as patient claim that she According to the patient. with others and had a good relationship with her teacher and enjoyed No past surgical history. both hypertension and diabetes and the brother is well with no known Current social situation diseases. take drugs or alcohol.her older sister has Forensic : She has no forensic history. admission she was kept in the hosp for more than 10 days and each time Childhood: She had no developmental delays but she appears to have an after getting discharged she has defaulted her treatment and did not go for unhappy childhood as she lost a parent at a young age and her mother follow up.Currently her relationship with them is not very children and do not know where they are now. was able to make friends No known chronic medical illness like diabetes. hypertension or asthma. she has 1 older Adulthood: She got married at 17 years old and had 6 children but she brother and 1 older sister. every 2 weeks or so. She is the last one out of three siblings. she goes to her sister's house to ask for money. accomodation. .

polite. attitude: She was a friendly person. (d) Possession Mood : There is no thought insertion. withdrawal or broadcasting. The amount was increased with evidence of pressure of speech however volume and tone was normal. . there were no (b) Flow frequent changing in posture and abnormal movements. Perceptual disturbance relationship: She had good relationship with her family and friends previously. Speech: (c) Content She spoke in malay and his language was relevant and could be understood. cooperative and rapport was easily established with good eye contact. She was friendly.Premorbid personality She says that her mood is normal lately.wearing clean hospital attire. Her reaction time to my questions were however normal. Affect: Habits: She used to be an athele before and liked to played sports. Patient has no hallucination or illusions Mental status examination Thinking Appearance (a) Form Patient is a malay lady who appears to be in his late 40's with moderate height and weight with greying hair at the side was sitting comfortably on her bed with fair hygiene . religion: She had good faith in religion and prayed 5 times a day.

Physical examination Provional diagnosis Patient was average built. He is alert. Immediate. patient has a very poor insight as she does not acknowledge the fact that she has mental illness and is not keen on continuing her treatment or going for follow up after her discharge. He had no medical instruments attached to him and did not appear to be jaundiced or anemic. conscious and well responsive. Weight : 58 kg Judgement Height : 164 cm Physical examination. fair Temperature : 37◦c ( afebrile) general knowledge to his level of education with adequate arithmetic Respiratory rate : 20 breaths per minute skills. recent and Pulse rate : 87 beats per minute remote memory was intact. as well as abstract thinking with good information and intelligence level.unremarkable Summary Insight Overall. place and person. abnormal posture or movements. There Bipolar 1 were no abnormal facial features.Cognition Vital signs Patient is well oriented time. He had good comprehension. . His attention is good as he Blood pressure: 144/87 mmhg was able to do 100-7 substration test up to 5 levels.

Diffrential diagnosis Management .