Quirino Memorial Medical Hospital, QC

Dr. Marites Ursula, Psychiatrist, M.D

98 Dagat Drive, Quezon City, Philippines.

MENTAL ASSESSMENT REPORT

Patient Name: Snow White

Age: 15 years-old

Diagnosis: Paranoid Schizophrenia

Snow White, a 15-year old Filipina girl, was disheveled and unkempt upon arrival in the
psychiatric ward accompanied by her mother. She was wearing a dirtied white dress, red slippers
and a white headband. She appeared distressed and looked a bit sleepless. During the interview,
she was restless, frequently changing seats. She was impatient and sometimes rude in her
interactions with the examiner.

During the examination, patient reported that she heard voices whispering to her again as
she woke up unusually early in the morning. She sounded nerve wrecked when she opened up
about the occurrence. Her speech was fragile, pressured, and stuttered frequently as she went on.
She would often get distracted and stop midway through her sentences and stare blankly at the
floor. When the examiner asked her what the voices sounded like, she explained that there were
numerous voices talking to her simultaneously. When asked what gender the voices sounded
like, she mentioned that she could not distinguish, but ascertained that some did not even sound
human. Patient further expounded on her auditory hallucinations where she was described that
the voice of God told her not to eat for 2 days because she was supposedly a “bad person”. When
asked if she thought of committing suicide, she merely shook her head seemingly confused about
the question.

The examiner further probed patient regarding the voices, and on how often she would
hear them. Patient exclaimed that she would hear them speak to her at random times during the
day. She then continued by saying that the voices would often tell her to lock herself in her room
until midnight, and specifically not to listen to anyone but them (the voices). When asked
regarding her relationship with her family; patient did not answer immediately. She stared
blankly at the examiner for around 27 seconds, and then proceeded to explain that she had no
family to begin with. Patient appeared distracted yet again as she spoke, and would stop midway
as she explained further. Patient suddenly became irate saying that the voices began speaking to
her at that moment; she likewise became frantic and had to be held down by one nurse as she
was given a sedative to calm her down. Patient’s judgment, reliability and insight were
significantly impaired.
 Quirino Memorial Medical Hospital, QC
Dr. Marites Ursula, Psychiatrist, M.D
98 Dagat Drive, Quezon City, Philippines.

MEDICAL CERTIFICATE
To whom it may concern,

THIS IS TO CERTIFY that, Snow White, of 19 Quercus Street, South Blue

Heights Village, Brgy Tunasan, Quezon City, was examined and treated at Quirino
Memorial Medical Hospital QC, on the following dates: July 28, 2018, August 25, 2018,
September 28, 2018, October 30, 2018, November 26, 2018 and December 29, 2018
with the following diagnosis:

Aforementioned patient is suffering from PARANOID SCHIZOPHRENIA based

on the routine checkups and examinations. Patient shows auditory hallucinations,
disorganized speech and catatonic behavior.

And would require prescribed medication and further examinations on a monthly

basis as needed.

Attending physician

Dr. Marites Ursula

 Quirino Memorial Medical Hospital, QC
Dr. Marites Ursula, Psychiatrist, M.D
98 Dagat Drive, Quezon City, Philippines.

PRESCRIPTION
1. 500MG Zyprexa [olanzapine] (3x a day for 2 weeks)

2. 1000mg Seroquel [quetiapine] (once a day for 30 days)

3. 250mg Clozaril [clozapine] (3x a day for 30 days)