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PSYCHIATRIC CASE REPORT

Presented to
Dr. Leah Manapat
Faculty of College of Medicine
Mindanao State University
Iligan City

In Partial Fulfillment
Of the Course Requirement
In Behavioral Science

APIPAH D. POLAO

October 30, 2018


PSYCHITRIC CASE REPORT

Submitted by: Apipah D. Polao Date Submitted: October 30, 2018


Place of Interview: Palao, Iligan City Date Interviewed: October 27, 2018
Informant: Patient and friend
PSYCHIATRIC HISTORY

I. Identifying Data

Mr DA is a 23- year old Muslim Filipino IT student currently residing in Tambo,


Iligan City. The Interview took place in a resto in Pala-o, Iligan City with the patient
looking accommodating. The source of information included himself and his friend.

II. Chief Complaint

“Di akn kapigilan a ginawa akn oman ako pkararangitan. Kailangan na milyo
akn so rarangit akn o di sa pd a tao na sii sa ginawa akn” as stated by the patient. /I
can’t stop myself every time I’m angry, and I need to lash it out to other people or
myself.

“Short tempered talaga skanyan a tao. Basta kararangitan na maluk ka dn”


noted by his friend. /He’s really a short-tempered person. He’s scary when he’s really
angry.

III. History of Present Illness

Seven months prior to the consultation, the patient observed that he became very
angry when there is something happened that he doesn’t like or doesn’t go on his way.
Especially when they argue with his girlfriend. He said that when he’s very angry, he
wanted to hurt someone, but he doesn’t want to hurt his girlfriend so he decided to
hurt himself. He said he usually punch or scratch himself to lash out his anger. This
always happen for the succeeding months.

Three months prior to consultation, the patients anger management got worsen,
he said he’s now got angry even with small reason. Even with small action of the
people around him or when he is bad mood or when he cannot make his code. Aside
from hurting himself, he’s now destroying the things around him. He said that he
cannot contain this to himself and need to lash it out, he knew he cannot hurt people
so he started to destroy things. His laptop, cellphone, chairs around him or other
things.
A month prior to consultation, the patient said his mind got black when he was
angry and didn’t know what did he do. He laptop got smash and destroyed totally. His
friend mentioned that he’s very scary when he is mad. He continue to hurt himself and
destroy things around him. His friend said he cannot do anything when he’s mad and
just wait for him to calm down.

IV. Past Illnesses

The patient has no diagnosis of any psychiatric disorder. He has no history of


substance abuse. There was no past hospitalization history.

V. Family History

There was no family of mental illness to the knowledge of the patient. The patient
was born in Paranaque, Manila and raised in Marawi when he was 7 years old. He is
the second child among the four siblings. His parent got annulled when he was in high
school and stayed with his mother together with his youngest brother. But from time
to time he visits his father who’s now residing in Cebu. His mother, 54 years old, is a
government employee at Marawi City. His father is 57 years old, had small business.

VI. Personal History

A. Prenatal and Perinatal


DA was born through normal vaginal delivery at Paranaque, Manila. No
deformities of birth were noted.

B. Infancy and Early Childhood (through age 3)


DA was breastfed until 6 months. His development was at par with his age.
He was raised by both of his parents

C. Middle Childhood (age 3-11)


The patient left Paranaque, Manila when he was 3 years old and live in
Cagayan de Oro for quite a while before living in Marawi where he started his
schooling.
Even as child, he was very shy and had no friends. He was not able to go
outside of the house so he hos playmates were only his siblings especially his
older sister. He usually have video games on his hands at early age and knew a lot
about technologies.
When he turned 12 years old and got exposed to his classmates, he became
more sociable and got friendly. He then started to learn playing guitar.

D. Late Childhood (puberty through Childhood)


When DA entered high school, his self-confidence and social skills got
improved. His parents got annulled during first year high school and caused him
to contained himself thinking no one can understand him, this made him more
inclined to music than to people.

E. Adulthood
i. Occupational History
No Occupation. IT student

ii. Marital and Relationship History


Single

iii. Educational History


DA is still studying at Mindanao State University, Main Campus,
Marawi City with a course IT. He spent most of his time alone or with few
friends during free time.

iv.Religion
He is a practicing Muslim.

v. Social Activity
He has small circle of friends at his college and treated them as mere
acquaintance. His rreal friends are all in different places and often see each
other due to busy schedule. He’s usually at his college or dorm making some
codes or at his house, playing guitar or video games.

vi. Values
The patient may have small circle of friends but he value them more.
He believes that he doesn’t need many friends. He believes that if he’s
right, he needs to make other people understand why he’s right.

MENTAL STATUS EXAM

A. Appearance

Patient is well groomed, well nourished, and fully developed. He has an


average height and is slim. He looks haggard and stressed but is attentive
and accommodating. He is very generous in sharing her case but insists to
keep his name a secret.

B. Speech

He speaks in a manly and serious voice. He talks spontaneously with


normal rate, rhythm, and tone. His speech was coherent and clear.

C. Mood and Affect

Subjective not depressed or irritable

Objective appropriate affect. He has ease in initiating and sustaining


emotional response

D. Thinking and Perception

Form has no flight of ideas. Shows rapid thinking.


Spontaneously speaks. No language impairments such as
incoherent or incomprehensible speech.

Content He thought that he does things when he is angry. There


were no clinical features of psychotic or affective illness.

E. Sensorium

Alertness He is aware of the environment. No clouding of


consciousness. Conscious

Orientatiion oriented to time, place, date, and person


Concentration No disturbance in concentration

Memory good remote, recent past and recent memory. Has good
immediate retention and recall

Calculations Good calculation ability

Fund of capable of functioning at the level of basic endowment:


Knowledge counting, calculation and general knowledge.

F. Insight

The patient acknowledges that he has a problem in his anger management.


He is very much welcoming for an intervention.

G. Judgment

Good social and test judgment

OTHER DIAGNOSTIC STUDIES

Review of Systems

General: (-) weakness, (+) fatigue, (-) weight loss, (-) weight gain

Skin: (-) rashes, (-) itching

Eyes: (+) nearsightedness, (-) eye pain

Ears: (-) hearing loss, (-) ear pain, (-) ear discharge

Nose: (-) nasal discharge, (-) rhinitis

Throat and Mouth: (-) speech difficulty, (-) hoarseness, (-) sore throats

Neck: (-) masses, (-) lymphadenopathy, (-) tenderness

Respiratory: (-) cough, (-) dyspnea, (-) chest pain

Cardiovascular: normal blood pressure, (-) palpitations

Physical Education

General Survey: Well nourished, well developed, conscious, coherent, not in


respiratory distress
Vital Signs: Weight 55 kg. Height 5’4. T 37 degrees Celsius. RR 16/min. PR
78/min. BP 110/80.

Skin: fair skinned, no scars, no lesions, no discoloration, warm to touch, good


skin turgor.

HEENT:

Head: normocephalic, no masses


Eyes: puffy eyelid, anicteric sclera, pinkish conjunctivae, PERRLA
Ears: no discharges, no tenderness
Nose and Sinuses: septum in midline no flaring, no discharges, turbinates not
inflamed
Mouth and Throat: pinkish, dry lips, pinkish oral mucosa, no tonsillar
enlargement
Neck: Supple, no vein engorgement, trachea in midline, no lymphadenopathy

Chest and Lungs:

Inspection: equal expansion, no retractions


Palpation: no masses, no tenderness, equal tactile fremitus
Percussion: resonant all over lung fields
Auscultation: clear breath sounds
Heart:

Inspection: PMI at 5th ICS LMCL,


Palpation: no heaves or thrills
Percussion: CAD not enlarged
Auscultation: regular rate and rhythm, no murmurs

Abdomen:

Inspection: flat, no scars


Auscultation: normoactive bowel sounds, no bruits
Percussion: tympanitic on all quadrants
Palpation: no organomegaly

Extremities: equal palpable peripheral pulses, no edema, CRT<2 seconds

FURTHER DIAGNOSTIC STUDIES

The diagnosis is based on the defining features of IED according to DSM 5.


Based on DSM 5, all of the features of CRSD are present in the patient. This
means that the patient has symptoms consistent with IED.

The DSM 5 does not specify diagnostic rule-outs for IED.


SUMMARY OF FINDINGS

The patient was a 23 year old IT student who has history outburst. Mental
Examination showed that he had no hesitations in sharing his problem. His
thought processes and content were at par with his age. His insight and
judgment were not impaired. His physical examination showed that he was
essentially normal.

The patient has outburst usually triggered when he is under stress. He has a
history of property damage and hurt himself to release his anger.

DIAGNOSIS

The symptoms of the patient coincide with the features of impulsive explosive
disorder. A retrospective evaluation of his symptoms points to anger management.

Diagnostic Criteria

A. Recurrent behavioral outburst representing a failure to control aggressive impulse


as manifested by either of the following:
1. Verbal aggression (temper tantrums, tirades, verbal arguments or fights) or
physical aggression towards property or other individual, occurring trice weekly,
on average, for a period of 3 months.
2. Behavioral outburst involving damage or destruction of property and/or
physical assault involving physical injury against animal or other individual with
in 12 month period.
B. The magnitude of aggressiveness expressed during recurrent outburst is grossly out
of proportion to the provocation or to any precipitating psycho social stressors.
C. The recurrent aggressive outburst are not premeditated and not committed to
achieve some tangible objective
D. The recurrent aggressive outburst cause either marked distress in the individual or
impairment in occupational or interpersonal functioning, or are associated with
financial or legal consequences
E. Chronological age is at least 6 years
F. The recurrent aggressive outburst are not better explained by another mental
disorder and are not attributable to another medical condition

PROGNOSIS
Good prognostic factors: recognizes the problem, willing to undergo therapy,
attempts to remedy the problem

COMPREHENSIVE TREATMENT PLAN (P-TREATMENT)

 Counseling Therapy to held and understand his thoughts and behaviors and to
help the patient learn anger management skills.
 Avoid stressors as much as possible that could trigger his outbursts.
 Suggest physical exercise to help reduce stress that causes him to become angry.