Case Presentation

CLIENT
Age: 43 years old
Date of Birth: November 25, 1969
Place of Birth: Balabak, Palawan
Address: M. Dimapilis St. Anuling Lejos I, Mendez Cavite
Gender: Male
Religion: Roman Catholic
Civil Status: Single
Educational Attainment: College Graduate (3 years) Electronic Technology
Occupation: Production Operator (Yazaki)
Referred by: Acute Crisis Intervention Unit
Purpose of referral: For evaluation
Date Examined: November 29, 2012
Date Evaluated: December 01, 2012

Family History

The client lives at Mendez Cavite, he is the eldest son of Mr. xxxx and Mrs. xxx.
The occupation of his mother was a teacher while his father was a police. His father
died 13 years ago while his mother died 7 years ago at the age of 57 and 56. They are
six (6) siblings, his second brother is Mr. xxx, he is a teacher and he has own family.
The third sister of the client is Mrs. xxx , she is the first one who took care of the client
but her mental illness occured after she delivered her second baby. His fourth sister is
Ruby, she is already a widow and her occupation is a manager. The fifth sister of the
client is Lhen, she is an encoder at Makati. Lastly is his youngest sister, Mrs. xxxx,
she is working at Analog Company and she is the one who accompanied the client in
the institution and took care of him. According to the sister of the client, he is much
close to his mother and is able to help her doing household chores as well as with his
other siblings. He is strict, especially when it comes to cleaning the house, because he
wanted their house to be clean and organized. Before, they used to go to church and
at picnic groove to have their family bonding. He is quiet and serious on his family and
he always obeys and follows his parents because he does not want to embarrass
them. According to his sister, their maternal grandmother and his paternal uncle have
mental illnesses. The client has his own room in their house because his mother pities
him and was always worried when the client strays in their house.
Personal and Social History

During the client’s childhood years he is able to play with other children but not
with his siblings, they were not close with each other and his parents are quite strict to
them that they are not allowed to go out sometimes. The client experienced a mild
head injury that he fell into a bike and he had his forehead stitched during the holy
week, a huge knife accidentally fell into his knee and caused him a mild wound. At
school he always joins and participates on school activities, he has awards and his
grades are good that is why he was always in the list of topnotchers at 6 th or 7th place.
The client really likes to give help and follow his parents. The client graduated in
Technological University of the Philippines at Salawag for 3 years with the course of
Electronic Technology and he likes to be an engineer. He graduated at 18 years old
but he was not able to have work immediately. He stayed at their house for almost one
year because he does not have work, but he tried to apply abroad as a seaman,
unfortunately he did not continue it. The client had his first and last work experience at
Yazaki as a production operator together with his cousin and it lasted for almost 2-3
years. The client does not have any conflicts with his workmates. The client was
generous enough to share his salary to his mother and provide some appliances for
their house. He knows how to deal with other people, but he does only have limited
number of friends. The client has history of vices which is smoking and drinking liquors
but only minimal.

History of present illness

It was almost 20 years since the client is suffering from his mental illness,
before he was an Out Patient Department and was a patient of Dr. xxx, at a
Psychiatric Clinic at Trece Martires City, Cavite for 4 years. The client’s first episode
was when he kept on asking his mother if he had a bad odor. He always take a bath
and became conscious to his self even though he does not have a bad odor. There
are some instances that the client try to hurt his sister, because he said that there is
someone that is telling him to do it and he saw that there is some person that was
hugging his sister that is why he hurt it and stabbed it. Another incident that happened,
he hurt and spank the baby of his sister without any reason. The client experienced
electro- convulsive- therapy. The client was able to have follow- up check up,
injections and medications. He always drinks a medicine named leponex 100mg, once
a day before he goes to sleep but sometimes he refused to drink it and he will throw
the medicine because as he perceived its size was seems to be too big. When his
parents died and his third sibling got the same mental illness, the client was not able
to have his check up for almost a year due to his sister’s work that she cannot
accompany the client and because the client seems to be difficult to convince to go for
his check up, but his medicine was still maintained. The client seems to be violet at
times especially when he saw violent scenes in the television that he used to imitate it.
During the time that he does not have his own room, he always walk into different
places within Cavite, but he can still go home after 3 days. In his owned room in their
house, he will pee anywhere, shout, say bad words and his pillow and blanket was
always put into the toilet bowl of the comfort room.
 The client was admitted on November 05, 2012 at this institution. His sister
brought him, because the client was unable to have a proper conversation towards
other people and he cannot recognize such person.

Duration of illness

The client starts suffering from mental illness, almost 20 years and started at
the age of 22.

Behavioral Observations

The client was presented to the tester wearing a green male ward uniform and
pair of rubber slippers. Approximately, five (5) feet and eight (8) inches tall with an
ectomorph body built and slouchy posture. He is bald and has fair skin type, he also
has small stitch on his forehead, his nails are clean and trimmed, and his teeth are
decaying. He can write simple words, letters, numbers and able to write his name.He
can also read and identify shapes and objects. The client has good mathematical
ability, visuospatial ability, and fair general information and memory. His mood is
empty and affect is blunted, and he speaks in a low tone and tend to have eye contact
to the tester. The client is oriented with only two spheres, the place and person. The
client has flight of ideas with poor judgment, insight and reliability. The client has
delusions and visual hallucination such as seeing superstitious individuals and ghost.

During the testing proper, the client seems to behave accordingly and
cooperative with no resistance to take the exams. He knows how to follow instructions
and he performs slowly. He does not easily gets distracted by extraneous stimuli.
Sometimes he fixed his hair and scratch it, his arms were closed, and he fixed himself
to his chair. Tests were finished in one session and commenced tasks with his right
hand.

Tests Administered

Draw A Person
House Tree Person
Bender Visual Motor Gestalt Test
Thematic Apperception Test
The Forer Structured Sentence Completion Test
Revised Beta Examination- Second Edition
Draw A Person

Draw a person test result, shows that the client tends to have a weak
personality. He is an insecure individual that lacks of opinion and his own point of
view. The client may have ego- centric attitudes based on his feeling of inadequacy. It
also appears that the client tends to be alcoholic. He sees the world with a little
discrimination that makes him have withdrawal tendencies. He also have fantasies.

It also appears that the client had low mental functions and lack of confidence
that makes him to have a need to be accepted in his environment. It shows that the
client have sexual concerns such as aging has effects on it. He has inadequate
controls on his basic drives and impulses that flows freely.

House Tree Person

House tree person test, shows that the client have a lack of interest among
other people but he also consider dealing with them in such situations where he act
accordingly to have an acceptable interpersonal relationship toward other people. The
client also feels inadequate in social situations which leads him to have introversive
self absorbing tendency where he becomes aloof. Being open to vulnerability causes
the client to have withdrawal tendencies and may have the possibility of losing his
ability to cope with environmental pressure which may lead him to have possible
aggressive roles within his environment.

It also revealed that the client has to emotional immaturity that makes him have
a lot of fantasies running over his mind as well as having ambivalence and no
consistency in his every course of actions. At times it shows that the client have
feelings of physiological and psychological immobility.

Bender Visual Motor Gestalt Test

Bender Visual Motor Gestalt Test, reveals that the client have difficulties when
it comes to interpersonal relationship with the fact that he prefers to be alone and this
may cause him to have dissociate and withdrawal tendencies. He restricts emotional
insensitivity that may arise within his environment. He may seems to have
disturbances that triggers because of depressive conditions.

It also shown that the client may have possibilities to have hysterical personality
and incipient severe personality disorder that may reflect effort in maintaining
personality against disorganization.
Thematic Apperception Test

Card 1: Nag- iisip kung paano malabasan yan, nag- iisip ng paraan kung paano
makalabas. Si Celyo kapag may nawawala sa bahay sa kanya hinahanap. Nakaalis.
May kamay na naka- hipo sa kanya.
Interpretative Summary: The main hero in the story is Celyo and he wanted to be
away and free from the abused. He seen the figure as a determined person enable to
evade. The client has possibly experienced being abused and his determined to break
away in that situations.

Card 4: Parang snocker na tindahan, napadaan sa ufo ang dalawa, si superman at

body guard na babae nag- hihintay sila na may dumaan at gustong matulog ng
maaga, kinakatakutan ng mga kasama.
Interpretative Summary: The client has flight of ideas and his story is irrelevant on the
plate that had been showed. The main hero in the story is himself and it shows that he
is dependent with others.

Card 6 BM: Si Allan nakatira sa Cambodia, sabi ng lola maramdamin. Nag- papray sa
tabi ng bahay sa kaluluwa at ibang bagay na nasa ilalim. Hindi siya masyado hinipo sa
buhok.
Interpretative Summary: The main hero in the story is himself and it shows that he is
longing for attention but he has tendency of being abused, and he used to supress it.
The client has flight of ideas and his story is irrelevant on the plate that had been
showed. He has delusions and hallucination.

Card 7 BM: Hirap siya na gumalaw sa ospital naranasan niya noong unang panahon
na nag- tubig ang ulo. Nag- hihintay ng biyahe, parang nahuli ng camera sa isang
kwarto. Nag- hihintay din minsan ng makakain tsaka para bang hindi sila pareho mag-
kasama parati.
Interpretative Summary: The main hero in the story is himself and it shows that he he
wanted to be heal, the conception of environment is complicated and his having
difficult to do such movements. He has flight of ideas and his story is not significant on
the plates.

Card 9 BM: Parang nahuli din sa camera, mga cow boy, gumagawa sila ng mga
dinamita, ginagamit sa pag- pasabog sa mga tren. Sumabog siguro ang tren. Nag-
iisip kung saan dadaan kung sa harap o likod nahuli ng aking ama ang kanyang
picture, sumabog si Janngo Herez na tumutulong sa kanilang bayan.
Interpretative Summary: The main hero in the story is himself, he feels that his in the
dangerous situation and he wanted to keep away and save himself. He used his
cognitive todeal with the problem. The thought process of the client is flight of ideas.
Card 10: Madaling tumanda ang bata, pinormula ng kanyang anak ginamitan ng
formula. Siya ay takot na takot kapag hindi nakaluto ang kanyang ina ng tinapay.
Natatakot sa maraming multo kaya hindi makaluto ng tinapay.
Interpretative Summary: The main hero in the story is himself and it shows that he is
afraid to be failed and needs to be strong enough to handle his obstacles in life. The
client has flight of ideas and the story is irrelevant on the plate.

Card 12 M: Kamunti Island nagtatanim, kumain, bulkan na may krus, para gumaling
ang ina. Ang kanyang ina at lola gumaling pero saglit lang dahil umiinom ng gamot.
Interpretative Summary: The main hero are the grandmother and mother that want to
be heal, with the environment it shows care among the family and the conflict that had
revealed is that they are heal but for only a short period of time and the source of the
conflicts is when one of the member of the family has sick. It also shows some flight of
ideas in the story and it is not much appropriate into the plate. The outcome of the
story shown unhappy because they were not able to be heal only for a short period of
time.

Card 13 B: Nag- iisang anak, galing sa super island si Johanna hindi nakatapos ng
abogado. Nakikita ng tikbalang, kamukha, nakikita tuwing tanghalli sa cr namatay
dahil sa prutas, nasirang bahay.
Interpretative Summary: The main hero is a woman namely johanna and her needs is
for achievement, to be graduate but unfortunately it is the source of the conflict
because she feels frustrate when she did not able to finish it. The outcome of the story
is unhappy due to she was not able to fulfil or attain what she wants in life, there is still
a flight of ideas within the story and its not appropriate into the plates.

Card 13 MF: Parang si Peter Parker, nag- tatabi ng gamit papuntang abroad, parang
may napansin siya sa kanyang kwarto bago umalis yung hindi niya natabi yung tape,
mahalaga yun sa kanya dahil bilin sa kanya ng ina na itabi ang tape kapag aalis. Mga
pamilya, makauwe na ang kanyang anak. Lumuluha palagi kapag walang kasama,
simula noong maliit pa. Ipinag- bilin sa mga madre na nag- aral si Elizabeth.
Interpretative Summary: The main hero in the story is himself and it shows that he is
longing for attention and love, he feels sad and alone whenener he was left alone and
supervised by other person. It shows he has some flight of ideas and the outcome of
his story is unhappy.

Card 14: Parang isang masamang kaibigan na sundalo na nalilipatan ng utak, nag
babantay ng bagoong nag- hahanap ng makakasama yata. Parang hindi palagay ang
loob niya sa bahay dahil diyan siya pinatay noong maliit pa sila Peter Parker.
Kasamahan sa trabaho mag- babantay ng kayamanan ni Peter Parker, naloloko sa
bagoong dahil natikman niya sa ibang bansa. Peter Parker dating mahirap na
biniyayaan ng kayamanan ng kapatid.
Interpretative Summary: The main hero in the story is Peter Parker, it revealed that he
wanted to be with somebody, he tends to become doubtful person and paranoid. His
not at ease at all times. The outcome of the story shows unhappy.
Card 18 BM: Nag- mamaster sa drawing, magaling yung mga kamay niya sa pag-
tugtog ng piano at mag- drawing sa kabilang kamay. Siya ay matamlay dahil namatay
yung anak na lalaki natuon sa ilong at bibig.
Interpretative Summary: The main hero in the story is himself, who wanted to achive
his needs in life and he will strive more enable to attain it but he feels not due to the
death of the child. The outcome of the story shows unhappy.

Card 20: May maliwanag na bagay, pero parang puro palibot na itim. Parang allien
swam, lumipat sa ibang katawan. Gusto niyang tignan ang buhay ng kanyang mga
kapatid sa ibang daigdig malaking pangil.
Interpretative Summary: The main hero in the story is himself, he wanted to assure
that his other siblings are in good and stable in lifes, his figure seen as a succorant
who always give help. It also shows some flight of ideas and his story was not
significant to the event.

Card 16: Parang kambal ni superman sa likod, dati silang nakatira sa malayong
probinsya, pinag- hiwalay ng ama ang kambal ni superman nasa ospital baon ng
kanilang ninuno, gustong may maitama sa kapatid. Dati pa namin napuntahan ng mga
kapatid ang magandang lugar malapit sa visaya, ate Natty Vicay Ledia kasama ni
superman sa sasakyan sa tindahan lang sila nag- kahiwalay hiwalay dahil may
gustong bilhin na gamit, hindi nabili dahil mahal. Nagugulat dahil may bagong damit.
Interpretative Summary: The main hero in the story shows that his desire is to feel
love and be with his own family. He does not want to be away and separated to his
family, this situation lead him to feel sad and become weak these results his story to
be unhappy though he has flight of ideas.

Summary:

Based on the integration of all cards, it shows that the he has prominent
ellaborative and interpretative level of the main theme. Most of the outcome of the
story shows unhappy and unrealistic, his thought processes is flight of ideas. The
common conflict that appear in the story is that he cannot escape to his obstacles
were he gets confused and does not know how to deal with it even his trying to work
on it. He also feels failure that no one arounds for him and felt being abandon. It
revealed that the client is a weak, alone, dependent, tends to be paranoid at times but,
he is determined person who always wanted to give help and care.

It also revealed that the client is longing for love, care and attention, with this
lack of love the client possibly depressed and feels neglected because his needs does
not able to meet. It also shows that the client has a big heart whom he always
consider the health of his family and assure that they are well fine. The client possibly
experienced or witness an abused in which he can be aggressive and hurt other
people but his submissive into his family which he obey and follow his parents.
The Forer Structured Sentence Completion Test

Forer Structured Sentence Completion Test revealed that the client shows love
protection and concern towards to his family, he perceived his mother a strong person
and he has distant relationship with his father and wishes to be closer. The client feels
that there is lacking with his family. He always wanted to give help and for all time he
gives consideration for his siblings, his not greedy and selfish person. He wanted to be
sure that his siblings is being cared and protected especially his sibling girls. The
client shared to his siblings all the good things that he had learned and he is able to
teach and help them. In dealing with other people, the client tends to keep away
himself to others but still he wanted to have good relations with other to avoid
conflicts. He is obedient and determined person. He will strive and learn more to be
able to achive what he want in life.

Test also shows that the client has anxiety feeling whenever one of his family
member got sick and he often blame himself when these situation comes to them.
The client feels very sad when his mother passed away, and it lead him to be feel
depressed and frustrated. He tends to escape and repressed his feeling when his in
the difficult situation but he will still try and think some possible solution to deal with it.
He has guilt feelings when he did something wrong that is not accepted in the society
and at times he became suspicious. The client shows some unclear responses
towards love, marriage and sex but he perceived love that it should be given to
everyone and deserve to be love.
Revised Beta Examination- Second Edition

Total Scaled Score: 26

IQ: Less than 60%
Classification: Mentally Deficient

The client has an above average logical reasoning and reflective thinking, poor
planning and visual motor coordination and with impaired abstraction, sensitivity to
details and judgment.
It also revealed that the client has less than 60% IQ level which fall in the
category of mentally deficient.

Psychopathology

CONTRIBUTING FACTORS

Biological Psychological Social Environment

43- Male
Mental Illness (Seasonal)
Has stitch on his forehead
Serotonin is high
Smoking and Alcohols
Conflict with father Joined fraternity, Loner
Failed to have work after graduated Middle family status
Low level of frustration tolerance
Low Self- concept

Symptoms
Aloof Delusions
Social withdrawal Visual Hallucination

Schizophrenia; Undifferentiated type

 The psychopathology shows that these are the contributing factors to the
client’s illness, with the biological it revealed that they have a family history of mental
illness both side of his parents and it only shows that it is hereditary. Another factor
that causes him to have that specific illness is a brain damage because of the stitch
that he had on his forehead. The serotonin of the client is high that resulted him to be
sad and depressed. He has vices such as smoking and drinking alcohols. In
psychological factors it revealed that the client has conflict toward his father, they were
not close to each other as well as to his siblings, there is a lackness of open
communication with them. The frustration tolerance and self- concept of the client is
low which lead him to feel inferior and frustrate while in the social environment
revealed that he is strict serious, quiet person that keeps himself to be alone, and
away in the society. He had prominent delusions and visual hallucinations, his thought
processes is flight of ideas. With these symptoms it shows that the client is evident to
have schizophrenic features under the undifferentiated type.

Test Results and Evaluation

Total Scaled Score: 26

IQ: Less than 60%
Classification: Mentally Deficient

The client’s intellectual functioning falls into mentally deficient. He got an above
average score on logical reasoning and reflective thinking. He scored poor on
planning and visual motor coordination . He got an impaired score on abstraction,
sensitivity to details and judgment.

Integrating the test results, it revealed that the client has difficulty in handling
his own emotions and his thought process is prominent with flight of ideas. He is shy ,
and a quiet person that causes him to have a poor contact with others and be socially
withdrawn. It also shows that he is aloof and dependent in some situations in which he
tends to ask for someone on what decisions he will choose. He is hesitant and no
confidence to himself that lead him to feel inferior and insecure. The client has a good
heart for his family. He wants his family to have a good health that is away from any
sickness because he feels depressed and blame himself when this situation arised.
He is not greedy and selfish, he always give help and care towards to his siblings. The
client assure that his family is being protected and away from any danger. He is a
determined person to achieve his want in life but he tends to become weak when he
feels losing hope. The is longing for the love,care and attention from his parents espe-
cially to father and it resulted him to have feeling of emptiness. The client shows he is
sexually abused or witness an abused that has effect to his personality and to have
poor contact in the reality, he had shown a social withdrawal and depressed.

The ego function of the client is weak, as well as his basic drives and impulses.
He seeks satisfaction and compensation through fantasy. The client is an alcoholic.
He uses repression and supression as his defense mechanism, he has low frustration
tolerance. Social withdrawal, suspicious and schizophrenic are prominent features, as
well as delusions and visual hallucinations.

Psychological Impression

Schizophrenia, Undifferentiated type tendency

Recommendations

 The client must maintain a prescribed antipsychotic medicine for this kind of
illness to ensure that his conditions will not aggravate.
 Possible therapy for the client is the psychosocial therapy. This specifically the
following areas will help the client.
 Illness management skills
 Communication
 Motivation
 Self- care
 Work
 Establishing and maintaining relationships with others

People with schizophrenia can take an active role in managing their own
illness. Once they learn the basic facts about schizophrenia treatment, they can inform
decisions about care. If they are taught how to monitor the early warning signs, they
can learn to prevent relapses. Patient can also be taught more effective coping skills
to deal with persistent symptoms.

Patients who receive regular psychosocial schizophrenia therapy are adhere

better to their medication schedule and have fewer relapses and hospitalizations. A
positive relationship with a therapist or case manager gives the patient a reliable
source of information, sympathy, encouragement and hope, all of which are essential
for recovery.