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Morning Report

FRIDAY MAY 8TH 2015


Patients Identity

1. Name : Mr. S
2. Age : 30 years old
3. Sex : male
4. Address : Batang
5. Job : Unemployed
6. Marital status : Single
7. Ethnicity : Javanese
8. Educational status : Elementary
Family Identity

1. Name : Mr. A
2. Age : 34 years old
3. Sex : male
4. Address : Batang
5. Job : Employee
6. Marital status : Married
7. Ethnicity : Javanese
8. Educational status : S1
Reason brought to hospital

Patient was brought by his brother


because he hit his mother by using a
stick and get easily angry
Progression of Illnes

2014
Patient start to get angry easily and irritable
Patient start to hear voices in his ear and see a ghost
Patient often wander
Patient still able to do ADL
Patient was hospitalized in RSJ Semarang
Progression of Disease

2015
Patient get angry easily, rage often, wander and talk to himself
Patient still can do ADL
4 days ago
Patient feels hard to sleep
Often daydreaming
Easily offended
Easily angry
Talk to himself
Seeing ghost
1 day ago
Patient hit his mother
Day of Admission

Patient was brought by his brother because his brother afraid the
patient can put others in danger
Patient will eat and take a bath only if told to do so
History of Past Illness

Psychiatric Illness
Hospitalized 1 year ago with the same symptom (11 days, patient get
better, didnt control to hospital)
General Illness
Patient has a few episodes of convulsion during infancy (his parent
didnt check to a doctor)
Patient has a retarded mental, known since elementary
Substance Abuse
Patient dont smoke, use drugs or drinks alcohol
Family History
There is no similar illness in the family
Physical Examination

Consciousness :CM, E4M5V6


Vital Sign
BP : 120/90 mmHg
HR : 90/min
RR : 24/min
General physical examination

Head :
normocephali, mouth deviation (-)
anemic conjungtiva (-), icteric sclera (-), pupil isocore
Neck : normal, no rigidity, no palpable lymph nodes
Thorax :
Cor : S1 S2 regular, murmur -, gallop
Lung : vesicular sound +/+, wheezing -/-, ronchi-/-

Abdomen :
flat, abdominal wall//chest wall, normal peristaltic, tympany sound,
tenderness -, mass -, liver, spleen and kidney not papable
Extremity : Warm acral, capp refill <2, edema (-), tremor +
Cranial nerves examination:
CN I : not assessed
CN II : not assessed
CN III,IV,VI : not assessed
CN V : not assessed
CN VII : not assessed
CN VIII : not assessed
CN IX : not assessed
CN X : not assessed
CN XI : not assessed
CN XII : not assessed
Physiological reflex
Upper extremities: not assessed
Lower extremities: not assessed
Pathological reflex
Upper extremities: not assessed
Lower extremities: not assessed
Meningeal sign
not assessed
Cerebellum function
not assessed
Mental State Examination
General appearance
A male, age 30 years old, appropriate to her age, and wearing good cloth, self
grooming enough

Consciousness
Clear

Orientation
Time : good
People : good
Place : good
Situation : good
Behavior
Hypoactive Mutism
Tremor
Hyperactive Acathysia
Floxilation
Echopraxia Tic
Loss of energy
Catatonia Somnabulism
Dischynesia
Negativism Psychomotor agitation
Muscle rigidity
Cataplexy Compulsive
Bradychynesia
Stereotipy Ataxia
Khorea
Mannerism Mimicry
Convulsion
Automatism Aggresive
Dystonia
Command automatism Impulsive
Aminia
Bizarre Abulia
Attitude
Infantile
Cooperative
Distrust
Non-cooperative
Labil
Indiferrent
Rigid
Apathy
Passive negativism
Tension
Stereotipy
Dependent
Catalepsy
Passive
Cerea flexibility
Active
Excited
Mood

Mood:
Euthymic Affect:
Elevated Inappropriate
Dysphoric Restrictive
Euphoria Blunted
Expansive Flat
Irritable Labile
Thought of perception

Halusinasi Ilusi
Auditory (+) Auditory (-)
Olfactory (-) Visual (-)
Visual (+) Olfactory (-)
Gustatory (-) Gustatory (-)
Tactile (-) Tactile (-)
Somatic (-) Somatic (-)
Undeferrentiated (-) Undiferrentiated (-)

Depersonalisation (-) Derealisation (-)


Thought progression
Kuantitas Kualitas
Logorrhea Irrelevant answer
Talk active Incoherence
Blocking Flight of idea
Remming Confabulation
Mutism Poverty of speech
Slow speech
Loosening of association
Neologisme
Circumtansiality
Tangential
Verbigrasi
Perseverasi
Sound association
Word salad
Echolalia
Content of thought

Idea of reference Delusion of grandiose


Preoccupation of being Delusion of control
guilty Delusion of influence
Obsession Delusion of grandiosity
Phobia Delusion of perception
Delusion of persecution Thought echo
Delusion of reference Thought insertion
Delusion of jealousity Thought withdrawal
Delusion of hipochondry Thought broadcasting
Delusion of magic-mystic Cant be assessed
Idea of suicide
Form of thought

Realistic
Non realistic
Dereistic
Autistic
Sensorium and cognitive

Level of education : poor


General knowledge : poor
Orientation of T/P/P/S : good/ good/ good/ good
Working/short/long memory : impaired
Writing and reading skills : poor
Ability to self care : decrease

Patient has a mental retardation


Impulse Control When
Examined
Self control: Enough
Patient response to examiners question: poor

Insight

Impaired insight
Intellectual insight
True insight
A female 36 years,

Symptom: Mental Status : Impairment:

Talking to himself Behavior : Hyperactive, Patient


Irritable. bizzare cannot work
Hit his mother and easily get Attitude : Cooperative, Patient
angry excited cannot
Wandering Mood: Euphoria socialize
Heard voices and see ghost Affect: inappropriate Patient can
Feel like being controlled Perseption: Auditory be a thread
when he hit his mother and visual hallucination to the other
Thought
progression:Blocking,
Flight of ideas,
Patient has a mental retardation incoherent
Content of thought:
delusion of control
Form of thought of :
Non realistic
Insight: impaired insight
Syndrome

Impairment of socialization
Schizophrenia
Delusion of control
syndrome
Auditoric hallucination
Visual hallucination

Sleep disorder Depression


Syndrome
Hyperactive
Euphoria Mania
Syndrome
Diagnosis Banding

F20.3 Skizofrenia Tak Terinci


F25.0 Schizoaffective tipe Mania
Multiaxial Diagnosis
Axis I : R. 69 (diagnosis Axis 1 Tertunda)
Axis II : F.70 RM Ringan
Axis III :-
Axis IV :-
Axis V : GAF 20 - 11
Management Planning

Hospitalization
Angry and rampage without any reason.
He can be a threat to the others
Emergency Department
Inj. Diazepam 10 mg IV
Evaluation for Mental Retardation
Remission phase
Target therapy :
100% remission of symptom
Inpatient management
Risperidone tab 2mg 2x1
Improving the patient quality of life :
Teach patient about her social & environment (interact with
her family, socialize with her neighbor or friends, find a hobby
to do on her spare time)

Outpatient management
Continuation of pharmacotherapy
Psychosocial therapy
Recovery Phase
Continue the medication, control to psychiatrist for at least 1 year
after hospitalization
Rehabilitation :
- Help patient to socialize well with other
- Give social support
- Find a hobby
Family Education
Explain to the family that anyone could have mental disorders
Mental disorders are caused by multifactorial factor, not only by
genetic inheritance
Mental disorders mostly are affected by chemical imbalance in brain
Mental disorders can be controlled by medicines, so it is important to
take the medicines routinely
Treat patient like you treat any other people
Help patient if he should be helped
Dont push patient to understand the family, but his family that has to
understand him
Dont be too emotional to patient
Thank You