Bed Side Teaching

BY : Muhammad Firdaus Bin Shahar Irhamsyah Chairandra Faza

PRECEPTOR:

dr. YASLINDA YAUNIN SP.

PSYC"IATRY DI#ISION MEDICAL FACULTY OF ANDALAS UNI#ERSITY RS! "B SAANIN PADAN$ %&'(

PHSYSIATRIC PATIENTS STATUS

A 35 year old male patient was admitted to RSJ HB Saanin emergency department on 3rd november, 20 3 and escorted by !is "amily and police# $!is patient presented wit! signs s%c! as restlessness, emotionally labile, always being angry wit!o%t reason, tal&ing senselessly, s%spicion towards !is "amily members and %sing violence to !is %ncle since aro%nd one wee& be"ore getting admitted to t!e !ospital Patients identity: 'ame *ender Age )arital stat%s Address Religion 2iti3en Race Internal Status *eneral appearance Blood press%re /%lse rate $emperat%re 2ardiovasc%lar system 7igestive system Speci"ic disorder ( ( ( ( ( ( ( 2ompos )entis 30.40 mmHg 40 5 per min%te 36,5 2 'o disorders "o%nd 'o disorder "o%nd 'o disorder "o%nd + ( )r $ ( )ale ( 35 years old# ( )arried wit! c!ild ( Jalan Jati ,amp%ng Jao no - R$ 03.05 /adang ( 1slam ( 1ndonesian ( )inang&aba%

0cc%pation and Sc!ool ( Secondary sc!ool, trader

Neurological Status *2S 5, p%pil re"le5 positive, corneal re"le5 positive 'o meningeal signs, no signs o" increased intracranial press%re 2ranial nerves )otoric ( ( 'o disorders "o%nd 8%ton%s, 8%trop!ic, no disorder, )%scle strengt! 9s%perior e5tremity 555.555, in"erior e5tremity 555.555 Sensibility Speci"ic disorder ALLOANA NESIS :as done on ;t! 7ecember 20 3 Alloanamnesis obtained "rom patients in law( 'ame Age ( Syams%l Ba!ri ( 5; years ( Jl#Jati &ampong <ao no - R$ 03.05 /adang ( secondary sc!ool ( ( 'o disorder "o%nd 'o disorder "o%nd

Address.$elep!one :or& = 8d%cation

Relation wit! patient ( inlaw !" ain reason o# Hos$itali%ation $!is patient presented wit! signs s%c! as restlessness, emotionally labile, always being angry wit!o%t reason, tal&ing senselessly, s%spicion towards !is "amily members and %sing violence to !is %ncle since aro%nd one wee& be"ore getting admitted to t!e !ospital Present co&$laint o# Illness /atient classi"ied as Healt!y wit!o%t any complaint '" History o# Illness Year '(() >)ont! %nidenti"ied? /atient got separated wit! !is "amily > one son and wi"e ? beca%se , !is wi"e t!o%g!t !e !ave mental problems , patient always angry w!en people dont believe wit! !is belie"s#
3

He always %sing violence to !is "amily w!en , !is "amily said t!at !e !ave mental problems# Year '(!( *&ont+ unidenti#ied, $!e patient started !earing voices w!ispering at !im# He started going o%t again wit!o%t any p%rpose and reason# And "o%g!t !is %ncle , and !e always %ses violence in people w!o b%lly t!e wea&# Year '(!- * arc+ till Present, $!e patient started getting angry wit!o%t any reason, always goes on rampage, tal&s to !imsel", !e pray to someone so !is "at!er may die# And so a"ter a co%ple o" mont! !is "at!er died beca%se , o" vomiting# He was !appy w!en !is "at!er died and didnt "eel g%ilty# He also "o%g!t wit! !is wi"e beca%se o" economic problems# Pre&or.id History 1n"ant 2!ild!ood Ad%lt ( born spontaneo%sly, birt! was assisted by midwi"e, no !istory o" <a%ndice, cyanosis, or sei3%re# ( growt! and development s%itable "or !is age# ( doesnt !ave "riends ( completed primary sc!ool Adolescence ( !ad some "riends, b%t start to wit!draw "rom comm%nity -" Educational /ac0ground /rimary Sc!ool 1" 2or0 +istory /atient is a merc!ant 3" arital status /atient separated wit! !is wi"e# He !as a c!ild "rom !is marriage 4" Socio econo&ic status @ives wit! !is in laws in a permanent !o%se, good electricity and water reso%rces, wit! a color $A and motor ve!icles# Secondary sc!ool ( completed secondary sc!ool

5" 6a&ily History

$!ere is no person in t!e "amily trees w!o !as t!e same clinical "eat%res li&e patient

7ra$+ic o# illness course

Bears
2009 2010 January Decemb 2013 2013

Su&&ary o# P+syciatric E8a&ination

I" 7eneral A$$earance ( compos mentis ( cooperative ( active ( good ( can tal&, clearly and "l%ently ( can be done, appropriate, long eno%g! ( present ( present
5

2o%ncio%sness Attit%de )otoric Cacial e5pression Aerbali3ation /!ysic contact Attention 1nitiative

II"

S$eci#ic Condition A# A""ective # A""ective condition 2# 8motional ( a# Stability b# 2ontrol c# 8c!t.%nec!t d# 8in"%l%ng e# 7eep.s!allow "# 7i""erentiation scale g# 8motional "low B# 1ntellect%al condition o" "%nction a# )emory b# 2oncentration c# 0rientation ( ( ( eno%g! eno%g! time orientation good, special and persons orientation good d# ,nowledge e# 7iscriminative insig!t "# 1ntelligence prediction g# 7iscriminative <%dgment ( ( ( ( %ndetermined not dist%rbed average not dist%rbed ( ( ( ( ( ( ( stable controlled ec!t adeF%ate deep broad "ast ( Hypertym

2# Sensation and perception abnormalities # 1ll%sion 2# Hall%cination Aco%stic Ais%al ( ( ( ( e5ists e5ists
6

none

0l"actory $actile *%statory 7# $!o%g!t process condition # Speed o" t!o%g!t process 2# G%ality o" t!o%g!t process( a# 2lear and s!arp b# 1nco!erent c# Sperr%ng d# Hemm%ng e# Clig!t o" ideas "# Aerbigeration g# /reservation 3# $!o%g!t condition a# 2entral pattern b# /!obia c# 0bsession d# 7el%sion e# S%spicion "# 2on"ab%lation g# Rep%lsion !# 1n"erior "eeling i# )%c!.little <# Ceeling g%ilty &# Hypoc!ondria

( ( (

e5ists e5ists none

clear and appropriate

( ( ( ( ( ( (

clear and s!arp none none none present none none

( ( ( ( ( ( ( ( ( ( (

none none none e5ists e5ists none none none m%c! none none
7

l# 0t!ers

none

8# 1nstinct%al drive and be!avior abnormalities a# Ab%lia b# St%por c# Rapt%s.imp%lsivity d# 85citement state e# Se5%al deviation "# 8c!opra5ia g# Aagabondage !# /yromania i# )annerism <# 0t!ers &# C# 0ver an5iety *# Reality testing ability "eelings ( ( none dist%rbance in be!avior, t!o%g!ts, and ( ( ( ( ( ( ( ( ( ( none none none none none none e5ists e5its none none

ULTIPLE A9IS RESU E

A5is # 2linical syndrome $!e patient was restless, emotionally labile, always being angry wit!o%t reason, t!reatened !is "amily, tal&ing senselessly, s%spicion towards !is "amily members since aro%nd one wee& be"ore getting admitted to t!e !ospital /!yciatric e5amination *eneral condition( compos mentis, cooperative, !yperactive, verbali3ation is clear and s!arp,tal&ative, psyc!ic contact good, appropriate, long eno%g!# Speci"ic condition (
8

# A""ective condition( !ypert!ym, stable, ec!t, 2# 1ntellect%al condition o" "%nction( memory good, good concentration, time orientation is good, &nowledge is di""ic%lt to eval%ate, discriminative insig!t dist%rbed, intelligence average, discriminative <%dgments dist%rbed# 3# Sensation and perception abnormalities( no ill%sion# ;# $!o%g!t process condition( "ast, clear and s!arp, circ%mstantial present, del%sional, s%spicio%s# 5# 1nstinct%al drive and be!avior abnormalities ( no dist%rbance 6# 0ver an5iety H# Reality testing ability ( none ( no dist%rbance in be!avior, "eeling and t!in&ing

A5is 11# /ersonal disorder and mental retardation disorder /ersonality disorder ( none )ental disorder ( none A5is 111# *eneral medic condition 'o !istory o" !ead tra%ma , or malaria w!ic! needed !ospitali3ation# A5is 1A# /syc!osocial stressor and environment 'one A5is A# *lobal assessment "%nctional Social( li&es s!opping and going o%t at nig!t 7aily Activity( no dist%rbance# @eis%re. recreational activity( no dist%rbance# ulti$le A8is diagnosis 1 # C#20#0 Sc!i3op!renia /aranoid 11# 'o 7iagnosis 111# 'o 7iagnosis 1A# Separated "rom !is wi"e and c!ildren, being %nderestimated by !is "amily# A # *AC ; I50
9

:i##erential diagnosis
Sc!i3op!renia Simple5 Sc!i3oa""ective

T+era$y
I I I 2/J 3 5 2 K 00mg Risperidone 2 5 $H/ 2 5 2 K 2mg K 2mg

Prognosis
2linical C%nctional Social ( d%bia ad malam ( d%bia ad malam ( d%bia ad malam

10

AUTOANA NESIS

Pertanyaan Selamat pagi, &ami do&ter m%da Cirda%s dan do&ter m%da 1r!am, bole! &ami bertanya 9 tanya sedi&itL 'amanya siapaL Berapa %m%r $ediL ,enapa $edi datang &esiniL

;a<a.an 1ya bole!#

Inter$restasi ,ooperati"

$edi 35 ta!%n
Saya perna! berteng&ar dengan om saya &arena dia tida& percaya dengan 1nterpool , &arena it% dia melece!&an saya , dan memb%at saya emosi dan saya mem%&%l dia

0rientasi wa&t% bai& 0rientasi sit%asi bai&

Siapa bawa bapa& &esiniL Bapa& ta% dimana se&arangL S%da! berapa lama bapa& disiniL 1ni &ali &eberapa $edi dirawat disiniL )en%r%t $edi, wa<ar g& dirawat disiniL Bapa&, perna! meli!at bayangI bayangL /erna! mendengar bisi&anL

Sama polisi dan &el%arga 7i r%ma! sa&it# ,iraI&ira b%lanla!# >$erdiam? s%da! ; &ali# Saya 1nterpol, %da! sering &esini# ,ala% sa&it,wa<ar la# $api saya s%da! ma% semb%! &o&# Ba, sering# Ada bayang la&i# Ba, ada bisi&an la&iIla&i mengata&an saya 1nterpol, dan saya !ar%s memb%n%! terroris di Ace!# /erna! d%l%# Ba% b%s%&, tapi se&arang s%da! tida& ada# Sering, tapi saya melawan bali&, dan orangnya %da! saya b%n%!# Biarin a<a, ata% saya &asi &e s%ster# B%&an p%nya saya#

0rientasi personal bai& 0rientasi tempat bai&

7iscriminative insig!t bai& Hal%sinasi Ais%al ada Hal%sinasi a&%sti& ada

/erna! menci%m ba% b%nga, &emenyan ata% ba% b%s%&L /erna! rasa dice&i& ole! orang, tapi tida& ada orangnyaL /a&, pada bapa& &alo &etem% H/ b%&an p%nya bapa&, apa yang bapa&

Hal%sinasi ol"a&tori%s ada Hal%sinasi ta&til ada 7iscriminative <%dgement bai&

11

la&%&anL Bapa& sering merasa c%rigaL )isalnya sama orang yang tida& di&enal ata% ma&anan,ta&%t di&asi rac%nL ,ini, bapa& merasa <adi orang !ebatL

Ba, d%l% saya sering c%riga ada mataImata dari A%stralia sama

:a!am &ec%rigaan ada

*A), mere&a terroris# Ba, saya interpol, dan saya !ar%s :a!am &ebesaran men<aga &eamanan 1ndonesia dari terroris# 1t% d%l%, tapi &ini <iwa interpol masi! ada# Ba, d%l% sering, sampai &el%arga mencari saya# Ba, saya 1nterpol, saya bisa p%lang sendiri ada

Bapa& perna! <alanI<alan sendirian, tanpa t%<%an sebel%m dirawat disiniL

&er%ma!# Bapa& perna! memba&ar ata% merosa& Ba,# 7an saya ada ilm% dari api# barang dir%ma!L Saya ada ilm%, &ala% saya 1lm% apa t%L mara!, saya t%lis nama orang yang saya mara!, dan saya ba&ar# 0rang it% a&an mati )emang bapa& perna! b%n%! orangL m%nta! dara!# Ba, saya perna! b%n%! aya! saya# Aya! saya mengata&an saya ana& tida& g%na, meng!abis&an %ang# @al% saya t%lis namanya, saya ba&ar dan dia m%nta! dara! dan mas%& r%ma! sa&it# Apa perasaan $edi memb%n%! aya! Saya rasa bangga# Saya 1nterpol

/iromani ada

$ediL se<ati# ,ala% bapa& p%lang dari sini, apa yang Saya ma% &er<a# Saya masi! ma% bapa& la&%&anL 1nterpol# ,ala% tida&, <%al ayam a<a#

Ab%lia tida& ada

12

Bai&la! pa&, terima &asi! banya& ya#

SamaIsama

13