Case English

7/28/2019 Case English

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The patient said that she had been taken to a landfill by the husbands (around October 2011), was

given a drink of water and after drinking husband said it was like drinking the blood of his own

parents. Once home, the patient found the goat's head inside the wardrobe and foul smelling. The

patient became frightened and eventually returned to her mother's residence Pasuruan.

The patient said that he had been treated for 3 weeks in Lawang mental hospital in May 2012.

Patients do not know why the brought there. After the patient's home, the patient returned home to

her husband's house. Drink drugs drunk white 3x1 tablet. However, after the patient is discharged

drug control again. The patient said during RSJ mace he did not tell her husband, but the patient

believes that her husband knew he cared, "Wong de'e know nduwe dock perawate RSJ kono

girlfriend, pokok'e pacare iku-nandi nandi onok dock".

Patients were told to go home, and said it was healed. The patient wanted to go back to the Mojo

and reunited with her husband and children. The patient said she would forgive her husband, the

patient wanted to live like flowing water, sometimes right and sometimes to the left. Patients still

love her husband, but she wanted him to promise not to beat him again.

Heteroanamnesis (Tn. M and Ny. A, elderly patients)

Mr. patients to know that the patient was taken to the hospital Dr IRD. Soetomo after a call from his

brother. When got to the hospital the patient looked angry, shouting and is tied. Looks bruises on his

face and hands. Mr. patients seemed angry to know that her son had been beaten by her husband

anymore and had to be hospitalized again. Mr patient believes that the cause of the patient's illness

was due to her husband's actions. During this time the patient is seen obliging the husband to his

wife. Mr patients know themselves during Lebaran years ago when her son was beaten because

their current home to Surabaya in Pasuruan. Patients are often told his brother, and did not want tofather. From the story knows that during these patients often beaten by her husband. Patient's

husband had also hit her patients while in hospital and people known. Husband patients repeatedly

apologized to the families of patients, especially parents, but still did the act again hit the patient.

Patient's family wants to separate patients with her husband due to concerns that patients will

regroup back pain as it is now.

Patients are also told that during her husband's family is doing evil to him. That patients have to say

is when going to sign up to work, by-law was told to use the diploma graduates of vocational junior

high when the patient, then the patient-in-law have also been told that the patient's son was an

unfortunate thing when the father-in-law arrested for gambling toggle. This interferes with therelationship between two families.

According to the father of the patient, the patient is not a child before marriage is like today, looks

very different. The patient is a quiet boy, according to the parents, rarely play anywhere in the room

preferred.

Mr new patients know the condition of the patient at the present MRS, although his father also

worked in Surabaya but rarely visited because of lazy met her husband and the husband's family of

patients who live around the patient's home.

Patient's mother had been living in Pasuruan with younger patients, pain patients know when

contacted by the father of the patient. According to the patient's mother, is sick of her because of


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who are currently studying in the Faculty of Dentistry. All women who had spoken with her husband

always envied.

The patient once said to boarding only and live apart from her husband's family as neighbors and

considers patient evil witchcraft patients are builders. Patients often angry without cause, hitting her

husband, throwing things at her husband, and sometimes up to beat his son. When told not to do it,

the more angry patients and said that this son and he has a right to hit their children. This often

makes the patient husband became angry and hit the patient. Husband patients do not know that

his wife had been treated in the psychiatric hospital for the past 7 months the patient left home

without saying goodbye. Husband know when patients are treated today.

When the evening before admission, the patient continues to live in the house, a lot of silence.

When told not to ring the water pump on the front continuously because there teaching, patient

angry and went to the bathroom, shower constantly and do not want told to stop. At that pakdhe

patient came to see the patient, but not admitted by the patient. Pakdhe patient brought a cake to

his grand niece, the patient should not be taken, because his son wanted the cake to the cake

secretly taken a bit by the patient's husband. Knowing that the patient became angry and yelled,

pastries and hand trampled patients bitten by the patient's husband. Because pain patient husband

tried to bite it, bite when the house was broken into detached new residents. When the patient was

naked and screaming. Finally, the citizens of the patients were given gloves and taken to the hospital

Dr IRD. Soetomo. My husband does not know the patient when the patient was taken to the hospital

because it is secured by budhe.

Currently, patient husband knows that pain suffered by the patient, realizing that when she angry

because of the possibility of pain, regret his actions ago and wanted to stay with the patient and her

son again.

On 13 September 2012, the patient came with her husband to a prosperous because it was sent by

her parents. Mean patient wants to entrust their children to her family, because today could not

care for myself. Patient's husband also wanted to help care for patients at night, alternating with his

wife's family. However, the patient's mother refused and said the husband was willing to care for

him if the patient refused to divorce the patient. After being briefed, the patient's family still do not

care for the child, the child is then invited to his home budhe.

Heteroanamnesa (Mrs. M, and Mr. budhe patient husband. T, Pakdhe patients at the time

home visit to Mojo, Surabaya)

According to Mrs.. M, the patient had been mostly silent in the house. Despite his lack of ventilation,

but patients during working husband rarely left the house. Ny. M never know what hit her patients,

when told do so, the patient actually shouted that this was his own son. Patients often bathe their

children until the children gasped breathlessly. When asked why did just that, the patient replied

that her hair smells musty. Even patients never cut her hair completely bald and her ears hurt.

Tn.T said that on 2 September 2012, he came with his wife because he wanted to see his grand

niece. But could not meet because not allowed to enter the house by the patient. Tn. T ended up

waiting at home Ny. M in front of the patient's home. When it heard noises from within the patient's

home, when a voice shouted to open the patient husband for help, finally forced open the door,


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then the patient has bloody hands of their husbands, the patient was angry and screaming naked.

Gloves be taken and the patient was taken to the hospital. According to Mr.. T over this small family

the patient is often noisy. Never even came around 2 nights to reconcile the patient and her

husband.

C. History of past illness

cal: never before severe physical pain

restless

a quiet, shy, submissive, likes to bury the problem,

rarely socializing and did not have many friends.

D. History of Private Life

The patient is a child expected, no problems during pregnancy, pregnant patients only find out when

the patient was born a twin. Patients born in shaman and normal. Having been born and then taken

to the midwife for review. Patients cared for by his biological parents, and her sister cared for by her

grandmother. 1 month after birth, the twin brother of the patient died due to illness.

Patients grow and develop like his age, tend to be quiet and not many friends. Only when the

patient's family gathering SD patients are in Surabaya, after which his parents live apart, mother and

father in Pasuruan in Surabaya. Patients meet with him once a week on Saturday-Sunday

Do not have a lot of friends, tend to pick and choose friends because patients find female friends

envy him so much that patients prefer friends with men, rarely go out with her friends. After school

patients spend more time in his bedroom. Patients close with his sister. Spoiled by the patient's

mother, with never told to do the job at home.

History of education


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Patients completed elementary, middle and vocational accomplishments ordinary. Patients and

elementary school in Surabaya, but junior high and vocational schools in Pasuruan.

History jobs

Before marriage patient worked as a shopkeeper snack Tile Market for 4 years, quit when pregnantbecause her husband asked.

The history of marriage

The patient was married to Mr.. R in 2009. Before marriage the two families could not approve the

marriage patient for being too hasty, and still be able to meet the family economy. Patients met her

husband while working in the tile market. Dating for 1 month before deciding to marry.

Tn. R a hard worker, tend still unstable and wishy washy decisions. Patients had 1 child: An D was 2

years old.

History of religion

Muslim patients, before the illness, the patient was a devout, always perform the five daily prayers

and fasting when Ramadan. When sick, prayer is not done well.

Social activities

Patients rarely get along with neighbors. Following the gathering PKK but sparse. Just leave it to

budhe to give money gathering.

Use of free time

Inside the house, watching television.

1) The house in the Mojo, Surabaya

Patients stayed in the room with a size of 2.5 x 1.5 m, with a wall of brick. Actually this is the room in

the back of the house budhe patient husband. Not yet finished, because the plan would level. To

enter the patient's home must pass lompongan or small street about 0.5 meters and only enough for

one person only. The lighting in the patient's home is less, because the ventilation and light source

enters the house limited. Sources of drinking water obtained from a water pump. 450 KVA electrical

power. Distance of the house with the other houses coincide. Around the patient's home is still a

family of her husband, including the chairman of the local neighborhood. Socio-economic condition

of the patient medium.

Patient-laws live in a different place, approximately 300 meters from the patient's home, which is

near the old boarding patients. The family lived in room size of about 3x4 meters occupied by 4

people. Patient-in-law knew the patient was quiet, stayed at home, often says rude to law. In-laws

do not know how the patient prior to marriage.


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From the narrative of the local RW (Tn. S), he was not too familiar with the patient and her husband,

just knowing that they are citizens of his RW. Knowing the local neighborhood of the report while

the patient was taken to the hospital. During this time Tn. S as RW has never seen the patient do

things like when will be brought to the IRD. Environment in the vicinity of the patient known as the

village drunkard, in this environment there are often people who drink alcohol and gamble. If the

gambling (gambling slugs) to large-scale by combining up to 1 cars. Patient's father-in-law also

includes "character" of the neighborhood. Patient's father-in-law had been arrested two times by

the police for selling toggle. Chairman of RW called the patient's home environment as a "gang

chatty" as it is often problematic and often ask for their rights but obligations as citizens of the

difficult run.

Description of Tn. M (former RT), the patient's family, including the family poor economy. During this

time the family was known less harmonious, often quarreled. Acknowledging the region is often

made patients drinking only when there is a celebration or just not often. Even so, he never saw him

take the patient drinking.

2) The house Pasuruan

Upon reaching home patients in Pasuruan, examiners meet with neighboring patients and patient

grandmother. Home patients must pass through a small alley, a motorcycle can still be bypassed, but

the distance between the houses are very close. At that time the patient was empty because the

patient's mother was waiting for patients in hospital and her son are going to visit the patient, so

that the examiner can not get into the house. The house on the right patient attached to her

grandmother's house, and on the left attached to the wall stuck. Using well water for their drinkingwater.

According to the patient's grandmother (Mrs. A), patient pain as unnatural since home alone about

the feast of sacrifice, after which the patient a lot of rambling, and finally admitted to the asylum

Lawang. During this time patients perceived an obedient child, not a lot of behavior, like other

children, make friends, but never dated (unlike her sisters), spent much time in the room to learn.

Perceived no change after having her first child. Grandma patients said this time the patient as

unnatural or use-efficacy because her husband is always looking at her mother's house.

Examiner also met with Mr. RT in the patient's residence (Tn. M), a long stay in this area, get to know

the patient's family, considered as the families of gengsian, as previously grandparents bu Nyai

patient is respected in the area. Knowing the patient's childhood, the patient was rarely out of the

house and hang out with the neighbors, rarely socializing so rarely get into trouble. School or out of

the house when his parents were told. Know also when the patient was taken to the hospital

Lawang, Tn. M said that it causes ill patient because the family wanted to separate the patient with

her husband. But until now the pack RT husband does not know what the patient is actually having

never met.

3) The house in Plemahan Big, Surabaya

Patients tingga at this school for 6 years now, and while working in Surabaya before marriage.

Neighbors average patient is still distant relatives though related. During his stay in place, patients


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rarely leave the house, get out while working alone or as told to his parents. The main house is a

house occupied by the late grandmother of patients, currently only used to meet guests and a

motorcycle at night. The house measures approximately 3x4 meters. There is a living room, but no

furniture such as chairs, couches, and cooking equipment. Patients Dad's house behind the main

house, close to the bathroom and well, just a room measuring 2.5 x 2, 5 meters, with less

ventilation.

The place to stay patient here is quite dense and a lot of houses that have been bought by the owner

of the hotel front alley patients.

4) Kost before anywhere now

The patient and her husband had rented room in the center of information pengkol before boarding

her husband's family now. Only last about 2 months, being unable to pay eventually moved to

another boarding house occupied now. In the boarding house, the room that once housed patients

had lived someone else. A lot of new people who are not too familiar with the patient. Just knowingthat the patient is a child Tn law. S are now living there.

Description:

1. Mr. M, the biological father of the patient, age 55 years, the driver, the hardness, discipline, rigid,

hard-working, easy to get angry, affectionate, loves to criticize.

2. Ny. A patient's mother, aged 50 years, IRT, inelasticity, hard, disciplined.

3. patient

4. Tn. R, patient husband, 21, a pedicab driver and worked odd jobs, nature loving, wishy washy

decisions.

5. Ny. M, budhe patient husband, age 54 years, IRT, the hardness, dear to the patient and her

husband

6. Tn. S, the father-in-law patient, aged 50, a taxi driver, the hardness

7. Ny. S, the patient's mother, aged 45 years, selling cups of tea in the school cafeteria and laundry

workers

8. An. D, 2.5 years, the child patient

F. factors Descendants

No family suffer from mental disorders such as this.

G. precipitating factors

Unclear, it is likely a problem with the husband's family


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H. Organic factors:

not found

I. Family Perceptions About Pain Patients

Fathers and mothers of patients said that before marrying her condition was fine, and had always

been ill like this. Family thought all this because patients used-to or "dilintrik" by her husband so

willing to obey what my husband said and did not want to hear the words of his parents.

All patients are saying is true that parents increasingly unhappy patient husband and family.

J. Patient Perceptions About Self and His Life

The patient did not realize he was ill. He was admitted to the hospital because her husband was

beaten. Patients also are currently treated because they want to cool down.

III. MENTAL STATUS (3 September 2012, at 09:00)

A. General Description

1. Appearance: The patient was a young woman, age-appropriate face, wearing a nightgown suit

shorts and short-sleeved shirts in brown, unkempt hair and eyelids terihat bruises over the right eyeand right arm, was sitting on the bed chamber prosperous.

2. Behavioral and psychomotor activity: at the beginning of the interview the patient looks

suspicious, but during the interview the patient calm and willing to answer any questions the

examiner

3. Attitude toward the examiner: patient during the interview to answer questions and look

examiner examiner, but seemed confused and wanted to go home.

B. Mood and Afek

1. Mood: suspect

2. Afek: shallow

3. Harmony: inadekuat

4. Empathy: can not dirabarasa

C. Talks

Spontaneous, well, relevant.

D. Perception


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During examination, it was found that auditory hallucinations sound of women crying. Previous

history of visual hallucinations.

E. Thinking Process

Shape: non realistic

Flow: Coherent

Content: delusions suspect (+)

F. Sensorium and Cognitive

1. Level of consciousness and alertness: composmentis, change

2. Orientation: Time / Place / Person: no impaired

3. Memory:

a. Immediate term: well, the patient may repeat the exact words spoken by the examiner.

b. Short term: well, the patient can recall the activities carried out 5 minutes ago.

c. Medium term: well, the patient could remember about his work in Tile Market

d. Long term: well, the patient can tell his childhood.

4. Concentration: well, patients can reduce ff 100-7

5. Attention: The good, the patient can spell the word "WORK" from behind

6. The ability to read and write: well, the patient can read the text properly and write sentences with

good

7. Visuospatial abilities: well, patients can draw a circle clock and can put the numbers and position

of the clock

8. Abstract thought: enough, patients can properly interpret proverbs eg no ivory that is not cracked,

the patient mean no one is perfect, empty barrel when interpreting patient tinny sound mean crap.

9. Intelligence and information: enough

10. Creative talents: no

11. The ability to help themselves: enough

G. Impulse Control Capability

Patients can control the impulse to both the time of interview.

H. Power value and insight


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done.

) or give it to the

police (if no address) if you find a wallet on the street.

I. Trust can level: the patient can not be trusted

IV. DIAGNOSTIC EXAMINATION

A. Status Internistik (held on 3 September 2012)

Physical examination:

Awareness: komposmentis

Vital signs:

Blood Pressure: 110/70 mmHg; Nadi: 80 x / min; RR: 18x/menit

Axilla Temperature: 36.4 C; Skin: good turgor

Head: eye anemis - / -, jaundice - / -, cyanosis -

Neck: goitre -; jugular venous pressure normal

Thorax: Heart: S1 S2 single murmur -, gallop -

Lung: resonant, vesicular, fremitus normal left and right,

rhonki - / -, wheezing - / -

Abdomen: Soefl, liver and spleen not palpable, tender -, + bowel sounds normal.

Extremities: warm Akral + / +, oedematous - / -

Localist Status:

- Regio orbit (D)

Inspection: hyperemia (+) superior palpebral, hematoma (-)

Palpation: tenderness (-)

- Regio brachii (D)

Inspection: hyperemia (+), hematoma (-)


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B. Neurological Status

GCS 4-5-6

Pupil isokhor spherical, 3mm diameter, light reflex + / + motion eyeball good

cranial nerves: not found signs of intra-cranial pressure increase

Stiff neck and signs of meningeal stimulation was not obtained

Motor: within normal limits

Sensory: within normal limits

C. Examination Support

1. Hecker's Cognitive Evaluation

1) Memory:

a. Immediate term: well, the patient may repeat the exact words spoken by the examiner.

b. Short term: well, the patient can recall the activities carried out 5 minutes ago.

c. Medium term: well, the patient could remember about his work in Tile Market

d. Long term: well, the patient can tell his childhood.

2) Languange

Naming: the patient may mention the names of the pictures on Naming Test

Repetition: well, psien can imitate the word "brown-conversation-articulation"

Reading: the patient can read a given text

Writing: the patient can write a sentence properly

3) Executive Function and Motor Performance:

Patients can perform three steps of "take the paper, bend it in half, and place it on the table"

4) visuospatial

Patients can simulate images with proper design

Patients can draw exactly 10:10 hours

Patients may draw interest

5) Attention and Concentration


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Patients can mention the reverse order of the word "WORK"

Patients may deduct points sequentially ff 100-7

6) Calculation: Good

7) Judgment

Understanding personal situation: the patient will come back if time forgot to bring money into the

market

Planning for future: living with the children and her husband, working again

Social insight: a thief should be punished for breaking the law

8) Reasoning

When asked why people should eat, the patient replied that no power to work

9) Abstraction

Patients can mention the differences and similarities oranges and tennis balls

Proverb: patients understand the meaning of the proverb "There is no ivory that is not cracked"

2. PANSS Score: (3 September 2012)

P = 25 N = 17, G = 35

3. Laboratory

Laboratory examination

(Results on 7 September 2012)

GDA = 83 mg / dL

SGOT / SGPT = 14/16 U / L

Albumin = 4.5 g / dL

BUN / Serum creatinine = 9 / 0.9 mg / dL

Na / K / Cl = 151 / 4.0 / 106 mmol / l

WBC = 6140

Hb = 12.6 g / dL

Hematocrit = 39.1%

Platelets = 195,000

4. Psikotest (18 September 2012)


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Aspects of intelligence: - the level below the average (IQ = 99)

- Logical thinking: adequate

- Abstract thinking: less adequate

- Understanding: lack adequate

Aspects of personality:

-esteem, fear and anxiety in the face of the neighborhood, in doubt,

considerable sensitivity, conflict over gender roles and self distrust

thefuture

Conclusions and suggestions:

Psychological condition of the patient at this time appear with the picture of the personality of some

responses that do not fit / not relevant to a given stimulus, especially to understand and deal with

the problem and the ability to empathize or sensitivity to the issue. On the other side of the patient's

ability to respond to an invitation to adapt, and the ability to maintain and protect the still relevant.

With personality characteristics and intelligence potential of less than average ability, the patients

require periodic evaluation and control, family psychotherapy, maintaining the response is still

relevant and provide therapy for irrelevant responses will be necessary for the improvement of the

current psychological state. Excavation of the identification of gender roles require attention as an

indication of the conflict that exacerbated his condition.

D. Consultation Results

1. General Surgery

Consulted on September 3, 2012, because there were bruises on his face and arms

Answer consul:

Localist Status:

- Regio orbit (D)

Inspection: hyperemia (+) superior palpebral, hematoma (-)


- Regio brachii (D)


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Inspection: hyperemia (+), hematoma (-)


At this time you do not get the gravity in the surgical field

Suggestion: Trombophob gel 4-6x/hari

Warm compresses

2. Consul Eyes

Consulted on 4 September 2012 complaining blurry eyes in the morning getting out of bed,

especially in the right eye.

Answer consul:

Currently, patients with OD obtained minimal palpebral hematoma and normal fundus

V. SUMMARY OF THE INVENTION Meaningful

It has been examined by a female, age 25 years, Javanese, Islam, marriage, vocational school

graduate, living in Mojo, Surabaya. The patient was taken to the IRD dated 2 September 2012

because angry and agitated.

From autoanamnesis earned young female patients, age-appropriate face, wearing a nightgown

suit shorts and short-sleeved shirts in brown, unkempt hair and eyelids terihat bruises over the righteye and right arm, was sitting on the bed chamber prosperous. When the examiner entered the

room, the patient seemed to be looking suspiciously examiner. Obtained thought of broadcasting in

which patients feel her inner contents known to others, suspicious of her neighbors malicious,

suspicious act cheating husband with another woman, the husband's family feels bad and does not

like patients. Patients are being sold by her husband, raped by her and her husband's family and her

neighbors. Patients hear a woman's voice crying, but the patient does not know his form.

From heteroanamnesis obtained, the symptoms had been going on since the beginning of

marriage in 2009, the patient fears while staying in a rented house in the area Manyar because often

see spirits. When moving to a boarding house in the Mojo patients often suspicious to neighbors andthinks that his neighbor shall not hurt the patient. Patients were then moved to a room at the back

of the house budhe husband, patients rarely get together with neighbors and relatives. When

november 2011 patients home without saying goodbye to Pasuruan after falling out with the law.

While in Pasuruan patients often fear during sleep and waking, grumpy, doing strange things like

throwing soapy water to the entire house, burn-burn the paper in the room. Patients diobatkan to

kyais yet until it was brought to the hospital Lawang and MRS for 2 weeks. After coming back from

the mental hospital patient looked well back to normal. No routine control and taking medication.

Until now the hospital Dr MRS. Soetomo because patients get angry, screaming and restlessness,

this happened after a fight with her husband.


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Patients have the personality traits a quiet, shy, submissive, if there are problems tend to keep to

themselves, rarely get along, picking friends as comfortable with male friends and female friends

envy him a lot.

On examination found no abnormalities internistik, the status of localist obtained a bruise on the

right eyelid and right arm, neorologis examination found no abnormalities.

There were no existence of genetic factors in the patient's family.

On examination PANSS score obtained P = 25 N = 17, G = 35

Laboratory tests are within normal limits.

The results of psychology:

Psychological condition of the patient at this time appear with the picture of the personality of some

responses that do not fit / not relevant to a given stimulus, especially to understand and deal withthe problem and the ability to empathize or sensitivity to the issue. On the other side of the patient's

ability to respond to an invitation to adapt, and the ability to maintain and protect the still

VI. Etiology FORMULATION

Etiology FaktorPredisposisi Presipitas & Facilitation Factor Factor Perpetuasi

Genetic Biology:

Not found Not found drug or substance abuse

Psychology - Parenting parents who live apart, hard, overcritical

- Characteristics of paranoid personality factor Stressor:

Problems with primary support group

Insight degree 1

Interpersonal family conflicts

Patients less hang out, pick-picking friend

Family relationships are not harmonious family relationship problems

Medical System in the treatment of Non-compliance

-

VII. DIAGNOSTIC FORMULATION


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In these patients found the behavioral and psychological symptoms that are clinically meaningful

enough in everyday life so it can be concluded that the patient was suffering from a mental disorder

by PPDGJ III.

In these patients there is impairment in the value of power manifest in reality awareness,

judgment, and insight are impaired, so it can be categorized in psychotic disorders.

Patients have been twice admitted to hospital, asylum Lawang and currently with complaints

grumpy and restless. From autoanamnesa and heteroanamnesa found changing consciousness,

orientation is still good, relevant contacts and smooth, there is interference with the non-realistic

thought process and the presence of delusions suspicious. In these patients there is also a history of

hallucinations auditory and visual hallucinations. Has been going on for about 2 years and the longer

cause a change in the quality aspects of personal behavior. There is a history of disorder medication.

So based PPDGJ III on axis 1 we diagnose Paranoid Schizophrenia Episode Recurring (F 20:03) and

Failure In Treatment (Z 91.1). On the second day of treatment (3 September 2012 at 14.30) patients

had stiffness in the body, okuligirik crisis, so the patient was diagnosed as a result of Movement

Disorders Drug (G 9.25).

Patients never use psychoactive substances, and there are no signs or symptoms of intoxication or

withdrawal, so that the diagnosis of mental disorders due to psychoactive substance can be

removed.

The patient is a personality trait that has reserved, shy, submissive, like bury the problem, rarely

socializing and picking friends, meet the criteria for a diagnosis on axis II paranoid personality traits.

On axis III, the patient's general medical condition found bruises on the superior palpebral dextra

oculi and the region brachii dextra

On axis IV, the primary problem is a support group with her husband, the patient's family and

husband's family.

On axis V, based on the assessment GAF (Global Assessment of Functional) Scale the current 30 (30-

21) = severe disability in relation to communication and power values, unable to function in almost

all areas. GAF scale best year was 60 (60-51) = moderate symptoms (moderate), moderate disability.

VIII. DIAGNOSTIC EVALUATION PPDGJ III multiaxial

Axis I: Paranoid Schizophrenia Episode Recurring (F 20:03)

+ Non-compliance in the treatment of (Z 91.1)

Drug-induced movement disorders + (G 9.25)

Axis II: Personality characteristics of paranoid

Axis III: Contusio in OD and superior palpebral region brachii (D)

Axis IV: Problems primary support group

Axis V: GAF Scale MRS 30


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GAF scale best 1 year 60

IX. PROBLEM LIST

A. Organobiologik:

No heredity in the family.

B. psychological:

Personality traits of patients quiet, shy, submissive, like bury the problem, rarely socializing and

picking out your friends

The problem faced is the primary support group

Insight 1

C. social:

Patients do not like to hang out and socialize in the neighborhood.

X. Prognosis: ad Dubia night

Mitigating factors:

1. Heredity does not exist

2. Type skizophrenia paranoid

3. Treatment costs borne Jamkesmas

4. There is a trigger just yet known for sure

Things damning:

1. Paranoid personality traits

2. Treatment adherence

3. Conflict second family

4. Families who are not in harmony

5. Young onset

6. recurrent episodic

7. Support families to treatment due to lack of understanding of the family that one of the patient's

pain


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XI. FORMULATION psychodynamics

Ny. ANC, 25 years, adult, married and blessed with one child, were taken to the IRD by relatives and

neighbors as angry and agitated. In patients also found bruises on the upper eyelids and arms.

The patient was born as the son expected, twin girls born. At 1 month of age his twin brother died ofillness. Patients are cared for by both parents until elementary school in Surabaya, the second time

the patient's parents worked. Because the mothers out of work, the patient's mother returned to

Pasuruan with patients and the two younger patients, the father of the patient remains in Surabaya

due to work. Mr patient goes home every week to Pasuruan. This makes the patient lose a father

figure. Raised separately make patients difficult to identify him. Mothers and fathers of patients

tend to be hard, discipline, overctical, and keep prestige. This makes the patient becomes quiet,

difficult to express an opinion, look meek, shy and rarely socialize. Patients during junior high and

vocational schools in Pasuruan, many friends with a male friend because he felt many female friends

who do not like and envy him. During school, the patient was freed by his parents from all the

housework even wash his own clothes were mothers of patients who do, it makes the patient more

dependent with his parents and difficult decision to make.

At the age of 23 patients who had been married to her boyfriend courted for 1 month. Before

marriage the two families could not agree and conflict. But eventually weddings still take place. After

being married is often a conflict between patients with patients with a family of her husband or

husband. There has also been economic difficulties. The existence of small to large conflicts that

arise in the patient's personal life leaves patients with decompensated psychological (According

Seyle). Thus, when conflicts and problems accumulate and become very severe, patients become

mentally exhausted in the face of stress, arose psychotic symptoms for the first time. This

phenomenon is not well understood by patients and their families, because the myths that exist in

the community who said that it was due to patient-used by his family.

XII. MANAGEMENT

A. Psikofarmaka

- Haloperidol 2 x 2.5 mg (morning and evening)

- Trihexyphenidyl 2 x 2 mg when symptoms arise EPS (morning and evening)

B. Supportive Psychotherapy to improve insight and treatment adherence, by:

- Suggestion

- Reassurance

- Guidance and counseling.

C. Family Education

Provide an explanation for the family to know that mentally ill patients were not for thesupernatural (used-to)


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Provide an explanation for the family to know that mentally ill patients requiring long-term

treatment and regular, so that should help the family to monitor the treatment of patients

Medication must be held by the family and given to the patient on the advice of a doctor.

If there are signs of recurrence, the patient should be immediately taken back to the hospital (sign:aloof, daydreaming, laughing or smiling to himself, heard the whisper without form, lazy activities,

lazy treatment, insomnia, angry for no apparent reason , slurred speech, lazy to take care of

yourself)

XIII. DISCUSSION

The first problem is the determination of appropriate diagnostic of these patients. Is the diagnosis of

recurrent episodes of paranoid schizophrenia is appropriate? The second problem was the

appropriate management for these patients. And the third problem is the presence of family conflict

that affected the patient's illness. Families who do not understand what the pain suffered by the

patient. Families who want to separate patients with her husband.

Case English

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