I saw a young Malay gentleman, tall and medium body built with short hair, well groomed with his white coat on, stethoscope on neck. There was no signs of self neglect.
There was excellent rapport but he looked uncomfortable standing at the bedside. He was sweating and trembling all the time. He looked sleepy.
He had no psychomotor retardation or agitation. But he had mannerism, ticking his pen all the time during interview.
He spoke terribly in English, his volume was soft and rate was slow. The tone was monotonous. The amount was inadequate and his speech is sometimes irrelevant but coherent. There was neologism, even the lecturers cannot understand at all.
His mood is anxious, and his affect was appropriate and congruent to the thought.
There were evidences of disorder of thought process, including circumstantiality and elements of tangentiality
Sometimes there was loosening of associations.
Of thought content, he had delusion of guilt, of not studied before the exam. He believe that he had no time, no time and no time.
He also had delusion of grandiosity that he is a multi tasking man, and he performed better with last minute work, and the fact that he had so much time to finish his SSM even he managed to blog.
Moreover, he had delusion of persecutory that the lecturers will fail him, and the patients are terrible and not cooperative.
He had delusion of jealousy, of friends who always performed better than him in exams although he knew that his friends are hard working.
He also jealous to friends whom are married, have children but still passing the exams with flying colors.
He had delusion of perception, small hand book and printed copies are enough for his study and delusion of references.
He also had erotomania but he cannot further elaborate on that matter. :)
He was not suicidal, but there was feeling of hopelessness.
He denied of visual hallucinations, and claimed that he had auditory hallucinations when answering in the examinations.
He was well orientated in time place and person. But his attention was poor, he kept requesting examiners to repeat the questions and his memory was partially intact. His abstract was good. His judgement and insight were clearly impaired.
My provisional diagnosis, Schizophrenia like syndrome, with co morbid medical student.
My acute management :
Do an ECT. Unilateral so that memory is not impaired. Just kidding.
My definitive management :
Cognitive and behavioural therapy, suggest to patient correct management of their SSM, CWUs Exams and hafazan.
Group therapy, there are lot of them actually.
Family therapy, encourage patient to spend time with family.
Motivation Enhancement therapy, to improve patient addiction to facebooking, instagraming and blogging.
Stop complaining, and bersyukurrlah !!!
- courtesy of Dr Loo.
Hi hi hi.