Bed Side Teaching A 36 years old man was admitted to HB Saanin emergency unit on Oct 5th, 2013 and

escorted y !S" HB Saanin security# Sent y social wel$are with com%lain & 'he %atient was amo( and ring clea)er and threaten the %eo%le o$ *u u( Basung# Patient identity: +ame and Age .! 0ender 1lace and date o$ irth .arital status Address Occu%ation-School !eligion 4iti5en 'ri e A. Internal Status 0eneral a%%earance Blood %ressure 1ulse !es%iration 'em%erature Body Sha%e Height 8eight & 4om%os .entis & 130-/0 mmHg & easily %al%a le, regular, /57 %er minute, & a dominotora(al %attern, regular, 237 %er minute & 33,104 & asteni(us & 165 cm & 60 (g & & & & & & & & & & ,edi - 36 years old 05 1/ 26 .ale *u u( Basung, August 11rd 1233 Single *u u( Basung $armer- graduated $rom Accountcy college .uslim 6ndonesian .inangnese

4ardio)ascular system & +o a normality detected ,igesti)e system & +o a normality detected
1

S%eci$ic disorder

& +o a normality detected

B. Neurological Status 4ranial +er)ous 9$i)e senses: .eningeal Signs & ;ision, smelling, hearing, tasting, and tactil are well & +one

High 6ntracranial 1ressure Signs & +one <yes = = = = = = .o)ement 1erce%tion 1u%il *ight !e$le7 & >ree to all direction & +o nystagmus, no di%lo%ia & !ound and iso(or & ?-? & +ot e7amined

4on)ergence !eaction

O%htalmosco%ic e7amination & +ot e7amined

.otoric = = = = = 'onus 'urgor Strength 4oordination !e$le7 & <utonus, & 0ood & 0ood & 0ood & 1hysiologic 9?-?:, %athologic 9=-=: & +o a normality detected & 0ood a%%etite, slee% well
2

Sensi ility ;egetati)e >unction

Basic >unction S%eci$ic disorder = = = !igid 'remor 'orticolis

& +o a normality detected

& +one & got,9?1: & +one

Auto~History taking, October %uestions Assalamualai(um %a(,,

th

!"#$ : Inter'retation 4oo%erati)e (oo%erati$

Ans&ers 8aalai(umussalam

Bang, nama saya do(ter muda +amo wa( se%rinal la)i, dan amelia , (ami do(ter muda disi(o, oleh tahu nama a%a sia%a@ A%a yang terasa se(arang %a@ +da( aa do, lai sehat

Aeluhan somatis 9=:

a%a( tau se(arang ada di 'ahu, di rumah sa(it Biwa# ga Orientasi tem%at ai( mana@ 8aBar ga menurut a ang@ Aena%a a ang di awa (esini@ tahu la, a ang am o yang di awa (e si(o untu( rawat ta%i am o yang dirawat## ,iscriminati)e6nsight terganggu inggung am o

Aena%a a ang marah=marah +da( tahu ang@

3

Ada %a mendengar suara=suara Ado,nda( tau do suara sia# yang a ang sendiri yang mendengarnya@ Suara sia%a tu ang@@ A%a (atanya@ 'erlihat yang icara tu ang@ nda(

Halusinasi A(usti( 9?:

Halusinasi ;isual 9=: Halusinasi ol$actori( 9?: Halusinasi'actil9=:

1a,ada ter au sama %a,atau Bau= au harum adoo terasa ada yang memegang@ 0a adaa yang %egang=%egang

Ba%a udaah ni(ah@

6yoo, udah 3(ali##%ertama %as 8aham (e esaran 9?: saya erumur 3#5 tahun,saya ni(ah dengan (a(a( sulung (emudian %ada umur 3 tahun / ulan saya ni(ah dengan 2 orang lagi ta%i urang luar# ana(=ana( saya (e Auwait,6raC iya (eluar +egara## 6yaa (arena nene(nya ratu di si(o

Aeluar +egara untu( a%a tu %a@

Bisa urang@

a%a(

aca

%i(iran Bisaa, insya allah

'hought insertion 9?:

Ada a%a( rasa %i(iran a%a( nda(( di aca orang@ Ada curiga sama orang %a@ %a, ada Balan=Balan sendiri,@ Ado nda( (an mere(a

'hought roadcasting 9=:

4uriga 9=: ;aga ondage 9=: masa( ,iscriminati)e terganggu 1iromani 9=:
4

1a ada a%a rasa elo( marah= 6yoo marah dengan(eluarga a%a @ %a,ada su(a mem a(ar@

Budgement

memilih=milih (asi harta 'ida( Ado

6alah, ma(asih anya( ya %a

Allo~history taking: Pri(ary couse o) hos'itali*ation 1atient emotionally unsta le, angry and threaten his community with a clea)er

Present co('lain o) 'atient 'here is no com%laint at this time# History o) illness& 2013 1atient had %ro lems with his $amily mem er regarding %ro%erty# %atient $elt he is not eCually treat y his own $amily# At $irst %atient seems Cuite,always li(e to e alone,and not much communicating with $amily#He always seems tal(ing alone,laugh alone as i$ there were a o%%osite %arty#1 month ago, %atient $reCuently got angry on his $amily# Because o$ economic %ro lem, the $amily mem er could not ring the %atient to hos%ital to get wise treatment#1 day e$ore he was rought to !S" H,B SAA+6+ he suddenly amo( and loss his tem%er until he was chasing the %eo%le o$ *u u( Basung with clea)er#'hen the social wel$are authority ring the %atient to hos%ital as according to him, the %atients acti)ity is getting worst day y day# %atient is sic( $or $irst time,and he is treat $or the $irst time#

Pre(orbid history 6n$ant & orn s%ontaneously, irth was assisted y %aranormal, no history o$ Baundice, cyanosis, and sei5ure#
5

4hildhood 'eenage Adolescence

& & &

growth and de)elo%ment according to his age# growth and de)elo%ment according to his age# had a $ew o$ $riends,%ro lem with $amily mem er

+ducational background 0raduated $rom Accountcy college

Occu'ation History $armer

,arital history Single

Biological -e.elo'(ent History 4ranial trauma negati)e, malaria 9=:, thy%oid 9=:, rain and neurological disease none

Social +cono(ic History *i)e with mother, sisters, rother and his $ather at semi=%ermanen house# <lectricity 9?:, '; 9?:, drin(ing water $rom 1,A.# 1atient gets money $rom his $ather#

/a(ily history o) illness 'here were no $amily mem ers that has same sym%toms li(e this

1 0 1 0 00 2ra'hic o) illness %ro%erty %ro lem among $amily mem ers 2013 2

de'ression 3 delusion 3 hallucination3 disturb 'eo'le around

+4P5ANATION AN- 6ON657SION O/ PS86HIAT9I6 +4A,INATION <7amination is on Octo er 3th 2012, 1D#30 86B 1# 0eneral a%%earance 4onsciousness-sensorial Attitude .otoric >acial e7%ression ;er ali5ation 1hysic contact & & & & & & com%os mentis-good coo%erati)e acti)e in a%%ro%riate s%ea( clearly could e done - ina%%ro%riate - long enough
7

Attention 6nitiati)e 2# S%eci$ic condition A# A$$ecti)e

& &

not good enough good enough

1# A$$ecti)e condition 2# <motional & a# Sta ility # 4ontrol c# <cht-unecht d# <in$uhlung e# ,ee%-shallow $# ,i$$erentiation scale g# <motional $low

&

lunt

& & & & & & &

unsta le not good enough echt inadeCuat shallow narrow $ast

B# 6ntellectual condition o$ $unction a# .emory # 4oncentration c# Orientation & & & not good enough not good enough distur ed in time,%erson, and situational

d# 0eneral and schooling (nowledge & hard to %redict e# ,iscriminati)e insight $# 6ntelligence %rediction & & distur ed a)erage
8

g# ,iscriminati)e Budgment h# 6ntelectual deterioration

& &

distur ed none

4# Sensation and %erce%tion a normalities 1# 6llusion 2# Hallucination Acoustic ;isual Ol$actory 'actile 0ustatory & none & & yes & none & yes & none & none

,# 'hought %rocess condition 1# S%eed o$ thought %rocesss 2# Euality o$ thought %rocess& a# 4lear and shar% # 4ircumstantial c# 6ncoherent d# S%errung e# Hemmung $# >light o$ ideas & & & & & & clear enough and shar% enough none none none none none
9

&

$ast

g# ;er igeration h# 1reser)ation

& &

none none

3# 'hought condition a# 4entral %attern # 1ho ia c# O session d# ,elusion e# Sus%icion $# 4on$a ulation g# !e%ulsion h# 6n$erior $eeling i# .uch-little B# >eeling guilty (# Hy%ochondria l# Others & & & & & & & & & & & & none none none yes,delusion o$ grandeur yes none none yes much yes none none

<# 6nstinctual dri)e and eha)ior a normalities a# A ulia # Stu%or c# !a%tus-im%ulsi)ity & & & none none none
10

d# <7citement state e# Se7ual de)iation $# <cho%ra7ia g# ;aga ondage h# 1yromania i# .annerism B# Others ># O)er an7iety 0# !eality testing a ility

& & & & & & & & &

%ositi)e none none none none none none there is, ut a little none

,75TIP5+ A4IS 9+S7,+ A7is 6# 4linical Syndrome 1atient had %ro lems with his $amily mem er regarding %ro%erty# %atient $elt he is not eCually treat y his own $amily# At $irst %atient seems Cuite,always li(e to e alone,and not much communicating with $amily#He always seems tal(ing alone,laugh alone as i$ there were a o%%osite %arty#1 month ago, %atient $reCuently got angry on his $amily# Because o$ economic %ro lem, the $amily mem er could not ring the %atient to hos%ital to get wise treatment#1 day e$ore he was rought to !S" H,B SAA+6+ he suddenly amo( and loss his tem%er until he was chasing the %eo%le o$ *u u( Basung with clea)er #'hen the social wel$are authority ring the %atient to hos%ital as according to him, the %atients acti)ity is getting worst day y day# %atient is sic( $or $irst time,and he is treat $or the $irst time#

1hsyciatric e7amination&

11

0eneral A%%eareance& com%osmentis coo%erati)e, low attention, initiati)e 9?:, acti)e, $acial e7%ression in a%%ro%riate, clear tal(, %hisical contact in a%%ro%riate and long#

S%eci$ic condition& a# A$$ecti)e condition& lunt, unsta le, 4ontrol not good enough, echt, inadeCuat, shallow, narrow, $ast # 6ntellectual condition and $unction& .emory not good enough, 4oncentration not good enough, ,iscriminati)e insight distur ed, ,iscriminati)e Budgment hard to determine, orientation distur ed %ersonal,situational and time c# Sensation and %erce%tion a normalities& accoustic, ol$actory halutination 9?: d# 'hought %rocess condition& $ast, clear and shar% clear enough and shar% enough, e# 6nstinctual dri)e and eha)ior a normalities& A ulia none, e7citement state %resent,

)aga ondage none, %yromani none, $# O)ert an7iety& %resent, little g# !eality testing a ility, distur ed& eha)ior, $eeling and thin(ing A7is 66 & 1ersonality ,isorder and .ental !etardation ,isorders 1ersonality& outgoing, has a lot o$ $riend .ental retardation& none A7is 666 & 0eneral .edical 4ondition Head traumas history was a sent +o history o$ malaria, ty%hoid, or rain and neurological disease

A7is 6; & 1hsychosocial Stressor and <n)ironment

12

1shychosocial & *i)e with mother, sister, si lings and his at semi=%ermanen house# <lectricity 9?:, '; 9?:, drin(ing water $rom 1,A. A7is ;& 0lo al Assessment o$ >unction ,aily acti)ity li(e $arming couldnt e done since sic( Social relationshi% couldnt e done since sic( S%ending time with watching ';, recreation, couldnt e done since sic(

,75TIP5+ A4IS -IA2NOSIS 6# 66# 666# 6;# ;# > 25#1 Schi5oa$ecti)e de%ression ty%e +o ,iagnosis# +o ,iagnosis %rimary su%%ort grou% 9$amily: 0A> D0=51

-I//+9+NTIA5 -IA2NOSIS 6# Schi5o%renia sim%le7

TH+9AP8 Halo%eridol 371 ta F1,5 mg 41G 171 ta F100mg 9malam:

P9O2NOSIS 4linical & du ia at onam

13

>unctional Social

& &

du ia at onam du ia at onam

S722+STION /O9 TH+9AP8 %sychothera%y & <ducation to the $amily

14