CERVANTES, FRANCIS VIEN S.
PSYCHIATRY II
YL3 DR. MARARANG
REFLECTION PAPER
As a medical student, I can say that I have a little bit more knowledge about
psychology and psychiatry. My prejudices and common misconceptions have been
corrected already through learnings and experience but there also some things that are
not written in the book and not taught in school that I still do not know. The movie
showed how Irene, played by Agot Isidro, developed her illness. It started when Irene
showed strange behaviors, from paranoia to talking to visitors that only she can see.
The movie portrayed not only how mental disorders manifest and develop in a patient,
but also how it affects the family of the patient as shown when Ed, her husband, went
home from Dubai to take care of the sick Irene. They are suffering as much as the
Irene. It brought a clearer view of how a mental disorder affect not only the patient but
also the people around him/her because in real life, we can only imagine the stories we
hear from the families of patients.
The movie not only validated my understanding of mental disorders, but it
actually added knowledge about mental disorders and a perception of what really is
happening in the patient, especially when the patient is at home. The movie changed
how I look at persons with mental disorders because it made me felt that patients are
really going through a hard time. There’s this particular scene in the clinic because Irene
relapsed for the first time because she did not took her medicine. There are 2 other
patients in room and they shared their experience to Irene’s mother-in-law. What they
said really hit me, that families of patients should not be ashamed of mental disorder
because just like any other disease, it is a sickness. Instead of being ashamed of it, they
used it as a means of educating other people. They did not look at it as a disgrace.
The movie made me more understanding of how a patient goes through her
condition. The movie made me more empathic about patients with mental disorder.
They should be viewed as someone who needs help and not some kind of person who
has illness. Patients with mental disorder need social support aside from medications
and therapy to get better. Psychiatric disorders really need holistic care and approach
compared to other medical fields. Psychiatry is a field wherein you need to be empathic
about your patients to give the best care possible.
CERVANTES, FRANCIS VIEN S. PSYCHIATRY II
YL3 DR. MARARANG
PSYCHIATRIC HISTORY
I. Identifying data
Irene is a 35-year old Filipino female, married and works as a nurse in a hospital
who was brought to the clinic by her husband to determine his current cognitive
and emotional status.
II. Source and reliability
Background information was obtained from her husband. This information was
obtained from interview. This information appears to be from reliable source and
valid.
III. Chief complaint
The patient presented to clinic with paranoia, visual and auditory hallucinations.
IV. History of Present Illness
One year prior to consult, patient became increasingly paranoid when there were
crimes happening in their area. She claimed that there was a man in a silver car
that was stalking their house. She described him like he was in the military. She
then told her family to change their routines to the point that she will bring her
son to work instead of going to school so that the “military” can’t follow them.
10 months prior to consult, patient claimed that someone has entered their home
in the middle of the night. She woke her brother-in-law, Carlo, up. He tried to
catch the alleged trespasser who was trying to escape when he was hit by a car.
In the hospital, the patient was talking to her brother-in-law’s girlfriend who was
visiting about how she really saw an intruder and that it was probably the military
trying to hunt them and get a revenge for their opposition during the Marcos
regime but Carlo does not have a girlfriend. After Carlo was discharged, the
patient have installed additional door locks in their house.
One night, the patient was heard talking to someone but when her mother-in-law
checked who she was talking to, there was no one. The patient claimed that her
visitors were NPA hiding from the military and her mother-in-law scared them
away. Her family was suspecting that it was a supernatural occurrence. They
invited an albularyo to scare the bad spirits away, but it triggered the patient to
remember the traumatic experience she had when her mother died in the hands
of an albularyo.
Patient became increasingly sick which prompted consult. She was diagnosed
with Schizophrenia and was given medication for her to take once daily.
Despite the medications, her symptoms had been increasingly worse. Patient
claimed that she heard her mother-in-law talking on the phone with a military
conspiring against the patient and that they will take her son away. She then
CERVANTES, FRANCIS VIEN S. PSYCHIATRY II
YL3 DR. MARARANG
went to her son’s school to hide him from the military. While trying to escape,
patient was caught by the military and told her son to run away. Her son did not
see anything and run home due to fear. Later that night, she was found hiding in
the woods.
Another episode occurred when she experienced auditory and visual
hallucinations. She locked herself in the room and was only calmed down by her
husband which prompted a visit to the clinic.
V. Past Psychiatric History
N/A
VI. Social History – Substance Use
N/A
VII. Family History – Genogramri
Mother had a psychotic episode but was undiagnosed.
VIII. Anamnesis
When the patient was a child, her mom was abducted during the Marcos regime
because she was a nurse helping the rebels during the Martial Law. Her mother
had a psychotic episode and was brought to an albularyo where she died.
She is currently a nurse in a hospital, married with 1 son, catholic and lives with
her mother and brother-in-law.
IX. Review of Systems
N/A
X. Mental Status Exam
i. Appearance and Behavior
Patient is dressed appropriate to age, time, place and weather. She is
well-kempt, with good hygiene. Patient appears nervous and tensed but is
cooperative.
ii. Motor activity
Unremarkable.
iii. Speech
Patient amount of speech is normal but is anxious.
iv. Mood and affect
Patient is anxious and nervous.
CERVANTES, FRANCIS VIEN S. PSYCHIATRY II
YL3 DR. MARARANG
v. Thought content/Process
Patient has paranoia.
vi. Perceptual Disturbances
Patient has auditory and visual hallucinations.
vii. Abstract Reasoning
N/A
viii. Memory
N/A
ix. Intelligence/concentration
N/A
x. Sensorium
Oriented to time and place.
xi. Insight
Poor insight.
xii. Judgement
Impaired.
xiii. Impulse control
N/A
XI. Physical Exam
Deferred.
XII. Formulation
Patient is a 40 year-old, female, married with 1 son, nurse, who was diagnosed
with schizophrenia. She was non-compliant to her oral medications which
worsened her paranoia, auditory and visual hallucinations.
XIII. DSM V Diagnosis
Schizophrenia DSM-5 295.90 (F20.9)
XIV. Treatment Plan
Pharmacologic Treatment
Invega Sustenna (Paliperdone palmitate)
INITIAL:
o Day 1: 150 mg IM
CERVANTES, FRANCIS VIEN S. PSYCHIATRY II
YL3 DR. MARARANG
o Day 8: 100 mg IM
Subsequent Monthly Dose
o 75 mg IM (may be increased or decreased to 25-150 mg)
Can be administered in either the deltoid or gluteal muscle
Nonpharmacologic Treatment
Education
Psychotherapy
Family interventions
