Chief complaint : Patient was brought in by the police and his parents due his This usually makes
kes him sad and guilty but he mostly ignores the voice. He also
belief that people are talking bad about him, hearing of voices, seeing
abnormal things, talking irrelevently with inappropriate and aggressive
behaviour for 1 month prior to admission.
HOPI :
Patient is an active drug user for more than 6 years and has history of
admission to hospital Permai twice this year. He started using drugs at 17
years old when he was a form 5 student, he mixed with the wrong group of
friends and got influenced by them and has since started to smoke and sniff
glue. He however managed to pass his SPM and after finishing school, his
family being concerned with his behaviour thought it was better for him to go
and live with his elder sister in Johor and get a job there. He then stopped
taking drugs and was working as a welder but the following year, he had a bad
break up with his girlfriend which then prompt him to take drugs again.
Initially he started off by taking 2 pills of pill kuda and then gradually
increased the dose up 5, and also tried other drugs like ice, ganja and ecstasy
but claims he mostly takes pill kuda and ice which he buys using his own
money from his working colleague. He said that by taking the drugs he felt that
his problems were gone, he felt happy and energetic and he takes about 3 to 4
times in a week depending on how much money he has and takes them by oral
and nasal route. After about 6 years of abusing drugs, he began to hear
abnormal voices early this year and experienced that while still actively
abusing drugs. It was a voice of a unknown female, 2nd person in nature,
talking to him and telling him to stop taking the drugs and to become good.
could see abnormal things which included seeing shadows of human figure
and pictures talking back to him. He however denies feeling any sensations on
his skin, smelling or tasting anything weird that others did not seem to
detect.He also believed that people are watching him and doing bad things to
him. He also began to talk and laugh to himself and spoke irrelevently at times
that his sister could not understand what he was saying. All of this then lead to
him losing his job and when his sister refuse to give him money he became
aggressive, threw house things everywhere and tried to burn her house . Due
to that he was later admitted in hospital permai in march and later in april for
similar symptoms and aggressive behaviour was treated with risperidone
2mg. Both his stay in the hospital was more than a week, during which he says
he does not hear or see any abnormal things and all his symptoms resolves
completely when he discharges.
4 months prior to this admission, patient came back to terengganu to stay with
his parents and was under hospital setiu follow up and was well until a month
ago when he started using drugs again and developed similar symptoms as
before. His behaviour has however worsened and he believes that his parents
are telling everyone about his condition and that they are all talking behind his
back. He also says that his parents have been mistreating him and favours his
siblings more than him. His family members noticed that he was easily
irritable, again talking to himself and behaving very inappropriately as he
would write on the walls, throw plates, play with fire and candles and burn his
own clothes and on the day of admission which was also his last day of his
drug consumption, he became aggresive and threaten to hit one of his fx
member and a visitor who came to thier house and destroyed the tv and
furniture which then lead him to be arrested. He has not been sleeping well for
the past two days, could only sleep for 3-4 hours maximum and has been
wandering around his neighbourhood at night. He admits of having suicidal
thoughts recently but no attempts have been made so far. However patient
denied having depressed mood, loss of ability to feel pleasure from previously
enjoyable activities, change of appetite, weight changes, fatigue, feeling
worthless, inability to concentrate, restless, slow thinking, inflated self esteem
, decreased need to sleep,more talkative than usual, easily distractible,
subjective feeling that thoughts are racing, palpitation, sweating, trembling or
shaking, shortness of breath, chest pain, nausea, dizziness, chills, numbnesss
and tingling sensation, muscle tension, fear of losing control or dying.
Denied having palpitation, sweating, tremor,diarrhea, hot or cold intolerance,
recent head injury, unexplain headache, seizure or altered consciouness.
his symptoms however has affected his functional status for this period of
time. He has neglected to take care of himself and his self hygiene, did not go
out with his friends like he did before and his behaviours has caused him to
have conflict with his parents and siblings.
Patient was later sent to hospital hulu terengganu for further management. On
the day of clerking, the patient condition appeared to be stable and he has
been free from hearing and seeing things since his admission.
Systemic review - unremarkable
Past psychiatric hx
Patient has previous admission to hospital permai twice but has no known
medical illness.
Past medical and surgical hx
No known chronic medical illness like diabetes, hypertension or asthma. No
past surgical history.
Family history
Patient father is 59 years old whereas his mother is 49, both of them own a
food stall and sell kuih for a living. His father is healty whereas his mother
suffers from hypertension and diabetes.Patient is the 4th out of 6 siblings and
their only son. all his siblings are well and does not suffer from any chronic
illness. There is no family history of substance abuse, mental illness or suicide.
Past personal history
Infancy :He was born via spontaneous vertex delivery at term, with no
antenatal,perinatal and postnatal complications.
Childhood: He had no developmental delays and had a happy childhood with
lots of friends and was content. He did not experience any abuse, rejection or
neglect. He started school at 7, was able to make friends with others, enjoyed
learning and had good relationship with teachers.
Adolescent ;
However things were different in secondary school, he mixed around with the
wrong group of friends and slowly his character changed to become more
rebellious and slowly he deteriorated in his studies and began acquiring bad
habits like smoking and inhaling gum.

Adulthood: He studied up to SPM but did not continue his studies after that.
He started working in johor and would frequent change jobs but worked
mainly as welder and stopped working early this year.

Forensic : He has no forensic history.

Provional diagnosis
Current social situation
substance induced psychotic disorder
He is currently staying with his parents and 2 younger siblings in a village
house in setiu. He is currently unemployed and both his parents supporting
the whole family, his elder sisters gives them some money sometimes. other
than abusing drugs, patient is also a smoker but does not take alcohol.

Premorbid personality

attitude: He was friendly and easy -going.

Habits: He liked playing sports esp football.

religion: He had faith in religion and would pray on time.

Diffrential diagnosis
relationship: He had good relationship with his family and friends

MSE----

Physical examination- unremarkable

Summary

Management