Case Presentation 20-11-2012
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This patient is a 48-year-old divorced housewife who has been involuntarily admitted multiple times over the past 16 years for schizophrenia. She presents with delusions that her relatives are imposters and her deceased husband is still alive. She reports auditory and visual hallucinations. Her symptoms have been progressively worsening over the past month with increased delusions, paranoia, and refusal to care for herself. Her past psychiatric history reveals a 16-year history of schizophrenia treated with antipsychotic medications with some periods of improvement. A mental status examination shows suspicious behavior, constricted affect, and impaired judgment consistent with active psychosis.
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This document discusses various aspects of leadership including defining leadership as inspiring others through knowledge, skills, experience and guidance to achieve goals. It outlines that effective leadership requires knowledge in your field and knowing how to find resources, communication skills, and learning something new each day. Leaders should develop skills like listening, communication, goal setting, planning, problem solving and evaluation. Experience is gained through learning from others, mistakes, and sharing lessons learned. Guidance involves leading by example, motivating others, setting goals and plans, and providing counseling. The key to leadership is influence over others and maintaining cooperation through respect, integrity and accountability. There are different types of leadership defined by the group's focus and the leader's style.
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1) Language and speech development is a complex process that almost every human child succeeds in learning. It involves the development of language, communication of thoughts and feelings through symbols, and speech, the act of expressing thoughts through words.
2) Children progress through different stages in their first few years, starting with babbling, then their first words around 12 months, word combinations around 2 years, and simple sentences by 3-4 years old. Their ability to produce sounds also develops over time as they learn the phonetic patterns of their native language.
3) The development involves both biological and learned aspects. It provides insights into the human mind as children figure out the rules and structures of their ambient language through social interaction
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· Client works at a Senior day program in Ypsilanti and has housing at this time however is at risk of losing employment and housing due to her worsening symptoms and inability to care for herself.
· Bio-psycho-social-spiritual history:
· Biological domain: Client is a 35years old female-single with two children. White. She reported that she was previously on the following: Paxil, Celexa, Lexapro however all have been discontinued and uncertain why.
· Psychological domain: Denied any auditory of visual hallucinations or paranoia. She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019 with an attempt in august.
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· Biological domain: Client is a 35years old female-single with two children. White. She reported that she was previously on the following: Paxil, Celexa, Lexapro however all have been discontinued and uncertain why.
· Psychological domain: Denied any auditory of visual hallucinations or paranoia. She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019 with an attempt in august.
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Case Presentation 20-11-2012
- 1. Case Presentation Dr. Rehab Shafik Dr. Reham Abd-Elmohsen
- 2. Personal Data: • 48 years old, female patient, she has divorced since 17 years, has one son, she’s house-wife. • Admitted on 30/10/2012, involuntary admission.(several admission)
- 3. Complaint :• from patient أخويا عمل لى عمل – بيحضر الشياطين عليا – بيخلى عينى تتشعلق فوق. دول مش أهلى أنا اتخطفت من وانا صغيرة – ممكن تكون الناس بتتكلم عليا. الناس اللى معايا عارفين أنا بافكر فى إيه إنما الناس اللى معاكم انتوا مش عارفين – الناس اللى معايا دول ناس أنا الوحيدة اللى باشوفهم واسمعهم وأحيانا بيتكلموا مع بعض عليا وأحيانا بيعلقوا على تصرفاتى.جوزي طلقني ورجعني تاني هم بيقولوا انه مات بس انا متأكدة انه عايش شوفته قريب.انا اهلي بيسيطروا على تصرفاتي بعمل حاجات من غير ارادتي
- 4. Complaint )• from relative: (her sister بتشك فينا وبتكرهنا – بتقول علينا مش أهلها – بتكلم نفسها كأن حد بيكلمها – بتقول باشوف خيال ت – بتكلم نفسها كل م مش مفهو م – رافضة العل ج – مش بتعمل أى حاجه فى البيت – مش بتقو م من على السرير.
- 5. History of present illness: The condition started by insidious onset, progressive course of lack of sleep since one week, believes that her father will harm her, and that her relatives are foreign and she didn’t know them since 1 month, ideas that others may talk about her since 1 month, saying that she sees persons who aren’t real and hears voices talking with her & comment on her behaviors sometimes, and sometimes argue about her since 1 month, refuse medication, lack of activity & self neglect since 2 months. She says that her husband is still alive but he’s died.
- 6. Past History: •Psychiatric: - Condition started since 16 years, by delusions of persecution, reference, ideas of grandeur, bouts of agitation, visual & auditory hallucinations since 10 years, bouts of hyperactivity and talkativeness since 10 years in which symptoms continue in-between attack, the ptient received Prianil 600 mg/day – clozapex 600 mg/day, since 14 years - Since 2 years she said that her parents kidnaped her but they treated her will, delusion of influnce and diagnosed as schizophrenia, received treatment and improved.
- 7. Past History: •Drug Abuse: heavy cigarette smoker •Medical: No HTN, No D.M, No other specific medical condition. •Surgical: No previous surgical operations.
- 8. Family History: No similar cases in her family Family setting & Appearance: •Father: seller, has renal failure, good relationship with her. •Mother: intact personality, good personality, has good relationship with her. ()مامتى كانت مغنية مشهورة اسمها شوشو عبده •Consanguinity: positive. •Relation in between: good •Siblings: 2 sisters, 3 brothers. •Housing & living atmosphere: medium.
- 9. Personal Hx: •Pregnancy: normal, •Delivery: normal. •Early Development: Normal. •Neurotic trait: didn’t present. •Child abuse: no child abuse.
- 10. Personal Hx: •Scholastic history: good, دبلو م تجارة •Occupational history: never has work. •Sexual history: good. •Marital History & offspring: good, widow, one son, denies that her husband is died.
- 11. Premorbid personality •Social relationship : has limited social relationship. • Mood: stable. •Energy: in reality. •Habits & hobbies: cooking. •Religiosity: was religious, praying regularly. •Personality trait: introvert.
- 12. Mental State Examination •General appearance & Behavior: suspicious with wandering eyes, average PMA, •Consciousness: fully conscious •Attention & Concentration: attentive, average concentration. •Orientation: oriented TPP. •Memory: intact recent, short, and long term memory.
- 13. Mental State Examination •Speech: induced coherent speech, relevant answers. •Thinking: - Form & stream: no Formal Thought Disorder -Content: Delusions of persecution, ideas of reference ?? Delusions that her husband is alive, delusions that her parents kidnapped her?, and her son isn’t her son. Thought broadcasting, -Possession: possessed by her brother. •Abstraction: abstract
- 14. Mental State Examination •Perception: auditory & visual hallucinations. •Mood & Affect: suspicious mood, constricted affect. •General information: average. •Assessment Of intelligence: average. •Judgment: impaired •Insight: partial.
- 15. Mental State Examination •Risk: -self: no suicidal ideas, no previous attempts -Others: no homicidal acts. -Neglection: mild •Mental capacity:
- 16. Physical Examination: -B.P: 110/70 - pulse: 80 temp 37 -Appearance: NO abnormalities -Clinical examination free. Investigations: routine are normal
- 17. جزاكم ال خيرا Thank You