The Smell of Fear
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Clinico-Pathological Conference (CPC) Date: 17th January 2008 Venue: School of Medical Sciences, USM
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The Smell of Fear
- 1. CPC 17th January 2008 Dr. Zahiruddin Othman
- 2. Chief Complaints Mr. SA, a 56-year-old Malay gentleman from Pasir Puteh, Kelantan First psychiatric contact on 24th July 2002 with complaints of Easily startled by noise Difficulty to control his anger
- 3. Complained of easily startled since early 2002 Hyperacusis noted by ENT specialist since mid 2001 Sound of spoon falling on plate as loud as thunder Irritable since 2001
- 4. Past Medical History History of RTA, as a pedestrian he was knocked down by a motorcyclist on 07/12/1999 He was unconscious for more than 15 minutes He was treated in Hospital Pasir Puteh and later in USM ICU from 07/12/1999 to 15/12/2000
- 5. On 15/12/2000 he was transferred to KBMC He was noted to be restless, confused, having visual and auditory hallucinations, and delusion of being controlled by unknown spirits However, he was able to walk with help. Patient could not recall the experienced during the interview in 2002
- 6. He sustained the following injuries 1. Scalp laceration – 5cm 2. Hematoma over the right temporal scalp 4x5cm 3. Deep laceration over the left elbow 4. Multiple abrasion over the right and left lower limbs 5. Right temporoparietal intracerebral hemorrhage 6. Subarachnoid hemorrhage 7. Undisplaced fracture of cervical spine c3 and c4
- 7. Pt KBMC TUDM TLDM Egypt died PPSK Form1 Personal & Family History Premorbid personality
- 8. Occupational History Temporary YIK Teacher Making furniture Trained in ITM (1974) Own a factory Supply to USM once Stopped after the RTA Sundry shop for short while
- 9. MSE (24/07/2002) General behavior Overfamiliarity Affective response Irritable Thinking Figure of speech, symbolic, circumstantiality Talkative Difficult to stop him talking Grandiosity Paranoia – non-bizarre
- 10. MSE (24/07/2002) Cognitive functions good Attention & concentration Serial subtraction 7 test Orientation Memory Judgment & insight
- 11. Progress – August 2002 Started on antipsychotics Initially: Risperidone 0.5mg Later: Sulpiride 200mg Possibilities of Olfactory hallucinations Sweat became smelly after taking risperidone Persecutory ideas Grandiosity
- 12. Progress – Sept 2002 Less irritable Less grandiose Less circumstantial No obvious persecutory ideas Less complaint of stench odor Previously said loss his appetite for 10 hours after smelling the odor from neighbor’s kitchen
- 13. Progress Jan 2005 – Slowed psychomotor activity Jun 2005 – Frequent thoughts of dying Nov 2007 – Invited 4 shamans to exorcise his house Hantu raya made noise as if someone running on the roof shaking the whole house Toyol stole RM5 & RM10 notes Ghost got into his body causing physical illness
- 15. Don’t Look Back
- 16. Psychiatric Differential Diagnoses Organic Personality Change Organic Mood Disorder Organic Psychotic Disorder