History of Present Concern:

The patient is a non-hypertensive, non-diabetic, admitted for work ups for kidney transplant
Patient is a house helper of the recipient, working for him for 4years.
6 months prior, the patient heard his boss will need a kidney for transplant. He feels indebted to his employers kindness,
as an act of gratitude he decided to donate his kidney. He mentioned that all of them, as employees were screened for
blood type compatibility. He was the one who matched with the needed blood type, thus he proceeded.
5 months prior, he stopped cigarette smoking (previous 1.5pack year smoker)
Throughout the interim, he denied difficulty sleeping, eating, weight loss, suicidal ideations, lethargy, loss of interest,
depressed mood. No palpitations, headache, nausea or vomiting, diarrhea, bowel or bladder problem.
He was admitted for clearance and work-up.
Awareness of the procedure: He is cognizant that he will undergo removal of a kidney although uncertain of the laterality.
Upon questioning if he is aware of the complications, he said he might have trouble passing urine and difficulty of
breathing, pain may be severe and he might not be able to work for 1year.
Past Medical History
(-) hypertension, diabetes, renal disease
(-) previous psychiatric pathology (anxiety, depression)
Family History
(-) DM, hypertension, kidney disease, psychopathologies
Personal Social History
Prenatal
The patient is the eldest among 6 siblings, born to a then G1P0 mother via normal delivery, no complications.
There were no noted complications during the course of the pregnancy and during delivery. There were no
congenital anomalies noted. His mother is the primary caregiver.
Childhood
Patient was raised by his parents. His father was the primary provider. He had an unremarkable childhood and
spent most of her time in school. He is not involved in school fights or brawls. He claims that he has passing marks
in school.
He continued through high school and engaged in sports activities such as basketball and Taekwondo.
Adulthood
After finishing high school, he enrolled into a vocational automotive course. He did not finish the course since he
felt more interested in earning money. Instead, he worked as a part time painter for 3 years.
A friend of him then introduced him to the family of his current employer (kidney recipient.
In terms of relationships, he had 3 sexual partners. No history of STDs.
He has 2 kids. His 1 st child is from his 1st wife (died of heart problem). His 2 nd child was from his current live in
partner.
Smoking, Alcohol and Illicit Drug History
The patient started smoking at 22 years of age and stopped 5 months ago.
He drinks occasionally, 4 shots of brandy per drinking session, 1 drinking session in a week.
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No illicit drug use

Review of Systems:
General. No fever, significant weight changes.
Skin. No rashes, dryness, or skin discoloration.
Head. No head injury or scalp lesions.
Eyes. No redness, jaundice, dryness, or pain.
Ears. No otalgia, otorrhea, or changes in hearing.
Nose and Sinuses. No epistaxis or abnormal discharge.
Throat and Mouth. No sores, bleeding gums, dysphagia, sore throat, or hoarseness.
Neck. No neck pain, lumps, or limitation of motion.
Respiratory. No cough or colds.
Cardiovascular. No chest tightness.
Abdomen. Regular bowel movements. No nausea, vomiting, diarrhea, constipation, or abdominal pain.
Peripheral Vascular. No varicose veins, cramps, or edema.
Genitourinary. No dysuria, hematuria, or nocturia.
Musculoskeletal. No joint or muscle pain.
Neurologic. No headache or dizziness.
Hematologic. No easy bruising, easy bleeding, or non-healing wounds.
Endocrine. No heat/cold intolerance, polydipsia, polyphagia, or polyuria.
Mental Status Exam:
Appearance

Patient was seen in his room, well-groomed, with no abnormal odors, abnormal facial
expressions, or signs of poor personal hygiene.
Speech
He answers in phrases or sentences spontaneously and fluently with no problems in
volume, rhythm, prosody, intonation, pitch, phonation, articulation, quantity, rate,
spontaneity, and latency of speech. There is no noted aphonia, dysarthria, aphasia,
stuttering, cluttering, mutism, echolalia, palilalia, or neologisms.
Mood and Affect
Euthymic mood with appropriate affect.
Depression Screening
Hamilton score is 0. Becks score is 0.
Thought Process and Content
Thought is coherent with no flight of ideas. Thought content is appropriate with no
reported delusions, overvalued ideas, obsessions, phobias, and preoccupations.
Perceptual Disturbances Perception was intact with no reported hallucinations and illusions.
Sensorium and Cognition He was alert, and oriented to person, place, and time with no gaps in memory.
Judgement and Insight
Insight and judgment are intact with no signs of psychosis or dementia.

Physical Examination:
Conscious, coherent, and not in cardiorespiratory distress
Anicteric sclerae, pink palpebral conjunctivae
Supple neck, no neck masses, or cervical lymphadenopathies
Symmetric chest expansion, clear breath sounds
Adynamic precordium, normal rate with regular rhythm
Soft, flat, non-tender abdomen
Pulses full and equal, no edema
Neurologic Examination:
Mental status intact.
Cranial nerves
CN I: No abnormalities in smelling
CN II: Pupils 3 mm, briskly and equally reactive to light
CN III, IV, VI: Intact and full extra-ocular movements
CN V1V2V3: Motor and sensory intact
CN VII: No facial asymmetry
CN VIII: Gross hearing intact
CN IX, X: Uvula midline
CN XI: Good shoulder shrug
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CN XII: Tongue midline

Motor:
5/5 | 5/5
5/5 | 5/5

Sensory:
100% | 100%

100% | 100% DTR:

++ | ++

++ | ++

Clinical Discussion
Major Depressive Disorder (MDD)
According to the DSM-5 criteria for the diagnosis of MDD, our patient has displayed 0 out of 9 symptoms, in addition,
Becks and Hamilton score were also 0/0, ruling out Depressive Symptoms for the patient.
DSM-V Diagnostic Criteria for Major Depressive Disorder
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a
change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest
or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad,
empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents,
can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as
indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a
month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make
expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of
restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not
merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or
as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a
suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of
functioning.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.
D. Note: Criteria A-C represent a major depressive episode.
E. Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious
medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor
appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms
may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition
to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the
exercise of clinical judgment based on the individuals history and the cultural norms for the expression of distress in
the context of loss.
F.D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia
spectrum and other psychotic disorders.
G.
E. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of
the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of
another medical condition
H.
I.
J. Generalized Anxiety Disorder
K.
According to the DSM-V diagnostic criteria for generalized anxiety disorder, patient had no excessive
anxiety and worry, restlessness, easy fatigability, difficulty in concentrating, and difficulty in falling asleep, ruling
out Generalized Anxiety Disorder.
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A.

B.
C.

E.

F.

L.
M. DSM-V Diagnostic Criteria for Generalized Anxiety Disorder
Excessive anxiety and worry (apprehensive
abuse, a medication) or another medical condition
expectation), occurring more days than not for at
(e.g., hyperthyroidism).
G. The disturbance is not better explained by another
least 6 months, about a number of events or
mental disorder (e.g., anxiety or worry about having
activities (such as work or school performance).
The individual finds it difficult to control the worry.
panic attacks in panic disorder, negative evaluation
The anxiety and worry are associated with three (or
in social anxiety disorder [social phobia],
more) of the following six symptoms (with at least
contamination or other obsessions in obsessivesome symptoms having been present for more days
compulsive disorder, separation from attachment
than not for the past 6 months);
figures in separation anxiety disorder, reminders of
D. Note: Only one item is required in children.
traumatic events in posttraumatic stress disorder,
1.Restlessness or feeling keyed up or on edge.
gaining weight in anorexia nervosa, physical
2.Being easily fatigued.
complaints in somatic symptom disorder, perceived
3.Difficulty concentrating or mind going blank.
appearance flaws in body dysmorphic disorder,
4.Irritability.
having a serious illness in illness anxiety disorder,
5.Muscle tension.
or the content of delusional beliefs in schizophrenia
6.Sleep disturbance (difficulty falling or staying
or delusional disorder).
asleep, or restless, unsatisfying sleep).
H.
The anxiety, worry, or physical symptoms cause
I.
clinically significant distress or impairment in social,
J.
occupational, or other important areas of functioning.
K.
The disturbance is not attributable to the
L.
physiological effects of a substance (e.g., a drug of
M.
N.
O. In our patient, no depressive or anxiety symptoms were disclosed by the patient. In addition, no other
psychopathology was also noted.

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P.
Q. Clinical Impression: Healthy Organ Donor Clearance; No psychopathology seen
R.
S.