CASE PRESENTATION

MEENAKSHI ANANDI

PRELIMINARY DATA
Mr.C. W. L, is a 32 year old Chinese married gentleman.

He is a freelancer and resides in Cheras.

Brought in by his brother and wife.
Language spoken was in English and Malay.

CHIEF COMPLAINT
I cant sleep for the past 1 week.

Raised his voice against his brother and wife for not giving money on the 31 st October.

HISTORY OF PRESENTING ILLNESS

He says he has been unable to sleep for the past one week. He sleeps only for about 4 hours per day
and claims that it is sufficient for him.
When awake, he keeps thinking of his unaccomplished mission to be a good husband and a good
father.
He wants to invest in business and learn new languages. 3 years back with the money he earned
through gambling in Australia( rm.70,000), he spent it in japan to learn Japanese in 6 months.
Likes to spend money. He claims that the money he earns he gives it to his mother to save for his
daughter. But gets money from her when he needs it.
He also likes spending his money on entertainment like gambling and also on drinking. He kept asking
for more money from his brother and wife. When they refused to give the money, he lost his temper,
raised his voice against his wife and brother. This made them to bring him to the emergency
department of HKL.

 PAST MEDICAL HISTORY

Nil
MEDICATIONS AND ALLERGIES
Cant remember the medication name. stopped recently, as the medicines caused bedwetting and he dint
like it.
No allergies were reported.

Past psychiatric examination

Has been admitted to the hospital atleast 10 times. The last one was in early 2014.
he has been always admitted to HKL and once in hospital cheras.

Forensic history:
arrested once by police for touching a woman inappropriately. He said he wanted to steal
rm.10 from the lady, but he was arrested for touching her. He said it happened long time ago.

 Sleeping habits:

Usually gets 6-7 hours of sleep during his early days.

But currently he is unable to sleep at night. He sleeps at 12-1am and wakes up at 45am. He says he cant sleep because his missions havent been accomplished. I need to
be a good husband and a good father.

Toilet habits:
Bed wetting because of the medication he was taking. Increased urinary frequency. No other UTI symptoms.
Bowel movements normal.

Appetite:
He has a good appetite.

Family history
Father was a construction worker and passed away at the age of 55 due to heart attack when
he was 20 yrs old.
Mother was a housewife.
Has a younger brother who is 30 years old and is working.

Personal history
Born via spontaneous vaginal delivery on the 16.10.1982.
Milestones- normal
School- was a cheerful child
school drop out at the age of 13, form 2.
Work history
Worked in japan 3 months- hard core labourer.
Australia- machinery helper
2014- Thailand 10 days trip HRM
Religion
He belives in god but he says it is not necessary to go to temple to pray.

Drugs and alcohol

Started smoking at the age of 13 . Started with one pack per day( 7 sticks). Currently smokes
20 sticks per day. If stressful smokes 40 sticks per day.
Started drinking alcohol at the age of 13. he was introduced by his father with a glass of beer.
currently drinks 4-5 big cans of beer or 5-7 shots of whisky. If he has money, he goes to a bar
and drink or else drinks at home. Drinks mostly alone.
Started smoking ganja at the age of 13 under the influence of his school friends. But now, he
takes it once in a while, when lonely.

Marital and sexual history:

Married 3 mnths ago. He claims that his wife is a Vietnamese whom he met at a pub.
She is currently pregnant. He is happy in his marriage.
Has previous history of multiple sexual partners. One Korean,
Australian etc. claims that Malaysian girls dont provide the service he pays for.
currently no other partner.

Premorbid personality
jovial and cheerful person

Psychiatric examination
He is well oriented to person, place and time.
Memory:
Five minute memory test: the five words given were
(bed/tree/bucket/plate/car)

His recent memory was good. He was able to recollect all the five words.
After 5 minutes, he was able to recollect 4/5.
Able to do simple calculations like 2+2

Intelligence:
It was fair
He was able to answer when asked about the current prime minister of Malaysia.

Abstraction:
It was good.
The proverb no pain, no gain was asked and he was able to answer.

Attention and concentration:

When asked to do the serial seven test, he was able to do the first
calculation (100-7=92) and refused to do after that.
He did well in the digit span test.
Judgment:
Good.
House on fire scenario: He would run out of the house to safe his life.
Insight:
partial
He says his problem is unable to sleep and taking the medication helps
him sleep.

TREATMENT PROVIDED

T.epilim 600mg
T.risperidone2mg BD
T.clonazepam 1mg ON
T.artane 2mg ON

 Precipitating factor Predisposing factor Perpetuating factor-

Differential diagnosis
Bipolar disorder type 1

Alcohol abuse
Substance abuse
Personality disorder?

DSM IV TR MULTI AXIAL CLASSIFICATION

AXIS I:

AXIS II: Nil

AXIS III: Nil
AXIS IV: Nil

THANK YOU!!!!