when i\’m feeling it…

This is a place for those who had captured the sun and caused it to shine

Case study: our 1st ECT

Mr MN

Baling, Kedah
1st admission:

Was shouting non-stop and talking irrelevantly on admission

Reason for admission: tried to harm family members, decreased appetite and sleep

Noted changes of behaviour 2005; social isolation – acquired traditional Rx

Condition deteriorated 2006; Talking To Self and Laughing To Self, wandering around, claimed being bullied by seniors at school, wanted to see ‘Tuanku Sultan Abdul Halim’, claimed people going after him, bringing ‘parang’ to go to war

seek Rx at psych department for 3 f/u, then refused to come back again

In ward:

+ Paranoid delusions with religious preoccupation:

Saying that Muslims are being victimized in Penang and Singapore

Wanted to chase ‘ghosts’

+ family history of mental illness: uncle-maternal side

Stopped schooling at 15 y/o

Used to take ganja

Started on haloperidol and changed to sulpiride

2nd admission:

Readmitted around 1 month after discharged

Reason for admission: irrelevant speech, poor sleep, disturbing public

In ward:

Need to be restrained nearly 2 days, preoccupied, hostile

Was put on 2 days of IM Acuphase

Still not yet settled considerably after 3 days of admission; praying in a disordered manner around the ward, still need to be restrained on 4th day of admission

+ Nihillistic delusison:

Claimed he was deaf and dumb during his childhood years because insects which were actually ‘syaitan’ flew into his ears, and currently being eaten up by dwarfs – ‘orang-orang kerdil’ which will be dancing on his pillow at the beginning before feasting on him

Crawling in the ward – claimed now being an ‘animal’

Still need to be restrained occasionally after more than 1 week of admission

Prominent psychotic symptoms still took place with gross thought disorder, hallucinatory behaviours and also some features of flight of ideas. Tangentiality developed after a initial short time of relevant answers during each interview

Slow response to haloperidol and developed EPS (Parkinsonism features and drooling of saliva)

ECT was started:

Better presentation after 6 course – came forward, calm but anxious to go home

ECT was continued until the 7th course, then allowed home leave

Came back from home leave:

Manageable at home for first 2 days after came back home, then started talking irrelevantly again about silat etc

Wanted to be a silat master to teach others how to fight the ‘dajal’ in the big war

IM depot 200 mg

T.Risperidone 2 mg BD

T.Artane 2 mg BD

Came back from 2nd home leave:

Still wanted to be involved in silat to defend the village and country

Mother agreed there were improvements, but not yet fully stable – able to care himself, able to take Rx accordingly , still had bizarre/irrelevant answers and ideas

T. Risperidone 2 mg OM 3 mg ON

T. artane 2 mg BD

Clinic f/u:

Improves a lot, no TTS, no paranoid ideation

Clinic f/u:

Improving

Clinic f/u:

Continuous improvement; mother more cheerfull

Start to socialize back again, riding motorcycle to g/mother’s house, helping the house chores

Planned to cont schooling next year

Reactive affect, euthymic mood, orientated, no flavid psychosis

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Tuesday, April 8, 2008 - Posted by | Jobs and Works | ,

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