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GENERAL DATA:This is the case of patient ARELLANO, JEMMYLYN, 27
y/o female, single, Filipino, o! Again
"h!istian, #o!n on Ma!ch $, %&$7 in O!iental Min'o!o an'
c(!!ently !esi'ing in Rosa!io, La )nion,a'mitte' fo! the %st time
in this instit(tion '(e to 'est!(cti*e #eha*io!, the info!mant is
the
patient+s (ncle ith &-. !elia#ility
CHIEF COMPLAINT:A""OR01N TO T3E 4AT1ENT5 63in'i o po alam (ng
#ait ao nan'ito8A""OR01N TO T3E 1NFORMANT5 6Naaala siya sa sa!ili
at nagiging #aolente apag
nagagalit8
HISTORY OF PRESENT ILLNESS:9i: months p!io! to a'mission, the
patient got sepa!ate' f!om he! li*e in pa!tne! '(e to
f!e;(ent physical ha!assment fo! almost a yea! The sai' lli*e in
pa!tne! as a (se! of ma!i
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The patient as #o!n te!m *ia N9H0 at home #y a mi'ife ith no
complications Thep!ima!y ca!egi*e! as his mothe! an' the patient as
#!eastfe' The patient+s 'e*elopment e!eat pa! ith he! age The
patient ente!e' school at age 7 an' a#le to Cnish high school as
ana*e!age st('ent The patient ent to college an' as an
(n'e!g!a'(ate of 9 To(!ism Theinfo!mant claime' that patient ha'
goo' inte!pe!sonal !elationship ith family an' f!ien's
RE'IE( OF SYSTEMS:
ene!al5 BD Fe#!ile episo'es, BD eaness BD n(m#ness BD eight
loss1nteg(ment5 BD pallo!, BD cyanosis BD >inessRespi!ato!y5 BD
co(gh, BD col's, BD nasal congestion, BD 'yspnea"a!'io*asc(la!5 BD
o!thopnea BD chest pain, BD palpitationsast!ointestinal5 BD
'ia!!hea, BD a#'ominal pain, BD *omiting, BD hematoche>ia BD
aci' !e=(: BDloss of appetite, BD constipation)T5 BD hemat(!ia, BD
'ys(!ia, BD pe!ineal pain, BD f!e;(encyM(sc(loseletal5 BD eaness,
BD n(m#ness, BD shooting pain, BD stiIness, BD limitation
ofacti*ity/playing, BD
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DSM 5: Bi./lar I Dis/rder& M/st Re1ent E.is/de& Mani1
Se2ere 3ith M//d C/n%r*entPs41h/ti1 Feat*res
asis fo! ipola! 1 0iso!'e! "!ite!ia ha*e #een met fo! at least %
manic episo'es5
A A 'istinct pe!io' of a#no!mality an' pe!sistently e:pansi*e
moo' an' a#no!mally an'pe!sistently inc!ease' goal 'i!ecte'
acti*ity lasting % ee an' p!esent most of the 'ay
4atient as note' to #e mo!e talati*e than (s(al 0(!ing the
pe!io' of moo' 'ist(!#ance an' inc!ease' acti*ity, @ of the
folloing symptomsa!e p!esent to a signiCcant 'eg!ee an' !ep!esent a
noticea#le change f!om (s(al #eha*io!
% 1n=icte' selfesteem 4atient states 6nag#iya#iyahe ao sa i#at
i#ang l(ga! sa i#ati#ang #ansa8 an' 6#ayani ao asi nililigtas o mga
tao s salanan nila8
2 0ec!ease' nee' fo! sleep 4atient is still ene!getic the ne:t
'ay 'espite lac of sleep? Mo!e talati*e than (s(alG Flight of i'eas
4atient tals a#o(t looing fo! a ation to p!e*ent ha!m to othe!s
The!e a!e also psychotic feat(!es lie a('ito!y an'*is(al
hall(cinations that someone as taling to he!
0 The episo'e is not att!i#(ta#le to the physiological feat(!es
o! eIects of a s(#stance5 Nohisto!y of intae of othe! s(#stances O!
to anothe! me'ical con'ition5 4hysical e:aminationis essentially
no!mal
E The occ(!!ence of the manic episo'e is not #ette! e:plaine' #y
schi>oaIecti*e 'iso!'e!,schi>oph!enic, schi>oph!enifo!m
'iso!'e!, 'el(sion 'iso!'e! o! othe! speciCe' o!
(nspeciCe'schi>oph!enic spect!(m an' othe! psychotic
'iso!'e!
asis fo! Moo' "ong!(ent 4sychotic Feat(!e 0(!ing manic episo'es
the content of all 'el(sions an' hall(cinations is consistent ith
the
typical manic themes of g!an'iosity #(t may incl('e themes of
pa!anoia
asis fo! 9e*e!e The n(m#e! of symptoms is s(#stantially in
e:cess of those !e;(i!e' to mae the 'iagnosis,
the intensity of the symptoms is se!io(sly 'ist!essing an'
(nmanagea#le an' the symptomsma!e'ly inte!fe!e ith social an'
occ(pational f(nctioning
Plan6 A'mit to female psychiat!y a!' (n'e! the g!een se!*ice B0!
"aya'/0!a(tistaD6 9ec(!e consent fo! a'mission6 4!o*i'e 2Gho(!
atche!6 Monito! H/9 e*e!y 2G ho(!s an' !eco!'6 0AT6 ith meals an'
me' s(pe!*ision6 9t!ict assa(lt/escape/s(ici'e p!eca(tion6 Rest!ain
as necessa!y 0iagnostic5 "", )!inalysis The!ape(tics5
o Olan>apine %-mg/ta#, % ta#let at #e'timeo Na 0i*alp!oe:
@--mg/ta#let, % ta#let ?: a 'ayo 3alope!i'ol @mg 'eep 1M as nee'e'
fo! !ef(sal to tae o!al Olan>apine ith 4
p!ecat(tiono 3alope!i'ol %-mg 0iphenhy'!amine @-mg 'eep 1m as
nee'e' fo! psychotic
agitation ith 4 p!eca(tion to a ma:im(m of ? 'oses at % ho(!
inte!*al
6 GA
RCIA& 7ani1e D! "linical cle! in cha!ge
