CASE PRESENTATION

GROUP 7
ASST. PROF. DR. KARTINI ABDULLAH
PATIENT’S PROFILE CHIEF COMPLAINT
• Mr Z • Known case of mental illness for the past 3 years
• 39-year-old • Brought in by police due to aggressive behaviour
on the day of admission
• Malay
• Divorced (10 years ago)
• Jaga parking
• Lives alone at Jalan Teluk Sisek
• Education up until form 2
 2007
• Elevated mood, energy
• Believed that he was
chosen by Terengganu gov
to conduct an investigation
to discover the cause of
low moral in the society. He
was given the title ‘Polis
Diraja Hak Asasi Manusia’.
• He purposely stole a bike
to get prisoned in order to
conduct his investigation in
prison
• Denies any depressed
mood, loss of interest or
suicidal thought.
• He was prisoned at Penjara
Maran for 18 months
2013
• He was first admitted due to
aggressive behaviour.
• Assaulted a visitor in a hotel
room
• Patient admitted taking ‘pil
kuda’ at that time
• Admitted for 1 month
• Discharge with medications
but not compliant.
• Defaulted follow-up
• He was working at a car wash
• Live alone in a rented room
2015
• Second admission because he
assaulted his neighbour. His
neighbour like to ridicule him
by calling him crazy.
• Brought in by police and
admitted for 1 and a half
month
• Compliant to follow-ups and
medications
• Claimed that doctor stopped
his medication in early 2016
• He claimed that he as stopped
taking drugs
• Still working and living at same
place
11 months ago
• Changed job – he rented a
land and turn it into a parking
space.
• He feels energetic  take
cleaning cars job at his parking
space
• Works everyday from 8.30 –
12 am. Only sleep around 3-4
hours/day
• He believe that his land is
wanted by triad gang
• He always felt that he is being
watched by people from the
triad
• He also believe that he has a
royal blood in him. Animals
wont harm him and obey him.
He also claimed that his
parking space were given by
the Pahang Gov to him
• Involved in a fight with people
he claimed from the gang,
broke his nose
• Denied being more talkative
than usual, easily distracted.
ON THE DAY OF ADMISSION

• Earlier that day, he admitted he took syabu around RM30 packet, jab
• He has been hearing voices, by his ear
• Multiple voices
• Talking among themselves, unsure the content
• Uncontrollable, but he choose to ignore it. He knows that is from the drugs
• No running commentary

• No visual, gustatory or tactile hallucination

• He worried that the people from the gang will come and harm him so he brought parang to work
• He was reported and brought in to ward Dahlia by the police.
FAMILY HISTORY

• Separated from his family when he was infant. No memory of real parents, only know
they have died during war
• Lives with adopted parents
• He is the 2nd out of 7 siblings
• Claimed that he had been married 7 times with 4 children. People want to have his
offspring because he has a noble blood.
PAST PSYCHIATRIC HISTORY PAST MEDICAL HISTORY
• 2 previous admission, 2015 last • No known medical illness
• Prescribed with epilim (valproate) and • No previous surgery
respidal (risperidone)
PERSONAL HISTORY

• Birth: SVD, uneventful

• Development: normal
• School: expelled at form 2 because he involved in sexual promiscuity, involved with
absenteeism, gangsterism,
• Occupation: multiple job, claimed to be very devoted to his job, customers are satisfied
with his car washing services
• Relationship: divorced around 10 years ago, not in contact with his ex-wife or his
children. Lost contact with his adopted family
DRUGS HISTORY

• Started first took cough syrup when he was 20

• The drink alcohol, around once per month. Believed that it can cleanse his kidney
• Then take pil kuda, syabu
• Syabu – sometimes chase, sometime jab
PREMORBID PERSONALITY

• He describe himself as a fierce guy, gangster

• He used to mix with his neighbours from his gangs, had multiple friends from his gang
• Good relationship with adopted family, they treated him like he was their own son
OTHERS

• Smokes around 1 and a half pack per day before admitted

• Involved in sexual promiscuity