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ANAMNESIS Anamnesis is the act of remembering the medical or development history of the patient.

It functions to form a background and measurement of clients functioning and provides understanding of the clients past, present and potential functioning. It is from the Greek word that derived from Anamimneskein, Anamne which means to remind, while Ana + mimneskein means to recall. Essential data were all gathered through verbal interaction, hospital records and informants. We started the gathering of data on May 14, 2013 until May 23, 2013 during our CIU and home visits. Considering the ethical conduct of confidentiality, we chose to call our patient as Patient Z. She was born on August 10, 1984, 29 years old, female, confined at SPMCMCPBM Crisis Intervention Unit (CIU) last May 13, 2013 12:05 AM diagnosed with Bipolar I Mood Disorder Mixed Phase with Psychotic Features. INFORMANTS These are the individuals who gave vital information regarding the present and past condition of the patient. It consists of patients family, relatives, neighbors and other significant person. The information we gathered from these informants give us a vivid picture of the circumstances surrounding the patients condition and further understanding of the psychodynamics of the patient. Informant #1 Name: Mr. Z Age: 48 years old Address: P-2 Manay, Panabo City Relationship to patient: Husband Length of time known to patient: 19 years Understanding Impression to clients condition: nasakit lagi ang akong asawa maam, nagwild man to siya, tungod kay murag nalisang siya sa pagkakita sa iyang anak nga nikalit rag tumba pagkahuman og inom atong tambal nga para unta sa iyang igsuon.

Attitude and Characteristics of Informants: Willing to provide information: able to have consistency in narrating events.

Informant #2

Name: Mrs. X Age: 52 years old Address: Koronadal, Cotabato Relationship to patient: Mother Length of time known to patient: 29 years Understanding Impression to clients condition: murag wala jud nag-alibyo ang iyang sakit. Unta lagi na maayo na siya para makagawas na siya diri, kay bag-o ra baya to nakagawas ang iyang igsuon na laki.

Attitude and Characteristics of Informants: Cooperative but sometimes defensive in answering questions about patients condition.

Informant #3

Name: Sibling F Age: 32 years old Address: P-2 Manay, Panabo City Relationship to patient: sister Length of time known to patient: 29 years Understanding Impression to clients condition: nabalaka ko maam kay tulo na sila kabuok naggawas sulod sa mental, unya karon naa si patient Z didto. Naluoy baya ko sa ilang kahimtang kay siyempre igsuon mi. nagaway man to sila sa iyang bana, tapos wala na dayon ni kaon si patient Z, nitukar napod to ang mga sintomas pareha atong 2008

Attitude and Characteristics of Informants: Cooperative and willing to provide detailed information about patient.

Informant #4

Name: Mrs. A Age: 33 years old Address: P-2 Manay, Panabo City Relationship to patient: neighbor Length of time known to patient: 4 years

Understanding Impression to clients condition: usa ka adlaw ato usa ato kay sweldo sa iyang bana, naguol siya kay ang sweldo nahurot rag bayad sa mga utang. Unya pagka-ugma man siguro, ang ika-upat niya nga anak naka inom og tambal na para sa iyang igsuon. Maong na nervous siya. Mao na siguro to ang hinungdan. Naa puy usahay kung mag-away na siya sa iyang bana kaydili siya mu kaon, kana ganing damayon niya ang iyang pagkaon

Attitude and Characteristics of Informants: Cooperative and responds to questions appropriately

Informant #5 Name: Mrs. B Age: 61 years old Address: P-2 Manay, Panabo City Relationship to patient: mother of her brother-in-law/ neighbor Length of time known to patient: 14 years Understanding Impression to clients condition: Bughat, pasmo ug kaliwat, pero murag kaliwat na nila ka y tulo naman na sila na ingun ana. Ang iyang papa pud tung sa Cotabato pa mi, makit-an namo nga mag-estorya estorya siya isa sa kilid. Amua ganing pakan-on kay basin napasmo

Attitude and Characteristics of Informants: Cooperative and willing to give more information.

Informant #6 Name: Ms. D Age: 20 years old Address: P-2 Manay, Panabo City Relationship to patient: relative/ neighbor Length of time known to patient: 20 years Understanding Impression to clients condition: makabantay ko nga murag dili jud normal si ante kay usahay pag mu istorya mi musimang iyang mga tubag. Nakabantay pod ko nga mag sige rana siya ug panglaba unya dili mu kaon sa saktong oras. Mas unahon pa jud niya ang mga buluhaton sa panimalay kaysa sa pagkaon maam.

Attitude and Characteristics of Informants: Willing to provide answers to questions.

Informant #7 Name: Mrs. E Age: 45 years old Address: P-2 Manay, Panabo City Relationship to patient: neighbor Length of time known to patient: 12 years Understanding Impression to clients condition: okey raman na si Patient Z kato lang jud nahibaw -an nako nga na admit siya sa pangkaduha nga higayon. tungod man daw to sa iyang anak nga nakainom atong tambal nga para dapat sa iyang igsuon.

Attitude and Characteristics of Informants: Willing to provide answers to questions.

FAMILY HISTORY: To preserve the principle of confidentiality, we thereby withhold the true identity of Patient Zs father; we shall address him as Mr. X and Patient Zs mother as Mrs. X. FATHER Mr. X was born in Panay, Antique. His educational attainment was only until 5 th grade. He had his first job as a farmer at their locality at the age of 18. After sometime he then worked as a laborer. His monthly salary according to his wife was 1,000 pesos/month. Currently, he is unemployed due to his age. Mr. X started drinking liquor and smoking cigarette at an early age. At this time he still continued to have his vices as verbalized by Mrs. X, muinum paman gihapon siya maam pero dili siya mahubog, muuli ra siya diretso kung makainon. Magsigarilyo pod diay siya maam mga isa ka kaha sa usa ka adlaw. Mrs. X claimed that her husband was diagnosed in Cotabato with a mental problem while he was still adolescent, as verbalized nakabalo nalang ko maam nga naa diay siyay sakit nga pareha sakong mga anak katong taod -taod na among kaminyoon ug dagko na among mga bata. Iya rapod mga igsuon ang nag ingon sa ako. Nahatagan man daw siya ug tambal sa una. When asked for any files that may support the admission of Mr. X from the wife, there was no documentation showed.

Mrs. X described her husband as a good person but with time Mr. X had changed his behavior and personality. He became moody and at the same he gets mad easily. dali ra jud na siya saputon maam wa nako kasabot sa iya. Mura naman siya gyud ug walay pakialam sa amu pamilya niya. Namatikdan nako sa iya maam nga karon tuiga maga istorya-storya na siya sa iyang kaugalingon pero murag sa katiguwangon man yata niya na. She stated that Mr. X was a good father to his children. As verbalized by Mrs. X, maayo man siya nga amahan sa iyang mga anak maam, kung mag disiplina siya iya ra istoryahon ug kasab-an aron mag tanda. she also added, suod man siya sa iyang mga anak, naa lang jud isa niya ka anak na permi niya badlungon mao na ang kinamagwangan namu. Kung makasala gani to siya, iya dayon mabunalan pero sa uban niya anak close man niya. Patient Z also added, suod man mi sa akong tatay maam makadum-dum gani ko nga iya kong ipababa sa iyang abaga. MOTHER Mrs. X was born in Luna Makilala, La Union. Her educational attainment was until 5th grade only. When she married Mr. X she became a fulltime housewife to her husband and mother to her children. When she reached 45 years old, she worked as a farmer in their locality as verbalized, naga hornal man ko sa una maam. She received a salary of 200/ day during that time. In relation to discipling her children, she verbalized, ako raman sila ginakasab an usahay mabunalan nako sila. Mag gamit ko ug stick nga kahoy pero sahay raman pod nako gamiton kanang dili na jud mutuo. She says that her relationship with her husband is not good as verbalized, dili na jud mi kaayo suod sa akong bana. Sige ra mi ug away. Mr. X met Mrs. X at their place. They then got married on the year 1979. The couple then moved to their new residence at Koronadal, Cotabato. They were blessed with 8 children; 4 males and 4 females. MATERNAL AND PATERNAL LINEAGES Looking both lineages; claims from informants supported that Mr. X has mental problems. Such behaviors observed were staring blankly, talking to his self, and change in approach towards other people. As for the mother she was only described having behavioral problem as verbalized, pag istoryahon nimu si Mr. X maam mukalit ra ug lihis iyang tubag.

SIBLINGS Patient Z supposedly has 9 siblings; with four females and five males. Unfortunately, Mrs. X had a miscarriage on her first pregnancy as verbalized, nakuhaan tuod ko sa una maam, mao dapat tu among eldest. 3 months akong tiyan atu. Nagdugo naman gyud ko maong gidala naku sa hospital, upat ko ka adlaw nag stay didtu. Mga 19 man tu akong edad. First child as sibling E, second as sibling F, third as sibling G, fourth as Patient Z, fifth as sibling H, sixth as sibling I, seventh as sibling J and the youngest and eighth child as sibling K. In relation to her siblings, Patient Z has 2 brothers who were also admitted at SPMC and was diagnosed with Schizophrenia Undifferentiated. Sibling E, aged 34, male, single and currently resides at Cotabato together with Mr. X their father. Sibling E was known to be a drunkard and a heavy smoker. According to his mother, there was no evidence of symptoms of mental problems. Sibling F was 32 years old, female, married and currently living at Manay, Panabo City. According to Mrs. D, Sibling F went to Singapore and was manifesting symptoms of mental problems as verbalized, katong iyang kamagwangan nga bae maam niadto man to ug abroad dayon gipauli diri kay nagsinto -sinto naman daw didto pero naagapan ra mao wa nilala. Sibling G was 31 years old, female and presently resides at Manay, Panabo City. There were no observable signs for mental problems. Patient Z was 29 years old, female, married and currently living at P-2 Manay, Panabo City. She is the subject for our grand PAR presentation. Sibling H aged 27 years old, female, married with 3 children and living at Manay, Panabo City. She stated that kung naay problema si Patient Z, iya ranang luom luomon maam hantod sa ma depress na siya unya din a dayon siya mukaon. Sibling I was 23 years old, male, single and currently living at Manay, Panabo City together with his older sister. He was admitted in SPMC twice; His first admission was on the year 2010. He was admitted due to the fact that he was mauling other people and his mother. He was also seen by his neighbor carrying sharp materials such as knife, was talking to himself, does not sleep properly, does not have any appetite to eat, and was staring blankly. He was then given treatments at the said hospital and was discharge with a diagnosis of Schizophreniform. His second admission was on July 10, 2012 where he was diagnosed with Schizophrenia Undifferentiated.

Sibling J was 21 years old, male, single and currently resides at Manay, Panabo still with his older sister. During the admission of Patient Zs second brother, her third brother together with their mother was the watchers and the ones who took care of him. According to their older sister, at the time her third brother came home after the discharge of brother 2, she observed that her younger brother was already acting weird. He was already talking to his self, was pacing, does not sleeps and eats, mauled other people as well as their mother. He was admitted last May 7, 2013 at SPMC and was discharged May 11, 2013 with the diagnosis of Schizophrenia Undifferentiated. One of the siblings also claimed that their youngest brother (Sibling K) who was now 17 years old were also projecting weird acts like laughing by himself and talking to his self. Sibling F also added, maam murag naa man yata sa among genes ug kanang pag mutung-tung na jud ang edad ug mga 18 musugod na dayon ug tukar plus kanang mapasmohan maam. Para sa ako mao yata na hinungdan mao nang mmagduha -duha gani ko ug bisita didto kay Patient Z kay ana akong bana nga basin matakdan daw pod ko. Patient Z claimed that they have a good relationship towards each other supported by her mothers verbalization, Okey raman sila maam, mag tinabangay man pud sila sa usag usa. , Mag-away usahay pinaagi sa estorya kanang mag yaw-yaw gyud. Dili man sila magpinasakitay. PERSONALITY HISTORY: PRE-NATAL Patient Z is the 4th child of her parents. Mrs. X was happy when she knew that she was pregnant for the 4th time. Mr. X also supported her all throughout her pregnancy; he accompanied her to the health center twice a month for the first and second trimester and thrice a month for the third trimester. Mrs. X eats healthy foods such as green leafy vegetables, fruits and foods that are rich with nutrients. She also takes in vitamin supplements which she received from the health center. As she can recall, she stated that she didnt experience any complications during the course of pregnancy. She also added that she had received vaccination in a form of TetanusToxoid for the 4th time.

BIRTH After 2 days of labor, Patient Z was born full term on August 10, 1984. Mrs. X stated that she delivered patient X through NSVD in their home attended by a partera/manghihilot. There was no problem experienced by Mrs. X after delivery. INFANCY AND CHILDHOOD After giving birth to Patient Z, she then immediately brought her to the health center for vaccination as verbalized, nabakunahan mani siya maam ngadto sa Cotabato. Gihatagan siya ug Hepa B, DPT,OPV, BCG, ug measles atong 9 months pa siya. She also attended to the needs of the newborn. Mrs. X said that she cuddles patient Z every time she breastfed her until two years of age. Patient Z started to wean at the age of four months as verbalized by Mrs. X Gisugdan nako siya og pakaon og lugaw na sagolan ra gamay asin atong four months siya. She also claimed that her daughter does not have any allergies to medications, food and/or environment. Patient Z was exclusively cared for by her mother. She started to say nay/tay at the age of one year old, started walking at 2, and had a history of fall from a duyan at the same age. Katong two years old si patient Z, natagak siya gikan sa duyan, okay raman pod siya, wala man hinuon na pi-ang, as stated by Mrs. X.She was toilet trained at the age of three years old as verbalized by her mother, Mo diretso na siya sa gawas unya sa yuta siya malibang uunya ginatabunan ra nako ug yuta. Nakatuon ra siya malibang sa CR kay gina kasab-an man nako siya. SCHOOL LIFE Patient Z was seven years old when she entered school. She had graduated her elementary years with special honors. She was not able to have her secondary education due to financial constraints. Mrs. X described her child as an obedient student. She does her homework every night by herself. She excelled in Filipino subject. During Patient Zs elementary years, Mrs. X stated that patient Z complained of being bullied as verbalized, Nagasumbong man siya sa ak o na gina-kusi man siya sa iyang mga classmates. Iya dayong i-sumbong sa iyang mga teacher.

Patient Z was punctual in school and only makes absences when she is not feeling well. Kaduha raman siya maka-absent maam, kanang maglabad iyang ulo tungod sa ka-init daw to sa iskwelahan. During school meetings, Mrs. X does not receive any negative remarks about her daughters performance. During childhood, Patient Z stated that she did not experience any major illness or had undergone any surgical procedure. She claimed that she only experienced fever, cough and colds. She was only given medications such as Paracetamol and Carbocisteine. PLAY LIFE According to patient Z, she prefers to play tumba-lata, bola-bola, tago-tagoan and dakop-dakopan. Mrs. X stated that she had observed that her daughter prefers to play with the same sex. She added by verbalizing, Magsunod sunod raman na siya sa iyang mga kadula kasagaran babae akong makit-an. Didto sa Cotabato, sa duol raman na siya sa among balay magadula-an. Mo uli man dayon siya kung tawagan na. Kung ting iskwela, panagsa ra na siya mo dula kay mo himo mana siya og mga assignments. PSYCHOSEXUAL LIFE Patient Z had her menarche at the age of fourteen years old. From then on, she had her regular monthly period lasting for 7 days. She has never experienced any menstrual cramps. OCCUPATIONAL HISTORY Due to financial problem, Patient Z started to work at an early age. When she was 17 years old, she applied for a job as a house helper in Panabo City. She verbalized, daghan naman ko ug natrabaho-an maam kanang mangamo jud. Dili man ko magdugay kay kapoy unya daghan pod ug trabahuon. She received a salary of 600 pesos per month and she shares this to her parents. According to her, she does not save for herself this is to help her parents for their daily needs. She described that her last job was a waitress/helper in a restaurant in Panabo City where she met her husband who was at that time working in a company. RELIGIOUS AND SOCIAL ADAPTIBILITY Patient Z together with her husband lived at Manay, Panabo City. She then had a lot of friends; she preferred to have a circle of the same sex. Accorrding to Mrs. E, okey

raman na sila nga pamilya maam, suod man pod mi ni Patient Z. lagyo -agyo lang ang mga balay diri-a mao ng kami-kami rasa dang magtapok-tapok. Katong bag-o ra maam, naa man to siyay naka bungol nga silingan namu ug pa rente pod to sa pamilya. Patient Z was Roman Catholic by faith until she was married. She verbalized, dili man kaayo mi maga simbahan maam kana rang naay time. MARITAL HISTORY Patient Z was 17 years old when she met Mr. Z her husband who was 30 at that time. Her husband proposed to her and asked the parents of Patient Zs approval for their marriage. It was on the year 2002 when the couple married. With their 11 years of marriage, the couple was blessed with five children with four males and one female. The couple resides then at P-2 Manay, Panabo City. Their house is a 1 storey building made of mixed concrete and wood with 2 bedrooms, a kitchen, a living room and a comfort room. The familys source of income comes from the work of Mr. Z who was a laborer of a banana plantation at Panabo City. Mr. Zs monthly salary is 20,000 pesos approximately. The money that the family gets from Mr. Z is just enough to sustain their everyday needs. Her usual activities start upon waking up and preparing for her daily chores. According to one of the informants, sayo pa lang sa buntag maam magsugod na siya ug trabaho maglaba ba kaha o maghinlo sa balay. Usahay gani makalimot nana siya ug kaon sa saktong oras kay mag sige ra ug trabaho hanyod nana mu gabii maam. During interview, Patient Z stated that it is normal for couples to have misunderstanding as claimed, mag-away panagsa maam tungod anang kwarta, bayad sa utang, tabang para pampalit sa tambal sakong mga igsuon, naa pay I ambag namu nga kwarta sa ugangan nako nga bae kay naa man to siyay Diabetes, para pod sa pag eskwela sa among mga anak unya sa among pang adlaw-adlaw na gastuhonon diri-a sa balay maam. As for their sexual life,Mr. X described their relationship as, okey raman maam, dili man mi maglalis sa panahon nga kami mag dulog. Ma satisfy man pod namu ang usag-usa. Mabalaka lang si Patient Z basin daw kapuyon ko nga aduna pa raba koy trabaho inig ka ugma. Wala man nabag-o maam bisan pa atong pagkahuman sa iyang pagka hospital atong 2008. He also added, wala man mi naga family planning maam

kato rang last mi nga nag dulog kay nag gamit nako ato ug medyas kay daghan naman jud amung anak. 5 naman jud sila maam. PAST MEDICAL HISTORY: Mr. Z narrated that on September 10, 2008 morning, Patient Z was in a hurry to pick up her son in school and was not able to eat breakfast. While she was waiting at the gate of the school, she bought and drank juice for herself later that day, her husband had observed that she was starving herself and shipped meals. Her husband cooked the familys meals, hoping that she would eat and her appetite would increase. No remedy worked. Three days later, September 13, 2008, she was brought to the hospital by her family because according to Mr. Z she was experiencing tetanus-like symptoms nanggahi ang jaw. In the hospital Mr. Z claimed that her wife seemed like she had powers since she broke glasses, tried to remove her IVF on her arm and she was uncontrollable. She was discharged from the hospital after 10 days. At home, after she was brought from the hospital, her husband observed her to be unusual. She did not like to eat, kept staring blankly and seemed like she had deep thoughts. Mrs. X decided to bring her daughter (Patient Z) to their hometown and took the responsibility of taking care of her. She lived there for three months and on December 24, 2012, her husband bringing groceries and presents went to visit her wife and was surprised to see his wife to be so thin and seemed like she has not eaten in years. After witnessing his wifes condition, he went back home to Manay, Panabo depressed with what he just saw. Her husband became very worried about his wifes state and on the same month, one of the co-workers of Patient Zs husband suggested to bring his wife in SPMC and try to receive treatments for it might be a good try. The husband claimed that he brought his wife to SPMC December 30, 2012 5:00 PM and was given medications. After which he said that Patient Z got better and was discharged after 4 hours. (There were no records found both on the archives as well as the OPD files with regards to the 2008 admission of Patients Z.)

After discharge, Patient Z managed to live a normal and healthy life with her family for almost 5 years. According to Mr. Z during the time her wife returned to her normal life, there was a change in her personality as verbalized by Mr. X, dali na s iya masuko maam. Unya ingon pod akong kinamagwangan nga grabe daw mamunal ilang mama sa iya tungod kay gahian man pod sila ug ulo. Dili dayon mutuo kung suguon. Sige ra sad mi ug away kay tungod sa kwarta. ONSET OF PRESENT ILLNESS: For almost a week already, Patient Zs 2 brothers and mother had their vacation at their home in Manay, Panabo City. On a saturday night May 11,2013 , Patient Zs mother prepared a glass of milk mixed with a pulverized anti psychotic medication for her newly discharged brother which he refused to drink and left it on the dining table. Unfortunately, patient Zs 4 year old child mistakenly took the glass of milk and drank it. Patient Z witnessed that her son fell into the floor and lost consciousness. She then panicked hysterically. After seeing the incident, she started to act differently. She

started pacing, talking to herself, crying and aimlessly walking around the house. Then she was admitted at SPMC-MCPBM May 13, 2013 12:05 am with an admitting impression of Bipolar I I Mood Disorder Mixed Phase with Psychotic Features. Her vital signs during that time were as follows: Temp.- 36.2 C, PR- 98 bpm, RR-24 cpm, BP110/80 mmHg. The patient was seen and examined by Dr. Ismael Cordero Jr. and was given the following orders: Please admit For UA, CBC and pregnancy test Medications: o Buscopan 1 amp IVTT now q 8 PRN for abdominal pain o Ranitidine 1 amp IVTT now o Omiprazole 40 grams 1 cap 30 min before breakfast o Risperidone 2 Grams tab 2x a day o CPZ 200 mg 1 tab tab in AM (6am) 1 tab BID (9pm)

o Lithium CO3 450 mg 1 tab (6am); I tab BID (6pm) o Chlorpromazine 200 mg 1 tab; tab in AM (6 am); 1 tab at HS (9 pm) o Haloperidol 5 mg amp (12:30 pm) 1 amp IM now

o Bepiridine HCl 2 mg/ tab (6 am); 1 tab PRN for EPS (6am). The patient stayed at the CIU for 8 days and was discharge on May 21, 2013 with the final diagnosis of Bipolar I Mood Disorder Mixed Phase with Psychotic Features.