GENERAL DATA

E.B., a 30 year old, right handed, single, Filipino-American, Roman Catholic, female, only child.

- She graduated from the University of Maryland with a degree of BA in government and politics.

- She was admitted for the first time at our institution last March 25, 2009.

CHIEF COMPLAINT

According to the patient: “I’m undergoing a change in my medications and I don’t know how it might affect me”

According to the mother: “She couldn’t sleep and she might get violent.”

PERSONALITY PROFILE

• Pre-morbid – loving, responsible, introvert, hardworking, intelligent

• Morbid – “weird”, “hyperactive”, assaultive, restless, boisterous

HISTORY OF PRESENT ILLNESS

1993

E.B was noted to lose weight, eat less, talk a lot, physically abusive to her mother, and would often break things in their house whenever she would not get what she wants.

There was also an incident where she grabbed the car’s steering wheel while Victoria was driving. They both luckily escaped the incident uninjured.

Victoria then brought E.B to Walter Reed Army Center( adolescent clinic) where she was diagnosed to have OPPOSITIONAL DEFIANT DISORDER and was admitted for a month

Upon discharge, she was able to go back to school and was able to finish her freshman year.

1994During E.B’s Junior year in high school, she was noted to have “extreme behaviors”.

She was noted to be crying and shouting because of the pressures in school since her mother wants her to excel.

1995E.B’s father died due to malignant melanoma.

Because of this, her mother transferred her to a public high school because she could not afford to send her to a private high school.

1996After graduating from high school, EB wanted to be away from her mother and to have a life of her own.

She went to Buena Park in San Francisco where she stayed with a friend.

She found work at the San Francisco Cookie Company doing errands. After a few weeks working at the cookie company, she went back to Maryland because she could not afford the cost of living in Buena Park.

She then worked as a cashier at HEX Department store to save money for college. However, her mother did not approve of her job so she was forced to resign after 7 mos.

August 1997

E.B studied liberal arts at Montgometry College in Maryland from 1997-1999.

She did not spend for her tuition fee since she qualified for a scholarship because of her good grades.

EB and her mother lived in a three room apartment near her school. The third room was occupied by a 64 year old Cuban man named Hugo. Unknown to her mother, EB had a secret affair with Hugo for more than a year. He was EB’s first boyfriend and she was deeply in love with him.

When her mother learned of her relationship, she told EB to break up with Hugo. EB then obeyed and broke up with Hugo.

September 2000

EB took up government studies at the University of Maryland; where she was diligent, studious, and belonged to the top of the class.

She finished her 1st and 2nd years in the university with good grades and was a part of the Dean’s List

April 2002She was noted to be very talkative in her class because of numerous things in her mind.

She was pre-occupied that her co-workers in the library were talking about her of the thesis that she was working on.

She could also spend recklessly buying a lot of things when she could not afford to buy it. Her mother observed EB had the tendency to shoplift things when she could not afford to buy it.

She filed a leave of absence from the university before her 3rd year because of her hyperactive attitude.

She would go shopping for clothes and jewelries maxing out her credit cards.

Jan 2003

Dec 2002She was approached by a man who told her about how miserable and sick she looked. Thereafter, she sought for a consult with another psychiatrist. She was prescribed with olanzapine 10 mg/tab

She took the drug compliantly and she has improved with the medication

Went back to UM and worked at McD’s to pay for rent and other expenses

She eventually graduated from UM in August 2006

Apr 2008

Oct 2006She worked at Aramark regional staffing in Washington DC where she was to told that she was going to be promoted soon. However, her mother did not approve of her job, and so she quitted.

EB’s mother decided that they will be going to the Philippines due to EB’s frequent misundestanding with her co-workers. EB did not want to go to the Philippines but she agreed since she does not want to disappoint her mother.

In the Philippines, she sought for another consult, at NMCH, because her drug was running out. Olanzapine was thereafter discontinued and she was prescribed with quentiapine (100 mg)

Nov 4, 08

Oct 31, 08Together with her mother and an uncle, EB went to a cemetery in Marikina; there, she was again observed to be very talkative. While on their way home, she ran out of the car because she thought that there was a coup’d etat going on. She then went to SM MOA where she spent P14,000 for shopping.

After shopping, she stayed at an apartelle in Quezon city for 3 days before going back to their house on Kamuning.

She opted to ba admitted at NCMH where she was given lithium, quetiapine and paliperidone

Mar 23, 08

Dec 12, 08

Mar 25, 08

She was discharged from NCMH with the same medication.

She would still have hyperactivity episodes and would always stay the gym so she would lose weight,

She experienced uncontrollable shaking of her thighs and generalized body weakness.

She sought for another consult and was told to discontinue paliperidone and was prescribed with quetiapine and alprazolam

EB ha a difficulty in sleeping and worried of the possible effects of discontinuing paliperidone; hence, her admission

SALIENT FEATURES• 30 year old female• Talks a lot because of numerous running ideas in her mind• Physically abusive to her mother• Hyperactivity episodes• Break things in the house whenever she would not get what

she wants• Diagnosed to have oppositional deviant disorder in 1993• Extreme behaviors in high school (1994) such as shouting

and crying.• Would shoplift when she can not afford to buy the things that

she like• Compulsion in buying things• Preoccupied that her coworkers were talking about her • Having thoughts of the occurence coup’d etat

Physical and Neurological Exam on Admission: Essentially Normal

Mental Status Examination No abnormal mannerisms and posturing were noted. Mood was euthymic with appropriate affect. She had spontaneous speech and able to maintain good

eye contact. She denied hallucination and no delusions were elicited. There was no looseness of association and she was able

to answer questions appropriately. She verbalized her aggressive thoughts towards other

people. She is oriented to person, place and time Concentration, attention and memory were all intact. She was able to read, write, and was capable of abstract

thinking. Judgement was fair and she had an intellectual insight

about her condition.

Review of the Systems

• Unremarkable

Past Medical History• Angiogram at the age of 10 due to

elevated BP

• (-) DM, cancer and TB

• (-) asthma, allergies

Family History

• (+) malignant melanona – father

• (+) hypertension – mother and maternal grandparents

• (+) DM – maternal grandfather

• (-) stroke, asthma, allergies and psychiatric dso

Past personal History

• Non smoker

• Non alcoholoc beverage drinker

• No elicit drug use

Family Profile

• Aladdin (+) – father– Retired chef of the US navy – Had a distant relationship with EB because of work – EB would describe him as workaholic, disciplinarian

and supportive.– He would always remind EB to work harder and to

excel in school. – (1995) on EB’s senior yrs, he died of malignant

melanoma– Was previously married; had a son 4 yrs older than

EB

• Victoria, 64 y/o– Worked as a daycare teacher back in the US,

and currently unemployed; living with her brother in Kamuning.

– Was the primary caregiver of EB – Would often give EB some advice whenever

EB confides her problems.– Would always give EB what she asks for, as

long as she could afford it

Family Profile

• Antonio 71 y/o widower– Oldest brother of Victoria– Owns the house where EB and her mother stays– Has a limited interaction with EB since, EB would

always stay in her room whenever Antonio is around

• Francisco 60 y/o – Youngest brother of Victoria – Never married so he lives with his siblings – Also has a limited relationship with EB

Family Profile

• Mila 35 y/o– The household helper of the family for 7 yrs.– Apparently has a relationship with Antonio to

whom she apparently has a child with.

• Jeremy 6 y/o– The son of Mila– Whom, EB thinks is her nephew

Family Profile