CASE SCENARIO NUMBER 2

II. ANAMNESIS

INFORMANT NO. 1

1.1 Name: LC

1.2 Address: Purok 2, Little Panay, Panabo City, Davao del Norte

1.3 Relation to patient: Mother

1.4 Length of time known to patient: Since birth (17 years)

1.5 Apparent understanding of present illness of patient:

According to the informant, the patient had onset of fever 8 days prior to admission in
Davao del Norte General Hospital. For seven days, the fever went on and off, and sponge
bath and increase in fluid intake were the only management given.

One (1) day prior to admission, the informant notice that the client had cyanotic lips and
extremities, these led the mother to decide to have her daughter undergo a laboratory
test at General Hospital, Inc. The client stayed for 2 days at Del Norte General Hospital.

On the second day of admission to the said hospital, and one day prior to admission to
Medical Center-Mindanao Center for Psychiatry, the client manifested changes in
behaviour, specifically talking to herself. This was first noticed by the watchers of other
patients on the same ward the client was in.

On the following day, these changes in behaviour worsened. The informant said that the
patient was crying, shouting and pacing inside the ward. The informant then decided to
consult a physician. The physician referred them to a mental institution in Looc City but
because it was a weekend, and that said hospital was only open for admission during
weekdays, the informant ask for the second nearest mental institution which was CMH.

On that same day, the client was immediately admitted at CMH. Informant LC believed
that one reason for the client's illness is insufficient intake of food. She further explained"
Kadtong wala pa siya gikalintura nagreklamo siya nga kulang iyang allowance ug sige
siya'g kagutman".

Furthermore, informant LC implied that this illness the client is going through is just the
same as what she had experience during her admission to CMH and that they need not
to worry. She stated, Naadmit man pud ko diri sauna pero 3 days raman adtong 1 year
old pa si DGC. Ing-ani man pud ko, buhat-tingag, kanang kabuhi nga gasaka sa ulo
pero mao raman to, wala na dayon ning balik. Wala na pud na ko giinom ang tammbal
nga gireseta pagkadischarge nako kay mahal kaayo.

The intormant was cooperative in terms of answering the questions but her responses
seemed defensive as evidence by highlighting only the positive attributes of the client
such as helping the household chores, doing her homework and complying with the
curfew, giving less attention to the cause of the present condition of the patient DGC.

We pose informant LC as our most reliable source in the sense that she is the mother, has
been with the patient and has known the patient since birth.

INFORMANT NO. 2

Name: DC

Address: Panabo City

Relationship to patient: Father

Length of time known to patient: Since birth (17 years)

Apparent understanding ofr present illness of patient

The father pointed out that the main cause of the patient's illness is probably her skipped
meals. He verbalized murag napasmuhan na siya kay usahay 30 pesos ra akong
mahatag; apiki man mi sa kwarta, mamasahero raman tawon ko ug pedicab, mao to
gikalintura siya hantud murag gikabuhi siya ug gi-salimuang; mao gi-reer mi didto (CMH).

When asked how he understood the illness and how he sees It will progress, he expressed
that he doen't find the illness as grave. He verbalized," Murag kabuhi raman nga gi-saka
bitaw sa ulo; na in-ana man pud akong asawa ug akong kamagulangan nga si May
pero murag wala raman to, mga lima ra kaadlaw, dayon wala naman ni balik sukad."

The informant was interviewed through the phone. He spoke spontaneously and was
consistent on the information he gave. However, he answered "okay raman" quite often.

We consider informant DC as a relative source for the fact that he is the father and he
has been there since patient DGC was born. Although he is busy as a pedicab driver and
he really isn't close to DGC, his answers to our inquiries were consistent with that of the
patient's motner.

INFORMANT NO. 3

Name: LM

Address: El Rio, Buhangin, Davao City

Length of time known to the client: Since the client was born

Apparent understanding of present illness of the client

The informant verbalized, "Nagsugod man to siya'g kaingon ato adtong na-admit siya
pagkadengue. Nakabantay dayon mi nga naglahi iyang batasan. Gakalit lang siya'g
wild ug gasturya-sturya ug bisan unsa. Nakabantay lang pud ko nga kalit lang siya
mumata ug magsinggit-singgit, dayun kung magsturya siya kay maglahi-lahi iyang
iingon."

LM also said that client DGC behaved strangely. She verbalized, "Matingala dayon mi
nga pag magsturya mi about sa iyang pagskwela atong hayskul kay gahilum lang siya
dayon kung sturyahan balik kay maulit na siya." She further stated that, " dili pud kaayo
sila close sa iyang papa, kung naa siyay problema, iyang mama iyang kasagara
isturyahan kay wala kaayo oras ilang papa sa ila kay sige trabaho, pedicab driver man
iyang papa."

The informant was very accommodating. She never hesitated to share all the things she
knew about client DGC's condition.

She is DGC's aunt and neighbor when she was younger. LM verbalized, "Close man mi ni
DGC." She also talks and comforts DGC whenever sha has a problem. She is aware of
DGC's present condition. However, her knowledge on DGC's condition is limited due to
the fact that she only seldom goes to DGC's house. Though her information is relevant
and coincides with other informant, still we cannot pose her as the most reliable source.

INFORMANT NO.4

Name:KJ

Address: Panabo City

Relationship to the client: Boyfriend

Length of time known to the client: 10 months

Apparent understanding of present illness of the client:

Though the informant is not aware of the actual mental illness of the patient, he was able
to give information regarding the patient's emotional and psychological stressors that
may have contributed to her present illness. He verbalized, "hinhin man na si DGC, kung
masuko o nay problema kay maghilom ra dayon muhilak kadugayan; sensitive pud na
siya; kung bahin sa among relasyon, mag away mi kay kana ra sa selos sa text pero
maokay raman; kung sa iyang pamilya, okay raman japon, dili lang sila close sa iyang
papa ug kanang naa pud silay problema sa kwarta; kung sa barkada, dili man kaayo mi
ga uban sa among tig-iya nga barkada kay kami man sige ug uban.

The informant was wiling and cooperative. He was interviewed through phone. Although
he was fast to answer our questions, there are times were in he joked around and answers
in a defensive manner and even hesitated to answer Some of our questions.

We cannot pose informant BF as the most reliable source since he had only known the
patient for 10 months and that he doesn't know the present condition of patient DGC.
However, the information he shared was able to aid in formulating the present school
and social ability of patient DGC.

FAMILY HISTORY

Maternal and Paternal Grand Lineage

Informant LC told us that she had once suffered psychosis for 3 days when client DGC
was 1 year old and that she had other 2 sisters who had suffered brief psychotic disorder
(undiagnosed). While in the paternal side, it was indicated in the chart that the father
also had a sister who had an unspecified mental ilIness.

Upon interview through phone call, informant DC (father of DGC) confirmed that he has
a sister who had mental illness but undiagnosed.

Father

Informant LC said that the client's father is an alcoholic drinker. He has limited time
spending with his children because he is busy with work. He arrives at home late at night
and leaves early in the morning to work. He is a pedicab driver and when interviewed,
informant LC, LM and KJ himself confirmed that he doesn't have a close relationship with
his children.

Mother
Informant LC shared that she is a considerate mother. She just uses verbal reprimands in
terms of disciplining her children. She helps her husband in terms of earning money for
household expenses by working as a street vendor. She was admitted in the year 1995 at
CMH for 3 days.

She also stated that between her and her husband, she is closer to their children. She is
the one her children talked to whenever they have problems. However, she often
checked DGC's phone without DGC's consent.

Siblings

Informant LC told us that she has 5 children, 4 of which are her own bearings and the
other one is adopted from her brother because her brother's wife died. Client DGC now
has 2 sisters and 2 brothers. Informant LC had a miscarriage once before her eldest child.
According to informant LC, DGC treated her siblings fairly.

The eldest sister of DGC also suffered from an unspecified mental illness similar to the
manifestations of that of Patient DGC.But after 3 days, these manifestations subsided
according to informant LC. She is now married in Leyte.

PERSONALITY

Prenatal

Informant LC said that with her 3 children including DGC, she was able to attend regular
prenatal check-up throughout the course of the pregnancy and that they were all fully
immunized. Yet her fourth child was not able to have prenatal check-up and
immunization because their religion encourages them to trust in God rather than in
medicine. All the pregnancies were planned.

Birth

Informant LC shared that client DGC was born full term on April 14,1995 at their house
attended by a "mananabang".

Infancy and Childhood Characteristics

Informant LC said that DGC was breastfed during her first year of life but was suddenly
weaned when LC was admitted to the CMH. However, information of her developmental
milestones during her first 12 months was not acquired during the interaction with
informant LC. When DGC was 1 year old, informant LC said that the first word of DGC
was "mama". At that time she was already learning how to walk.

At 3 years old, she was toilet trained but not strictly. She stopped thumb sucking when
she was in second grade but still experiencing enuresis until now. Then LC reasoned,
"Gapangihi pa na siya sa higdaanan hangtod karon labi na kung kinapoy siya sa skwela."
LC also stated that, "Grade 2 nag-start ang tantrums, galigid-ligid siya sa putik kng dili
niya makuha iyang gusto.

LC said that DGC started to be conscious of what she wears and applies make-up when
she entered secondary school. She also had her menarche that time but LC cannot
remember DGC's exact age when she had her menarche.

LC and DC said that DGC was very active in sports especially on volleyball and basketball
and was also interested in chess. It doesn't matter who she plays with, though her
playmates were mostly younger than her. She is more of a leader when it comes to
planning and implementing games.

LC said that DGC entered school at the age of 6, proceeding immediately to first grade.
Informant LC stated that DGC wanted to stop going to school during her second grade
because she still didn't know how to read. She had good grades and did well in school.
She had a good relationship with her teachers but had difficulty interacting with her
classmates, as informant LC said "Dili siya ginaapil kay lahi daw siya kay taas man siya
nga bae unya iya tanan

classmate mubo". LC said that DGC is very inspired in going to school.

According to informant LC and DC, their family were Roman Catholics before they
converted to Born Again-Jesus Miracle Church. We were not able to assess the religious
aspect of the patient. But LC stated," magtext-text pa man gani na siya maskin naa sa
simbahan. Dili pud na siya galuhod kung ting luhod." LC describes DGC as friendly,
superior, moody and sometimes stubborn and irritable. She is also sensitive when it comes
to the opinion of other people about her. Patient didn't have any occupational history
as noted by informant LC

Patient is not married. However, the patient currently has a boyfriend. As informant LC
noted, "Nakauyab ni siya kadtong September 11 last year. Una adto kay wala pa siya
nagsaba pero nabantayan man nako nga sige na siya ug text-text mao to nagsaba na
dayon siya nga nakauyab na siya." LC also noted that the boyfriend is very kind. BF
always visits DGC in their house.

But accordingly, there were two incidents were LC found DGC crying because of a
conflict between DGC and her boyfriend BF. Patient DGC showed intense guilt feelings
toward premarital sex. The patient verbalized, "nakasala kaayo ko, nagsex mi ni BF
(boyfriend), dako kaayo akong sala, magskwela ug tarong, maminaw sa mama,dili
palabi sa gugma." According to BF, "kung bahin sa amongrelasyon, mag away mi kay
kana ra selos sa text pero ma okay ranman."
Onset of present illness

There were several incidents that informant DC scolds DGC on her mistakes in the house
and tells her she's stupid. The patient also experienced having premarital sex which
greatly affected her feelings and had her feel guilty for a long time. Eight (8) days prior
to admission in Del Norte General Hospital, the patient had onset of fever. For seven days,
the only interventions given to manage fever were sponge bath and increase in fluid
intake.