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CaseGroup

History
7
General Data
NAME B.S.

AGE 23

SEX: MALE
SOURCE
OF
Self- Referral
REFERRAL
Client B.S.
Client B.S.’s Biological Mother
Client B.S.’s Biological Sister
Informants Client B.S.’s Wife
Chief Complaint
According to the client:
• “Di ako maka-maintain ng trabaho. Ilang
beses na ako nasisante mula pa nang grumaduat
e ako sa
college.”
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• “Nirereklamo na rin ng mga cliente ko na hindi


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maayos mga gawa ko at ang pagiging huli ko sa


mga
deadlines kaya nawawala mga cliente ko.”
Chief Complaint
According to his wife:
• “B.S is creative in general. Pero yun nga, mor
e often than not, hindi natra-translate sa traba
ho niya.”
• “Paminsan sa house, parang gulung-gulo siya
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. Hindi niya alam kung saan mga gamit niya o


r kung ano uunahin niya.”
• “When he works naman, mabilis siyang ma-di
stract lalo na sa mga video games niya.”
Chief Complaint

According to his mother:


• “Ganyan na talaga siya kahit noong bata pa siy
a. Ngayon nga sa bahay, kapag may pinagaga
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wa ako sa kanya, nakakalimutan niya agad o p


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arang di pa nga siya nakikinig.”


• “If magagawa man niya, mali-mali, kaya ako na
rin nag-aayos paminsan.”
Chief Complaint
According to his sister:
• “Si B.S kasi hindi rin nakaka-keep ng friends or
at least, good relations with the people he wo
rks with. Kahit nga sa bahay paminsan parang
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ang insensitive at hindi siya nakakapaghin
tay. Kapag nag-uusap kami sa hapag-kainan,
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may nagsasalita pa pero inuunahan niya or na


gcu-cut off siya.”
• Paminsan naman ang gulo niyang kausap. Ka
pag may naisip siya, sasabihin niya lang. Hindi
niya inaayos para maintindihan siya agad.”
History of Present Illness
• 19 years PTC: When B.S was 4 years old, B.S would come
Home with his sister with scratches and bruises from playing too ro
ughly. The scratches and bruises were often on his arms, legs and
knees. His
mother only reprimanded him to not to be rowdy with the other kids

• 16 years PTC: At 7 years old, his mother was called often by his
teacher due to his disruptive behavior in class. His teacher describ
ed that he fidgeted and taps which distracts the other students. He
was said to
ignore the commands of the teacher to sit down and remains to go
around the classroom. During this time, he was characterized as a
‘lazy’ child who
did not want to study.
History of Present Illness
• 14 years PTC: At age 9, B.S failed 3 of his subjects. According to his
mother, his teacher explained that his work had not been up to par. In
particular, he failed in Math, Reading and Language. When B.S was
asked he said that he found those subjects boring and difficult to
concentrate on. Due to this, his mother had tutored him.

• 12 years PTC: When he was 11 years old, he had been involved in a


physical fight with his classmate. His mother described this event saying
that, “his classmate wanted to stop him from interrupting his tasks. He
would not listen, so they exchanged verbal words that led into a fight.” He
was suspended by the school and grounded by his mother.
History of Present Illness
• 11 years PTC: His adolescent years indicate similar behaviors. T
hese
behaviors ranged from making careless mistakes in his tests to con
stantly needing to move. Although these had been difficult and unru
ly, the people around him found this attributable to his life at home
or the lack of father
authority.
History of Present Illness
• 5 years PTC: At age 18, his records show that he was barely passing
college. He failed most of his class because of failure due to absences.
Other reasons were because he passed his outputs late and wrong.

• 3 years PTC: B.S had become more distracted due to the


transition from college to employee, from being a single man to being
married, and from changes of work. He was described to be more
aggravated and more stressed which manifested in his finger tapping,
difficulty and lack in concentrating, talking without regards for other people.
• 2 weeks PTC: the client had been involved in a physical fight with
his supervisor. This had started when his supervisor had criticized his
work and him. This, then, turned into a fight that had cost B.S’s job
Medical History
• Born Prematurely with low birth weight

• Delay in crawling which had only been achieved at 15 months,


rather he would only shuffle at first.

• Had acquired measles

• Prone from getting colds since he was 3 years old

• Had a mild concussion when he was 7 because of a bicycle


accident and was confined for observation and ordered bed
rest, fluids and mild pain reliver. According to her mother,
there were no unusual behavior occurred after the incident.
Family History
• Youngest among 3 children.

• His mother currently serves as an executive secretary to the Vic


e President of a well-known petroleum company. She indicated t
hat she has no learning or attention problems nor anyone in her
family.

• According to his mother, B.S’s father is unemployed much of the


time when B.S was growing up. When they were living together,
he worked at grocery stores, at gasoline stations, and at a carw
ash. He is reported as being hot-tempered and violent with her a
nd on a few occasions with their children.
Family History
• The parents of B.S. have been separated and no
longer living together since B.S. was 5 years old.

• His mother reports a history of depression on both


sides of the family.

• Both of his siblings graduated from the University of the


Philippines and graduated with the highest academic honors

• The eldest sister lives and works in New York City as


a Communications Manager. Due to this, B.S does not
have a close relationship with her right now.
Family History
• His other sister, the second child in the family, works as a
professor in University of the Philippines-Diliman. The client
described that he is closest with the second child in the famil
y, since they often bond during Sunday dinners.

• He comes from a family of academic achievers. With


that said, he sets his career as top priority, because of the
pressure that stems from what his family expects from him.
Childhood History
• He had been described by his mother and sister to be easily
frustrated that he often acted aggressively by biting his parents,
siblings or playmates.

• Making friends was a challenge for him since he is perceived


to be difficult to play with. This stemmed from his lack of
understanding when it comes to social cues and deficits in social
skills.
Childhood History
• When he was encouraged to play with other children, it was
observed by his parents that he often gets into small accidents
because he would not think of his actions.

• His sister described that she would often see her brother alon
e at school and avoided by the children. She explained that B.
S had no regard when it comes to his speech; he would share
his thoughts without thinking of them first.
Childhood History
• When he was encouraged to play with other children, it was observed b
y his parents that he often gets into small accidents because he would n
ot think of his actions.

• His sister described that she would often see her brother alone at schoo
l and avoided by the children. She explained that B.S had no regard wh
en it comes to his speech; he would share his thoughts without thinking
of them first.
Childhood History
• When he was encouraged to play with other children, it was
observed by his parents that he often gets into small accidents
because he would not think of his actions.

• His sister described that she would often see her


brother alone at school and avoided by the children. She
explained that B.S had no regard when it comes to his speech; he
would share his thoughts without thinking of them first.
Marital History
• Married to his wife for 4 years but were already together since
they were in high school.

• Married civilly on July 27, 2016

• Forget his lunches, their date nights, or family dinners with


his family or Alice’s. When he’s reminded of these things, he
gets easily frustrated and angry Alice found herself writing
notes for him to ensure that he would do them; but when she
does not write them, he would not do it.
Marital History

• She described that they argue all the time, even with trivial
things. According to her, B.S tunes out whenever they argue an
d has trouble following what they have agreed upon.

• Their fights are mostly about his job or him helping around at
home.
Occupational History
• After graduating and acquiring a degree in advertising, he
got a job in a small company as a graphic designer but got fire
d after 5 months.

• His co- workers often complain about his excessive/


impulsive talking and distracting actions like finger taping and
gaze shifting when talked to.

• He tried to work in a publishing house, which he was fired


from. With only working for 9 months, he got fired because of t
ardiness, absenteeism, unmet deadlines, and a general
impression that he was not reliable or competent.
Occupational History
• After getting into a new job in a magazine and being
there for only 3 months, he impulsively quit when he got
frustrated with the working environment and blamed his colle
agues for his actions.

• Additionally, he had worked with a newspaper company


which he was fired from for the same reasons. During times
when he had no work and looking for work, he would return
to freelancing to earn for their daily expenses. However, due
to problematic relationship with his clients, he rarely
accomplishes and earns from these projects.

• For 2 years, he has been working back and forth in


companies and his freelance projects.
MENTAL STATUS EXAMINATION
• His concentration and storage into recent memory are
affected.
• He has difficulty with calculation tasks and recent memory
tasks but judgment is grossly intact.
• He showed reasonable insight to perceive himself as
being in need of assistance with his difficulties in adaptive
functioning.
• This presents that he has an average ability to perceive
and integrate logical relationships between, and among
abstract concepts
MENTAL STATUS EXAMINATION
Differential Diagnosis
Major Depressive Disorder
Prepresent a change from previous functioning; at least one of the symptoms is either (1)
depressed mood or (2) loss of interest or pleasure.
X Depressed mood most of the day, nearly every day, as indicated by
either subjective report or observation made by others
X Markedly diminished interest or pleasure in all, or almost all, activities
most of the day, nearly every day
X Significant weight loss when not dieting or weight gain, or decrease
or increase in appetite nearly every day.
X Insomnia or hypersomnia nearly every day.
 Psychomotor agitation or retardation nearly every day
X Fatigue or loss of energy nearly every day.
X Feelings of worthlessness or excessive or inappropriate guilt nearly
every day
 Diminished ability to think or concentrate, or indecisiveness, nearly every day
X Recurrent thoughts of death recurrent suicidal ideation without a specif ic plan,
or a suicide attempt or a specific plan for committing suicide.
Generalized Anxiety Disorder
A. Excessive anxiety and worry, occurring more days than not for at least 6 months,
about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six sy
mptoms (with at least some symptoms having been present for more days than not
for the past 6 months):
 Restlessness, feeling keyed up or on edge.
X Being easily fatigued.
 Difficulty concentrating or mind going blank.
X Irritability.
X Muscle tension.
X Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying
sleep).
Antisocial Personality Disorder
A. Disregard for and violation of others rights since age 15, as indicated by one of t
he seven sub features:
X Failure to obey laws and norms by engaging in behavior which results in
criminal arrest, or would warrant criminal arrest
X Lying, deception, and manipulation, for profit or self-amusement,
 Impulsive behavior
X Irritability and aggression, manifested as frequently assaults others, or eng
ages in fighting
X Blatantly disregards safety of self and others,
 A pattern of irresponsibility and
X Lack of remorse for actions (American Psychiatric Association, 2013)
The other diagnostic Criterion are:
B. The person is at least age 18,
C. Conduct disorder was present by history before age 15
Diagnosis
Upon the results of data gathered, the client show signs and symptoms of
adult Attention-Deficit/Hyperactivity, Combined type.
According to DSM-5:
Inattention: Five or more for adolescents 17 and older and adults; symptom
s of inattention have been present for at least 6 months, and they are inappr
opriate for developmental level:
 Often fails to give close attention to details or makes careless mistakes in scho
olwork, at work, or with other activities.
 Often has trouble holding attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
 Often does not follow through on instructions and fails to finish schoolwork, ch
ores, or duties in the workplace (e.g., loses focus, side-tracked).
 Often has trouble organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework).
 Often loses things necessary for tasks and activities (e.g. school materials, pe
ncils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
 Is often easily distracted
• Is often forgetful in daily activities.
According to DSM-5
Hyperactivity: Five or more for adolescents 17 and older and adults; symptom
s of inattention have been present for at least 6 months, and they are inapprop
riate for developmental level:
 Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is not appropriate (adol
escents or adults may be limited to feeling restless).
 Often unable to play or take part in leisure activities quietly.
• Is often “on the go” acting as if “driven by a motor”.
 Often talks excessively.
 Often blurts out an answer before a question has been completed.
 Often has trouble waiting his/her turn.
 Often interrupts or intrudes on others (e.g., butts into conversations or g
ames)
Treatment Plan
Medication with exercise
• Ritalin (medication) combined with regular exercise to improve
concentration, motivation, memory, and mood.
• Basketball is chosen because the client is particularly intereste
d in the sport while allowing him to play outdoors; this may help
reduce the symptoms of ADHD.
Behavior Therapy
• This is for improving the client’s social skills and understand
of social cues, helping him create more structure with his time,
establishing predictability and routines, and increasing his
positive outcomes.
• This involves creating an environment conducive to suitable
behavior, providing positive feedback and reinforcement for
acceptable behavior and improvement, establishing clear
consequences for unwanted behavior and being consistent about
expectations and consequences.
Treatment Plan
• The client agreed to meet with his psychologist at least once
every two weeks. This may change depending on the client’s
progress.
Regular and quality sleep
• It is suggested that the client must strictly follow a scheduled time
of sleep, in his terms of 10:30 in the evening while the waking
alarm is set 7 in the morning to give him ample time for good sleep
.
• For this to work out, it is essential for his bedroom to be
completely dark and electronic gadgets must be stowed away.
Maintain a diet plan
• His diet plan must include enough zinc, iron, and magnesium, as w
ell as protein and complex carbohydrates.
• This nutrition and supplement can help with the brain to function at
optimal levels.
Treatment Plan
• To supplement his diet, the client must take note of his
eating schedule and stick to it. The agreed upon schedule
is an 8am heavy breakfast, 10am snack, then 12nn lunch.
For the afternoon, the client must practice diligence in
selecting healthy snacks to eat at 3pm then a decent dinner
at 7pm. It is advisable to avoid caffeine consumption
throughout the day, especially in the evening in order to
maintain his sleeping pattern.
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Thank you
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