This is a case of KMT, 24/F, from ******* ** *** ****.
CHIEF COMPLAINT: (according to patient) "I'm depressed..."
Patient had no reliable companion at the moment of interview.
HISTORY OF PRESENT ILLNESS:
The patient was apparently well until around 9 days prior to consultion (PTC), when she had to shift out from one department to another. She took a post-rotation test and fared poorly, after which she was noted to be more quiet and appeared to be more deep in thought. The next few days, since she was tasked to be the liason officer of their group for the next two weeks, she seemed to be very busy the whole day, and when she went "home", she would just sit quitely on her chair, and immediately fall asleep. Sometimes she would perk up and talk excitedly about a certain Ortho resident, but then she would fall quiet again when she realizes that she was just being ridiculous. She has a general loss of interest in doing anything, was noted to be sleeping early but was up and about doing nothing at wee hours in the morning. She also fails to do her typical chores (i.e. wash clothes, arrange stuffs, etc), and could not answer her mentors' questions. She was noted to have an increase in appetite, and on one occasion cooked three packs of noodles at midnight, only to realize she couldn't finish it. She would sometimes be talking or singing to herself, and was often staring blankly into space. She has increased hours of sleep, but she would be sleeping on the chair (and haven't slept in the bed for days), yet she still feels tired and sleepy during the day. No auditory/visual hallucinations or delusions, however, she has ideas of references. She said she has a feeling that her room mates are talking about her and her negative characteristics. She often attempts to study, saying she is so frightened of her next rotation, but she could hardly finish reading a page. She was also noted to be frequently calculating some numbers, only to be frustrated that they don't add up. She would sometimes cry silently, her back turned to the whole world. She claims to have feelings of fear, doubt, anger, disappointment, anxiety, and self-worthlessness. Persistence of condition prompted this consultation.
Past Medical History: unremarkable
Family History: (+) hypertension, diabetes mellitus - paternal side
Personal/Social History: Patient finished a four-year post graduate course and is currently undergoing some sort of stressful training with no payment. She is a non-smoker, non-alcoholic beverage drinker, and denies illicit drug use.
Anamnesis: The patient is the eldest of two children, allegedly a wanted pregnancy, born via Cesarian Section in a private hospital to a then 26 years old G1P0 mother, with no feto-maternal complications. Her development was at par with her age. She was shy and quiet as a child, but was noted to be a quick learner. She could recite the alphabet and count in at least two languages at age three, and by age four was already reading out loud from the newspaper. She started schooling at age 5, with above average school performance, and was allowed to skip a year. She was sometimes friendly and sociable, but was generally shy to her peers. However, at third grade, she was noted to have several "enemies", mostly males, whom she would sometimes kick when they were praying in class. Because of this, she decided she wanted to transfer to another school. In her new school, she was noted to love to perform and take the front stage roles. She was also an achiever. However, her family suffered a financial tragedy, and at her young age she also thought her best friend has betrayed her. During that time of despair, she has learned to cope with her stressors by praying and giving herself to Jesus Christ. She became a devout Christian at age 12.
In high school, she continued to do well in class, but now preferred to do backstage roles. She loved writing stories and poems, drawing, and enjoyed watching movies. She had a close knit of friends. She also had one main crush, but thought other boys in her school were cute too. She grew up however without her father by her side, because he had to work somewhere far. Because of this, she has learned to be more responsible towards her family, and was emotionally close to her mother and sister. She finished high school with honors, but claims she was not totally happy with it, because she was constantly under the pressure of some of her realtives. She also claims that she felt jealous of some of her friends, but was quick to accept their differences because she believes in a God who is fair and loving.
Before entering college, she was emotionally traumatized(?). She refused to elaborate on this. She was a scholar and took up a course in BS Biology, but she really wanted to be an accountant. In college, she was more aloof, and often went shopping or watched movies on her own. Although she has a warm group of friends, she was noted to be quite peculiar, and had a sudden interest in Japanese animation, which eventually became an obsession to anything Japanese. She also stayed at home almost all the time, and was often encouraged by her mother to go out with friends, but she would decline. She was helpful at home and was a diligent student. She also finished with above average standing, but said she still wasn't satisfied with herself. She said there was something empty. Again, her father wasn't able to make it for her graduation because of work. Their family had financial difficulties, but they were somehow able to overcome their daily problems.
She proceeded to take on a post-graduate course, also with a scholarship, expecting she would also fare well. However, she was already tired of studying and hardly read her books. She would sometimes fail, and sometimes would get just barely passing grades. She lived a happy-go-lucky life and didn't take her studying seriously. Her obsession for anything Japanese also turned into an obsession for anything Asian, and she would splurge all her money on a lot of pirated CDs and on internet fees. In her fourth year, she got a cut off her scholarship and felt ashamed about it, but didn't show any signs of her pain. She underwent one year of harsh training in the hospital, but said she feels she did not learn anything and was often not confident in whatever she's doing. She graduated at age 24, this time with both her parents on her side. She applied for another year of training in a far away place, and was accepted, and is now living alone in an old building with poor water supply. She claims to have problems with money and time management.
PHYSICAL EXAMINATION
Seen and examined conscious, coherent, ambulatory, not in cardiorespiratory illness with stable vital signs, essentially normal systemic findings, and essentailly normal neurological exam.
MENTAL STATUS EXAM
Seen and examined
ASSESSMENT
Axis I - Adjustment Disorder with Depressed Mood
Axis II - None
Axis III - None
Axis IV - Financial Constraints, Preoccupations with various thoughts, Exposure to a ward of psychiatric patients
Axis V - GAF 81-90
PLAN
Initial supportive psychotherapy.
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Addendum (but this is unconventional, and not medical, therapy):
> To secure funds - LOTS of funds.
> To secure 1 unit laptop, with DVD-Writer, after which...
> May load patient with one dose of her favorite anime, then continuous anime infusion every day.
> May also start patient on terebi doramas or scanlations, whatever is available.
> May hook patient to a DSL connection.
> May restrain patient to a certain good looking Ortho resident, if he is willing. XD
> Refer accordingly.
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