The hidden psychological evaluation in 1996 of a guy whose fate of our nation lies the President of the Philippines. DEPARTMENT OF PSYCHOLOGY ATENEO DE MANILA UNIVERSITY, LOYOLA HEIGHTS, QUEZON CITY Psychiatric Evaluation Form Patient Name: Benigno Simeon Cojuangco Aquino III Patient Address:Times Street, Diliman, Quezon City Chief Complaint:Depression History of Present Illness:The patient is a 36-year old single male with a history of profuse salivation and labile moods since his childhood. His sister reported that he had been [unreadable], withdrawn and depressed over the past 10 days. He was observed to be sleeping excessively, disoriented, and confusing family and household members’ names. When interviewed at the time of psychiatric [unreadable], the patient said he had difficulty in speech, poor concentration, impaired thinking and a melancholia brought about by the stresses of his work and the break-up of his flight attendant girlfriend. He also claimed he felt clumsy and uncoordinated. He also described what appeared to be a deep sense of foreboding and feeling that the “world was coming to an end.” His physical exam is notable for BP 140/90 without orthostatic change, with a need for eyeglasses to correct poor eyesight, no [unreadable], lungs clear, regular cardiac exam with rate 72. Overall body build leans toward slightly overweight with enlarged hands and feet. Neurological exam reveals normal [unreadable] nerves, symmetric motor function and normal reflexes, no memory deficit, no abnormal [unreadable] findings, but with a slight flaccidity of muscle tone. He is able to get on and off the exam table without much trouble, and when walking in the hall exhibits slowed gait and hesitant motion. Current Symptoms: 1.Psychomotor retardation 2.Slowed gait and activity 3.Lack of initiative 4.Melancholia 5.Fatigue 6.Lack of self-confidence 7.Lack of social interest Past Psychiatric History The narration of the patient indicated a traumatic childhood marked by three troubled images that persist in his mind. First, a beloved father who was arrested by soldiers in the “middle of the night”; Second, his mother having to go for psychiatric visits to a clinic in Manila; Third, the picture of his father lying dead in a pool of blood. All these images evoke a feeling of grief and a profound longing for an absent father and an attraction for strong, matriarchal women having been raised by his mother and sisters. It was during his late elementary and high school years that he noted profuse salivation and mood swings when under stress, i.e. arrest of his father during Martial Law and after the visits to his father in prison, but thought nothing about it. When he accompanied his mother to her psychiatrist, Dr. Manuel Escudero, he mentioned this condition. After an interview, it was recommended that he undergo a psychiatric therapy for six months. After the therapy, he was given a set of exercises and relaxation techniques to manage his salivation and mood swings. In Boston, during a general physical examination he was diagnosed with homocystinuria when further investigations were performed on his blood. According to the patient, he was given pyridoxine, folate supplementation and dietary modification. His recommended diet is low protein food. MMSE The Psychologist conducting the interview noticed that the patient would occasionally walk slowly and aimlessly around the room when being interviewed. He appeared inattentive, vague, non-spontaneous and detached in interactions, but passively followed simple commands. He appeared disoriented. There was some difficulty in communicating due to his deep depression and melancholia. On mental state examination, he was a lanky man of medium height who was mildly psychomotor retarded with a latency of verbal replies, and a slowness of movement. He was preoccupied with his inner thoughts, brooded and felt melancholy. He appeared quite elevated and irritable when he spoke of the loss he was feeling when he recounted his relationship with his girlfriend. He claimed it was her fault that the relationship was over. He said she didn’t understand him or give any weight to his beliefs especially when she wanted a more physical relationship. He hated her when she said he was too controlling and would openly contradict his wishes on how he wanted her to dress and act in public. He wanted her to be more conservative and sometimes her dress and manner was too liberal. It was her growing up with her sisters and their great influence on him that made him measure how women should act, think and dress. His speech began as a low volume monotone then rose in volume and pitch as he recounted his affair. Sometimes, there was a poverty of thought form dwelling in the depressive state. He expressed a poorly-formed grandiose delusion that the world was ending and described feelings of foreboding but no disturbance in any other sensory modality. The patient was oriented in person and place, with only a very mild impairment of time. Attention and concentration deficits were evident, though much in the slightest and confirmed on formal testing (he had minor difficulty in counting down by seven from 100 and could not readily spell some words backwards). Registration and short term memory were intact on testing, but he was often distracted and distant. There was evidence of dysphagia, mild difficulty with three-step commands, [concretism] and visuo-constructional dyspraxia (he could not copy complex diagrams). No confabulation or remote memory deficits were identified. His Mini-Mental State Examination (MMSE) score totaled [28/30] (No cognitive impairment). He denied being in need of medical assistance and explained his presence in the school as being due to his sister’s concerns, but did not appear suspicious possible motives or irritated by his presence in the department. He denied that he had any cognitive deficits. He said he required medication and dietary modification, but did not accept medication offered in fact requiring detailed explanation on why the medication had to be taken. Assessment/Diagnosis Clinical disorders, including major disorders, and learning disorders Axis II Personality disorders and mental retardation Axis III Acute medical conditions and physical disorders Axis IV Psychosocial and environmental factors contributing to the disorders Axis V Global Assessment of Functioning or Children’s Global Assessment Scale for children and teens under the age of 18 In as much as the patient exhibits the following symptoms; (1) Depressed mood (i.e. feeling sad and empty) most of the day for 10 days, (2) Markedly diminished interest or pleasure in almost all activities (including lack of social interest) most of the day for 10 days, (3) a noticeable fluctuation of appetite most of the day for 10 days, (4) Psychomotor agitation or retardation (i.e. increased restlessness) most of the day for 10 days, (5) A diminished ability to concentrate bordering on indecisiveness most of the day for 10 days, (6) [unreadable] mostly every day, (7) Fatigue nearly every day, And (8) a feeling of foreboding every day. He is diagnosed as suffering from Major Depressive Disorder. Recommended treatment in continuing, regular psychotherapy sessions, including CBT, until the depressed state of the patient is lifted. Signature: Date: 2/10/96 Carmelo A. Caluag II, SJ
Posted on: Sun, 19 Jan 2014 00:20:43 +0000
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