MENTAL STATUS EXAMINATION

A. HISTORY

HM’s family was the second family of her father, however, her mom was the legal wife.
When asked how was HM as a child the grandmother said that patient HM is malambing and
mapagmahal. She was very close to her father according to her grandmother. Her father loves her
very much, opposite to Dr. Pagaddu’s statement that she was physically abused. But on the latter
part of the interview the grandmother said that “Suspetsa niyo din ban a narape siya? Pero di ba
anong malay natin? Wala namang sinasabi. Mahilig kasi yung papa niya sa babae. Eh di ba
meron naming mga tatay eh minomolestya nila yung mga anak nila.” Since they are the second
family, everytime HM’s mom and dad have a misunderstanding, HM’s father would always
confide to the first woman he got pregnant. During his marriage with HM’s mother, HM’s father
had another affair with a woman who works near his workplace.

On the father side of HM, two of them had similar problem like that of HM’s. His father’s
direct aunt and one of his uncle, a cousin of his father.

On 2002, patient HM was then 9 yrs old, their father left them and went with another woman
who hails from Bataan. HM’s father went with her because the woman’s father was NPA and
they threatened to kill him. According to patient HM, she was very sad when her father left them.
“Yung nagtatanong ako ma’am na bakit niya kami iniwan, ganun? Kasi di ba siya ang father ng
house, eh bakit iniwan naman niya kami ma’am.” It is also on the same year that a case was filed
on HM’s father by HM’s mother. Her father however, got her younger sister and bargained on
his wife to discontinue the case and he will give back her daughter. When their father left them,
HM’s mother was assisted financially by her siblings, aunts and uncles.

On the year 2005, HM’s mother went abroad (Lebanon) and worked there for 3 years. While
her mom was away, HM together with her siblings lived with their grandmother who lives next
to their house. They only stayed there for about 6 months because their grandmother can’t take
them fighting over petty things such as washing the dishes. They went home on their own house
but was continuously overseen by their grandmother. HM stood as the role model in the house
because she was the oldest among the siblings. “Ako po yung model nila ma’am. Ako po yung
sumasaway sa kanila kung may pangit po silang ginagawa. Pero minsan hindi naman po sila
nakikinig sa akin.” As verbalized by the client.

On the year 2006, patient HM was then second year high school when she went to Lucena
because her grandfather volunteered to send her to school. However, she only stayed there for a
year and went home here in Tuguegarao to continue her studies at Cagayan National High
School. According to her, her friends at Lucena were “Plastic” and “Hindi Totoo”.

On the year 2008 HM’s mother went home and after a year or so, she went again to work
overseas, this time it was in Dubai.
 As a teenager, HM was always insecure of her skin tone. She would always say “Bakit pa
kasi ako pinanganak na maitim? Bakit si Marizh maputi? Bakit ako pa kasi ang nagmana kay
papa?” As verbalized by the grandmother. Also according to HM, she was not attracted to boys
but to girls. She said she hates boys because of her father.

In 2010, patient HM’s family observed that something was wrong with HM. According to
her grandmother, she does not respond to questions properly. Their relatives asked her mother to
come home because they think something is wrong with Harlyn but she didn’t come home.
“Parang ayaw ko kasi maniwala ma’am na yung anak ko eh may sira na daw sa ulo.” As
verbalized by HM’s mother. She only came home when her employer asked her to because she
frequently miss work because of her migraine.

When she came home, she accompanied HM to the psychiatric department. She was an
outpatient then. She was prescribed with home medications but HM was not compliant.
“Dinudura niya. Sabi ko nga sa nanay ihalo sa juice pero nalalasahan daw niya.” As verbalized
by the grandmother. The chart also showed that during follow up check-ups . HM sometimes
does not go with her mother. She does not open up with her other and would always say
“Hihintayin ko si papa. Sa kanya ko sasabihin ang problema ko.” Also according to the chart,
hers was a chronic case.

It was also on the same year that there was an incidence in HM’s school where her Instructor
embarrassed her in front of the class, told her “Bobo” and threw papers at her. After this, HM’s
hallucinations that her instructor and god are having sexual affair started. This was also the year
when she had a fight with her best friend Sheena. She had hallucinations about Sheena and often
times Hm’s family hears her saying “ Lubayan mo ako Sheena. Wag mo na akong guguluhin
Sheena.”

“Meron pa yan si HM eh pag bumibili siya dun sa tindahan, bigla bigla niyang sasabihin na
buti pa kayo may tatay kami wala na iniwan na kami ng tatay ko.” As verbalized by the
grandmother. She also added that when HM was still outpatient, they would seek the help of
quack doctors. Since 2010, they have consulted quack doctors for 7 times. When asked what do
the albularyos do, “Ay madami. Pinaglay kami ng manok. Meron pa yung pinagkatay kami ng
baboy tapos kailangan daw ubusin. Meron pa yung dugo ng baboy pinahid na krus sa dingding.
Pinagnovena kami pinagalay ng kung ano ano. Pero wala pa rin naman. Mero nga nakimisa pa
kami sa kulto at nagalay pero wala pa rin. Pinaglibing pa kami ng kung ano anong bagay gaya ng
6 na saucer na red tapos, nakalimutan ko na basta 6 na red. Pinabless pa nga naming tong 2
bahay eh wala pa rin. Yung last nga na binless to, nirefer kami nung pari na magsulat sa wish ko
lang. Wala din naman. Baka nga hindi sinned nung kpatid ni HM kasi baka sabihin nung mga
classmate nya na baliw yung kapatid niya.”

When asked how was HM when she was still in their house, they sid that she often times go
to their roof and attempt to jump. She jumped once but attained minimal injury. She breaks thins
such as bottles and she always shouts and yells that “Walang Panginoon.” and
“Nakikipagkantutan si lord.” She also once ran around their street nude.

Her first admission was in 2010. She ran away from home and they only found her after 2
weeks when they received a call from CVMC psychiatric ward. According to them patient HM
was referred by the Holy Infant Hospital because they said she was yelling and screaming on the
streets near the hospital.

Her second admission was on 2013, with the same complaints. She stayed in the psychiatric
for more than a year. She was only discharged in the late 2014. When she came home, nothing
changed according to them. She was non-compliant to home meds and still exhibits delusions,
hallucinations and paranoia.

On the first quarter of 2015, her father went home because his father died. According to the
family, patient HM was very happy then, She would even ask her father to carry her. Her father
went home again here in Tuguegarao for the celebration of his father’s 40 days. Then he went
back to his family in Bataan. This April 2015 her father went home here again for the graduation
of her younger sister. After the graduation their dad left again “Pero mga 2 weeks ata yun na
hindi simupong si HM. Pero yun after 2 weeks na naman eh sinumpong na naman sya.” This
prompted them to seek again the help of a physician.

B. GENERAL APPEARANCE AND MOTOR BEHAVIOR

Patient HM was properly dressed and appears to be in her stated age. She always wears her
purple shirt. She doesn’t have automatisms and waxy flexibility. HM is dressed appropriately,
she is neat and there is no evidence of soiled clothing and no smell of body or breath odor.
Her skin is moist and her hair is shiny. Her fingernails are well groomed.

She has poor posture and exhibits hand gestures when speaking She wears shorts and
loose t-shirt she does not wear inappropriate clothing

Overall motor behavior also may appear odd. HM sometimes is restless and unable to sit still,
demonstrate odd facial expressions such as grimacing. Sometimes the client may does not
participate in activities unless encouraged or demanded.

C. SPEECH

HM typically shows patterns of word salad (jumbled words and phrases that are disconnected
or incoherent and make no sense to the listener). Her speech may be slow and volume is audible
and the pitch is high. When she is having delusions or hallucinations she hesitates before the
responding to questions. This hesitation may last 30 or 45 seconds and usually indicates the
difficulty with cognition or thought processes.
 She does not talk non-stop. She perseverates on the topic regarding her hallucinations that
god is having a sexual relationship with her instructor. The rate of her speech is neither fast nor
slow. She answers close ended questions with elaborations.

D. MOOD AND AFFECT

HM often are has a flat affect (no facial expression) or blunted affect (few observable facial
expressions). The typical facial expression often is described as mask-like. Her facial expression
or emotions are incongruent with the context of the situation. For example, HM has a facial
grimace when describing herself as “beautiful, strong”. But when talking about the loss of his
father her facial expression is congruent. HM reported feeling depressed and having no pleasure
or joy in life (anhedonia). Conversely, has reported a lack of energy or pleasurable feelings
during the activities.

E. THOUGHT PROCESS AND CONTENT

HM’s thought processes are disordered, and the continuity of thoughts and information
processing is disrupted by auditory hallucinations and delusions. For example, HM may
suddenly stop talking in the middle of a sentence and remain silent for several seconds to 1
minute (thought blocking) and that others are taking their thoughts (thought withdrawal), or that
others are placing thoughts in their mind against their will (thought insertion).

Religious delusions often centered around God and the devil and other saints. These religious
delusions appear to affect HMs psychosis religious faith. For example God, the devil, and his
teacher are having sexual relationships. She also claims that she sees people’s soul or the good
part of them going away.

F. ASSESSMENT OF SUICIDE OR HARM TOWARD OTHERS

She does not inflict harm towards others because according to her it is not good to hurt
others, however she has a tendency of harming herself. She once tried to kill herself by cutting
her hand by a screwdriver near the brachial artery. There is an evidence of a scar on her left
hand. “Kapag sinusumpong siya minsan inuuntog niya yung sarili niya sa pader.” As verbalized
by her mother and co-patients. According to her, if she is trying to hurt herself it is because the
voices inside her told her to do so.

G. SENSORIUM AND INTELLECTUAL PROCESSES

1. MEMORY

When asked about the things she did yesterday, she said, “Wala ma’am
sinumpong ako.” Patient HM seems to remember the activities she did recently. She
correctly stated the name of her parents by answering “Harry and Mylyn”. She
remembers her birthday which is January 9, 1993. She even stated their complete address.

2. ABILITY TO CONCENTRATE
 Patient HM can spell her name backwards but she has difficulty counting
backward from 30-1. She said, “30, 29, 28, 27, 26, 25, 24, 23, 22, 21, 20, 1, 2, 3, 4, 5, 6,
7, 8, 9, 10, 11, 12, 13, 14 15, 16, 17, 18, 19, 20.” However she does not have difficulty
stating the days of the week in ascending and descending order. She is not oriented to the
date.

3. ABSTRACT AND INTELLECTUAL ABILITIES

When asked to explain the proverb “Kung ano ang puno siya ang bunga” she
stated “Eh kung ano ang puno siya ang bunga eh yung quality ng parents ganun din kung
magkakaanak sila. Kung yung parents eh mabait yund din yung quality na makukuha ng
mga anak nila.” She exhibits abstract thinking.

She was also asked to explain the proverb “Aanhin mo ang damo kung patay na
ang kabayo?” she answered “Kapag may nangangailangan ng tulong ma’am saka mo lang
ba siya tutulungan kung wala na siya. Hindi mo ba siya tutulungan munaa, saka na lang
pag nawala na siya?” She displays abstract thinking. She was able to explain the
application of the proverb in the real life and she was able to explain its meaning.

4. SENSORY/PERCEPTUAL ALTERATIONS

She is having auditory and visual hallucinations. Her auditory and visual
hallucinations are the same, god is having a sexual relationship with her instructor.
“Pinaparinig nila sa akin ma’am yung pagkakantutan nila.” As verbalized by the client.
“Ang mahalaga lang sa kanya ay yng uwak niya. Nakikita ko sila ng instructor ko.” As
verbalized by the client. She aslo said that she can see the “Diwa” of Jovelyn, a ptient in
the psychiatric ward. According to her, it is also Jovelyn’s twin that she is hearing. She
doesn’t have gustatory, tactile and olfactory hallucinations.

5. JUDGMENT AND INSIGHT

When asked what she will do if she found a wallet on the ground, she would
return it she said because it is not right to get something that is not your own.

When asked what does she think of her illness she stated, “Ayaw ko, kasi hindi
pwede ang ganito, kase kung pag asa ang hinihiling mo kelangan hindi talaga dapat na
magtagumpay ka sa mga positibong dapat na yun lang ang mangyari sa buhay natin, kahit
may pagsubok pa, mas maganda pa din yung pag asa ang na iiukit kase dun ang
kasiyahan ng luwalhati mo at dun ang diwa. Sumakit ang loob ko kasi bakit ganun hindi
naman dapat dahil mabait naman ako alam kong lahat ng bagay, binibigay lang na
pagsubok, hindi din tama yun na kelangan din na maayos na pinakamaganda na maganda
ang nangyayare sa ating buhay.”

When asked what doeshe thinks of her medications, according to her she eeds
them for her to be good so she could go home. She said she was compliant to her
 medications but based from the doctor’s note and the statement of her family, she is not.
She just complies to the medication when she was admitted.

6. SELF CONCEPT

HM thinks of herself as “Mabait” or “Good Girl”. She describes herself as true

friend and not Plastic.

7. ROLES AND RELATIONSHIP

When asked how is her relationship with her family, she stated “Maayos
relationship namin kasi pagmamahalan nga, maayos relationship namin lahat”. Right
now, patient HM is still hoping that her father will come home. She doesn’t have a sexual
relationship with anybody.

8. PHYSIOLOGIC AND HEALTHCARE

Patient HM can’t eat or sleep well especially “Kapag sinusumpong ako” as

verbalized by the client. The client is well groomed and is compliant to medications when
admitted.