PEERLS TUTORIAL 2
Nor Adilah is a 39 year old married Malay (lady) housewife with a history of past suicide attempts.
The patient is the only source of information as the relatives were not
around to interview.
Chief Complaint
The patient said in her own words “Saya ada sakit perut dan belakang
semasa marah” which roughly translates to stomach and back pain when she
is angry.
HOPC
She was brought to the hospital by her husband on Friday and
admitted by approx. 11am. She had attempted to commit suicide earlier in
the morning by self strangulation but was coaxed to stop by her daughter.
Throughout the month leading up to the incident, she claims to see a
female apparition at the foot of her bed every night. She also claims to
hear a female voice telling her that she is useless and that she should
commit suicide. When she gets angry, multiple voices can be heard. She
also claims to have back and stomach pain that increases in severity and
frequency within a week of the incident. She complains of loss of
appetite leading her to refrain from eating solids for a week and
drinking fluids instead. These symptoms are aggravated when she gets
angry at her daughter, who is not on good terms with her.
Functional Enquiry
My patient’s mood was low in the month leading up to the suicide attempt.
She claimed to have cried daily. She claimed to have not enough energy to
do her daily activities and was not interested in them. She hints on not
having sex with her husband for a while.
She claims to take alcohol as an adolescent but has stopped after her
marriage nearly two decades ago. She does not smoke. She does not take
illicit drugs.
She worries constantly about her daughter and seemed preoccupied with her
apparent truancy and smoking.
She sees a female figure and hears a female voice talking to her.
She has had three suicide attempts including this one. She did not have
any suicide plans and claims that it came to her spontaneously.
Past Psychiatric History
Early last year, she attempted to kill herself by ingesting 9 sleeping
pills. She was found unconscious by her husband who brought her to the
the hospital. She claims to have been upset by her daughter who smoked
and stopped schooling secretly. She claims to have argued with her
daughter and physically hitting her. After her discharge, she claimed to
have no symptoms until December.
In December, she claimed to start having the hallucinations. She
attempted to commit suicide using a knife but was stopped by her daughter
on the spot. She was admitted in the psychiatry ward for a week. She
claims to have taken pills prescribed to her and claims compliance.
Soon after her discharge, her symptoms reappeared but she did not do
anything about it until the present incident.
Past Medical History
She was diagnosed with diabetes mellitus 5 years ago and is on metformin.
She was diagnosed with end stage renal failure last year and is awaiting
an AV fistula.
She has had no previous history of epileptic fits or head injury
No allergies.
Family History
No family members with psychiatric symptoms in past or present. Both
parents are healthy with no known medical illness.
Personal History
She does not know of any incidences or health problems during her birth
and early childhood.
She claims to lead a happy childhood with friends in school.
She claims that her adolescence was marked with truancy, and alcohol use.
She claims to have been delinquent.
Her life had been stable after marriage and the birth of her child. She
claimed to have a good relationship with her daughter until last year.
Ddx
Major depression (with psychosis)
Schizophrenia
PEERLS Tute 2
Tasks
1. Aetiology, RF of suicide- alvin
2. Suicide and the Law (Australian and Malaysian Law) + Ethical issues -chris
3. Prevention of suicide (NGOs, hotline, services)- yazid
4. Management of suicide patients- christine
5. Risk assessment of suicide- maz
6. Fun facts about suicide- manno
7. Food and refreshments