This is a reminder that I’m better off now than I was 10+ years ago. Found this in my old online journal.
The patient is Aubrey Rodriguez, 21 year old, female, single, Filipino, in-coming 3rd year advertising student in UST, admitted under medicine-Gastrointestinal service on May 25, 2005 and referred to Psychiatry service on the 3rd hospital day of evaluation and management.
The patient lived in Papua New Guinea since age 8 after her parents divorced to live with her mother. She visited the country every Christmas time and was said to be adjusted with the set up. She has a good relationship with all her siblings but her father claims that she sometimes feels insecure about her older sister excelling in academics. After high school, the patient was sent to new Zealand where her older sister was studying but only stayed for 4 months before asking to be sent to the Philippines instead. She enrolled in UST and had a difficult time adjusting to the system, failing in a couple of subjects during the 1st semester. She was also introduced by her brother to Judo which she took a liking to and started training for it and joined the varsity team. In February 2005, the patient needed to lose a few lbs to make her weight criteria. She took laxatives and diuretics but claimed to have stopped after a couple of days when her trainer discouraged her from doing this. A day after the competition, the patient, experienced nausea and vomiting, she had cold, clammy extremities, was palpitating and her shortness of breath. She was confined at UST and was given Losec for maintenance and was manageable since. Her father wanted her to stop judo training and live with him instead but the patient refused and told her mother about it. Her parents had an argument regarding this and she ended up staying in the dorm. Two weeks prior to referral, the patient was vacationing in Bangkok with her mother and younger brother when she again started retching despite Losec maintenance. She was notably weak looking and had poor sleep and appetite. Upon coming home, she was to her doctor who shifted her to Nexium for a week. Symptoms abated but after 1 week, the patient had recurrence of symptoms. The family then decided to have her admitted for check up. Endoscopy done showed non-erosive, acute gastritis. She was then referred to psychiatry service for evaluation.
On referral, the patient is fairly kempt and groomed, on the bed, with IV line. She is conversant and cooperative but is uncomfortable-looking. Mood is dysphoric with appropriate affect. Speech is spontaneous, coherent, and soft. She denies perceptual disturbances or suicidal ideations and is preoccupied with her GI discomfort. Attention and concentration are sustained. Memory is intact. Impulse control is tenuous.
Our impression is t/c Major Depressive Disorder with Anxiety Features.
We will start her on mirtazapine 30 mg at hs and Clonazepam 2mg/tab 1/4 BID.
Thank you for this referral. We will follow up the patient.