Case Presentation

Haya Hayek
Identifying Data
Name: N.B
Date of birth: 21/10/1993 (23 years old)
Sex: Female
Marital Status: Divorced
Area of residence: Alwihdat with her father, mother, 2 sisters and 3
brothers.
Occupation: Unemployed
Religion: Identifies as a Muslim
Education: Finished 10th grade
Chief Complaint

ever since her brothers murder on 21/4/2016
 History of presenting illness
N.B, a 23 year old female, was admitted on Saturday, the 22th of October,
after her fourth suicide attempt, this time by cutting her wrists, only to be
stopped initially by her mother, who brought her to the hospital to be
admitted. The patient claims that after her brother got shot and murdered
in front of her on 21/4/2016 (7 months ago), , and
tried to commit suicide a few days after her brothers murder, by
swallowing 70 pills of an anti-epeliptic medication, which got her into a 3
day coma followed by 2 sessions of dialysis. She was seen by a psychiatrist,
who prescribed a medication, that didnt help her improve as she claims.
After that she became very depressed and she said that
. . A month
later she attempted another suicide, by strangling herself with a satellite
wire. During this period, the patient experienced somatic and auditory
hallucinations. The somatic hallucinations were of a man touching her
inappropriately, while the auditory ones were of voices commanding her to
rage and break things down. She experienced both twice, at different times
that she doesnt recall exactly.
 History of presenting illness
The patient stated that she tried to commit suicide once before her brother got
murdered. It was in 2015, while she was still married to her drug addict husband.
She claims that she was very unhappy with him, and that he and his family treated
her badly. Her parents wouldnt let her get a divorce, which only made her feel
worse. One day when her husband was high, he physically abused her, which drove
her to in an attempt to end her life. After receiving medical
intervention and regaining her health, she got divorced in the same year. The
patient didnt experience any hallucinations during that time. She states that after
her divorce, she got a training in a hair saloon and started working for six months,
which were 6. Then her brother died and
her condition deteriorated ever since.
N.B states that she had decreased appetite, low mood, disturbed sleep, and almost
no energy throughout the past 7 months (since her brothers death). She denies
that she tried to kill or hurt anybody else. No delusions, phobias, obsessions or
compulsions. She also states that she doesnt like sitting with her family or
speaking to her relatives.
No family history of psychiatric illness.
Medical History
Apart from her admissions after her suicide attempts, N.B claims that
she was never admitted to a hospital, and that she doesnt suffer from
any illness.

She underwent a cholecystectomy when she was 15 years old.

Social History
Our patient is a non-smoker, non-alcoholic drinker, and has never
tried any illicit/illegal drugs.

No criminal/legal history

History of physical abuse by her husband.

No history of trauma
Mental State Examination
Appearance and behavior:
The patient is kempt, wearing clean clothes that are appropriate for age, sex
and season. Normal posture and no physical abnormalities. No tics or
stereotypical movements. Patient is very cooperative and maintained a good
eye to eye contact.

Speech: Regular rate, tone and rhythm. Appropriate volume. Good

articulation.

Mood and Affect: Patient has a very low, depressed mood. Dysphoric, full,
supple, congruent affect.
 Thought:
i. Process: No formal through disorder
ii. Content:
Patient had a significant suicidal ideology, with an intent to commit
suicide if discharged. However, no official plan was formulated and the
means to do so were unknown.

Perceptual Disturbances:
Somatic hallucinations of a man touching her and holding her.
Happened twice, during the day, in different occasions after her brothers
death.
Auditory commanding hallucinations asking her to burst out in anger
and break things around her.
 Sensorium and Cognition:

i. Consciousness: patient was fully conscious

ii. Orientation: patient was oriented to time, place and person
iii. Calculation: patient was able to solve all addition and subtraction
problems
iv. Memory: intact immediate, short term and long term memory.
v. Fund of knowledge: patient was able to answer general
knowledge questions
vi. Attention and concentration: patient was able to subtract serials
of 7s from a 100.
vii. Abstract: patient was able to tell the abstract similarity between
an orange and an apple, and was able to explain the proverb told.
 Judgement: excellent critical and functional judgement

Insight: full insight.

Follow up?