Category Archives: Clinical Case Studies

An Inspiring Patient

Clinical Case Studies

Nobody really likes to talk to her, because she talks non-stop, about herself and her “disorder”.

She mentions the word “disorder” once every few minutes. I’ve always said having insight about your illness is good, and utmost important in your recovery, but when I talked to her, I kept wondering whether this level of insight is good.

She’s divorced with a 10 year-old daughter who lives with her. Her parents are kind of supportive but she thinks it was her mother who pressured her too much and somehow caused her disorder so she refused to live with them, and refused to let them bring their granddaughter. But her relationships with her parents remain close.

She has been through a lot since young. Being the top student but wasn’t allowed by the mother to continue her studies. Working three jobs to cover and support her own family which still fell apart at the end. Having an ex-husband who transmitted HPV to her and left her with the baby daughter to deal with all by herself. Bringing up a baby girl all by herself while coping with her mental illnesses.

She has problems sleeping, and when she doesn’t sleep well, she gets panic attacks. She can also turns aggressive, when she is in that mood, she could punch the wall till she bleed. She sometimes can’t control her emotion, she cries out loud, like a baby.

But she learns about her problems and illness. She goes for jogging, learns yoga and meditation, understands what she should and shouldn’t do in front of her daughter, reads psychology, self-help books, learns about psychiatric pills, and what’s surprising, she teaches the daughter about her illness, so the daughter understands her, loves her, be patient and caring, even when she needs to release her anger and agitation by punching, even when she asks her to stay away from her, the daughter understands that she’s just not well, she still loves her. When she knows she can’t handle it well enough, she seeks professional helps.

She’s often in needs of reassurance. But she’s doing is in fact doing very well.

After a 50 minutes conversation with her today, she was very grateful, and so was I. To learn about someone who’s mentally ill and who’s been through a lot in their lives, but still stay positive, inspirational, motivated, this can’t be achieved just like that by ordinary “normal” people.

Alcohol Related Amnesia / Post-Injury Personality Change

Clinical Case Studies, Unclassified Disorders

He has a history of substance abuse but he overcame the addiction spending 3 years in a rehab centre in Singapore. But during this period of time, he’s become dependent on alcohol.

He was involved in an accident one day when he was taking a cab. His head was injured. Since his recovery he seemed to have become somebody else. He was calm and patient. Now he’s short tempered and very easily agitated. He also doesn’t care about what people think about him anymore, he’d walk around naked in the house, in front of the very young daughter and maid.

What’s worse is his attitudes and behaviour after he gets drunk, he became aggressive and very bad-tempered. He has injured people on several occasions now, on one occasion he even held a chopstick wanting to put it through somebody’s throat, but he was stopped by several friends, whom injured by him.

He had no memories of these incidents the next day when he’s awake.

His wife was very worried. He even beat her up when he was drunk, but the next day he couldn’t recall anything. He was very sorry so the wife forgave him. But she doesn’t what to do as if this continues she and the daughter will be at risk. They don’t know what he’ll do when he’s drunk.

From the wife’s view, he’s very kind and friendly, although he does see quite low of himself, as he’s an adopted child, growing up being teased and laughed by his peers. Till he was involved in the accident his personality has all changed.

What’s the treatment option for such kind of personality change following head injury? How about the alcohol related amnesia – is quitting it the best or the only solution?

It doesn’t have to be your fault for you to change

Basic & General, Clinical Case Studies

She said he has been supportive all financially and mentally to the family of 5 since their marriage over 10 years ago. He has no bad habits, he doesn’t use violence.

But she wants a divorce. She was terrified yesterday, when she talked to him, regarding an outing with friends. She said it was the way he looked at her and the way he talked to her was scary.

She knew he has changed for her, since she initiated the divorce. But she said there are certain things that people can’t change, it’s in them, in their personality, long-standing habits (just wondering here, if it was his personality and long-standing, the problems would have been there before they get married isn’t it? Why wasn’t she scared?). So she insisted the divorce despite his efforts and knowing how responsible a husband he is.

So we gave up talking to the wife, we spoke to the husband. He thinks he has done nothing wrong, in fact he’s done well since the marriage.

But he wants the marriage back. He was told that if he continues with how he is, the wife is going to leave him. So despite doing nothing wrong, he’s the person who needs to change. We pointed out a few things that the wife mentioned, and asked him to start paying attention on them and changing them. So if he has tried hard enough to change, to improve his way of talking and treating her, looking at her, but she still insists the divorce, then at least he has tried.

It really doesn’t have to be your fault for you to change. If you want something badly you will have to initiate the move.

Nobody’s fault

Clinical Case Studies, Depression

The wife has requested to divorce earlier this year.

This is a husband who has no bad habits, and has not done anything guilty to the wife and their 3 daughters. He has supported the family financially and mentally from day one.

Why is the wife unhappy about the marriage? Frequent rows? Personality? Wife having affairs? Too boring?

They have their first daughter about 10 years ago. One year later the wife is pregnant again, and one day when she was already 8 months pregnant, the husband called the wife, and needed the wife to do something for work urgently. The wife did it as requested. And that was the day, the baby boy was born prematurely, … then passed away one day later.

In the next 5 years they have another two baby girls. But the wife couldn’t let go of it, the one and only baby boy. She blames it all on the husband, even after 8 years, can still never forgive him. She thinks the husband ruined her day and hence the water broke earlier. She thinks if the baby wasn’t born prematurely he wouldn’t have died.

She could be right. But is the husband not feeling guilty about it? Will the husband want his baby boy to die? If he knew that could happen, even on the slightest chance, will he still want the wife to do that?

OK well we can’t judge whether one’s guilty just by saying he has no motive to do so, because people do make mistake accidentally, just because you somehow kill this person accidentally, doesn’t make you guilt-free.

Now every day the wife is picking on the husband, moody, bad-tempered, and getting angry over little things. She tried to take some chinese herbs medicine, but the traditional chinese med doctor said her condition is getting so bad that she’d have to see a psychiatrist for a faster effect and action on her condition. The husband also tried to bring her to see Clinical Psychologists and went through a few sessions. But still, she couldn’t let go of the incident, and is putting the marriage and the family’s happiness at stake.

Nobody’s fault isn’t it? But when you step into her shoes you may understand why she’s feeling and behaving this way. Yet I feel so sorry for the husband and 3 daughters.

When traditional chinese medicine and psychotherapy (quit half-way) failed, will medicine help this family?

Guilt Feeling

Clinical Case Studies, Depression

She’s newly wed, just half a year ago. But she isn’t happy, as she’s involved with another man, after the proposal, before the wedding.

Few months after her wedding, the husband found out about the affair, by then she has already separated from the man. The husband also chose to forgive her about it.

This makes her feel worse. Within few weeks she was getting more and more depressed. She thinks she ruins their marriage, their lives. She would rather the husband being angry. She knew the husband loves her so much that he can forgive her about it and hopes that nothing like that will ever happen again.

But she feels so sorry, can’t get over with it and slowly develop depression, with agitation. The better the husband treats her, the worse she feels, and the worse she treats the husband back. The husband thinks he must have done something wrong, but doesn’t what to do to help with their relationship. Their marriage is at stake.

The root of the problem is her guilt feelings, that has to be spoken out, to a professional with the husband, that has to be solved, before any other problems it has caused can come to an end.

So speak out, when you feel sorry or guilty, depressed or sad, angry or agitated, you may not know what you’re doing, and may cause things to happen that make you regret for the rest of your life.

Schizophrenia Triggered by Relationship Problems

Clinical Case Studies, Schizophrenia & Psychotic Disorder

Do you think it’s possible? For one to suffer from schizophrenia triggered by relationship issues? (quite commonly triggered by drugs, trauma, stress, alcohol, adverse experience… But relationship problems?!)

They have been in a relationship for few years, after knowing each other since 7 or 8 years old in tuition centre. They also have a common childhood friend Ernest who attended the same schools with the guy Kenji. Sue knew Ernest had a crush on her when he was 12 or 13. But she didn’t think it was a problem, and didn’t take any action. She continued to maintain their friendships, spending a lot of time together, sometimes they could chat over the phone for hours. Sue didn’t hide any of this from her boyfriend Kenji, for the first few years, Kenji never (appear to) mind his girlfriend’s close relationship with another guy.

Till one day more recently, Kenji started to shout at and scold Sue, for still staying with Ernest despite knowing the latter admiring her. He said Ernest isn’t a good guy to befriend with, and he is kind enough to warn her about this. For the sake of her boyfriend, Sue decided to slowly keep her distance from Ernest. That didn’t help, Kenji started to hear voices, asking him to leave her, saying she wasn’t “the one” for him, he’d be better off without her. The voices were haunting him, day and night, especially when he was alone, so bad that Kenji started to stay away from Sue (which somehow relieves the symptoms).

Of course he still loves her. But he couldn’t bear the voices and hallucination. He didn’t feel better staying away from Sue, as he’s still thinking about her all the time, and fighting for her against the voices. He feels like he’s going crazy. He’s slowly losing his ability to function in other parts of his life.

Sue then decided to seek professional help for him. There wasn’t any apparent or direct family history of mental illness in Kenji’s family. It was in fact difficult to find the trigger. But Sue thinks it was all her fault, she is the cause and trigger of the psychotic symptoms in her boyfriend.

Is it possible?