After admission, depressive mood, auditory hallucination disturbance,
persecutory delusion, delusion of being-controlled, self-harm ideas and social
withdrawal were noted during the diagnostic interview. We added apa-risdol
2mg PO HS for her psychotic symptoms. Otherwise, individual supportive
psychotherapy, special psychotherapy, psychoeducation, occupational training
were arranged for her, too. Lab survey showed elevated prolactin level. Drug-
induced hyperprolactinemia was suspected and we added abilify 2.5mg PO HS for
hyperprolactinemia. Psychological test showed FIQ=52, and moderate mental
retardation was impressed. After a period of hospitalization, she was discharged
under a relatively stable mental condition.
After admission, depressive mood, anxious affect, referential,persecutory,religious
delusion, helpless feeling and social withdrawal were noted during the diagnostic
interview. We keep uspen 300mg PO HS for her psychotic symptoms, and ever added
solian/rezulti/surin for augmentation. After a period of medication, less
delusional ideas and less somatic complaints were noted. Otherwise, individual
supportive psychotherapy, special psychotherapy, psychoeducation, occupational
training were arranged for her, too. After discussion with the patient and her
brother, we decided to refer the patient to 錦和康復之家 for further rehabilitation.
After admission, referential/bizarre delusional ideas, r/o visual hallucination and
social withdrawal were noted during the diagnostic interview. We added INVEGA 6mg
PO HS and silence 1mg 1# PO HS for her psychotic symptoms. Otherwise, individual
supportive psychotherapy, special psychotherapy, psychoeducation, occupational
training and multi-phasic psychological examination were arranged for her, too. Lab
survey showed hyperthyrodism. After treatment, she had relatively stable mental
condition. Discharge and further PSY/META OPD follow-up were suggested.
After admission, depressive mood, referential delusional ideas, self-harm ideas and
social withdrawal were noted during the diagnostic interview. We added zyprexa 15mg
PO HS and depakine 1000mg HS for his psychotic symptoms. Otherwise, individual
supportive psychotherapy, special psychotherapy, psychoeducation, occupational
training were arranged for him, too. Lab survey showed hyperlipidemia. After
treatment, he had relatively stable mental condition. Discharge and further PSY OPD
follow-up were suggested.
常低著頭往下看，執著想法，與她人爭執衝突引起糾紛
病人為 31 歲單身女性，診斷為 1Schizophrenia 2.mild mental retardation，據舊病歷，個
案於就讀幼稚園時，即開始有坐不住、無法配合活動等情況。當時個案被帶至台大醫院就醫
，診斷為過動症。之後個案之發展較遲緩，雖然仍可就讀一般小學，但在校成績差，且時常
遭同學欺負。約在個案 10 歲時，個案開始出現自言自語、自笑等症狀。並有許多怪異的行為
，會不自主起身走動、跑步、跳動等。同時思考固著、態度較固執、情緒起伏較大，因此與
家人多爭吵。當時因個案被帶至南部居住，故被帶至成大醫院就醫，診斷為輕度智能不足及
精神分裂症。之後個案返回基隆，於基隆長庚醫院規則門診追蹤，主要使用藥物為
Quetiapine 600mg/day 及 Fluoxetine 40mg/day。個案國中及高中皆就讀於啟智學校，高中
畢業後即於基隆長庚醫院日間病房住院約一年多。之後因個案於日間病房表現不佳，多次逃
跑、缺席，故辦理出院。
個案在家皆與案祖父母居住，尚可料理自己之生活起居，但功能稍差，自我清潔之維持較草
率。若未注意，則會有向外跑、outside-wandering 等行為。因案祖母年事已高，感無力照
顧個案，希望有長期安置之場所，因此將個案帶至本院門診就醫，102.3.5-102.5.1 住院治
療評估後轉介至本院護家安置，期間會發現病人有不適切行為(觸摸他人身體、干擾病友)，
無法配合行為約定且情緒易起伏，故 107/8/2 轉急性病房住院治療，穩定後 107.8.27 返回護
家。
108/8/15 日因偷拿別人洗髮精並偷改名字，不承認偷竊行為，予以行為治療時，生氣不合作
，情緒激動難配合，拒絕吃藥，趟在床上不動，故 108/8/15 至 108/9/11 本院住院治療。
109.1 月，容易情緒激動，近兩天作勢要攻擊其他住民，故 109.1.17-109.1.22 住院治療。
出院後回護理之家，期間爸爸將家中初音娃娃丟掉，因此跟爸爸吵架，爸爸說要把初音娃娃
買回來，結果爸爸買成憤怒鳥，說要跟爸爸算帳，身體右邊傾，常低著頭往下看，執著想法
，與她人爭執衝突引起糾紛，所以送來急診處理安排住院。
<Personal History>
Birth：FT，NSD
Development： develop delay
Schooling： 高中
Premorbid personality： 外向活潑
Interpersonal relationship： poor 容易與人衝突
Occupation：從未工作
Psychosexual history : unmarried single
Past medical history :
Denied other systemic diseases or allergy hx
Substance use history :
Denied smoking, alcohol use, and other illicit drugs
alcohol（－） smoking（－）
<Family History>
Family History of psychosis（－）
Family History of MR（－）
Family History of epilepsy（－）
<PE & NE>:
NE：grossly normal
PE：grossly normal
脖子常常往下看
<Mental Status Examination>
Conscious：clear
Appearance： clean
Attention: distracted
Affect： restricted
Attitude： cooperative
Behavior: 走路低頭
Speech：relevant and coherent
Thought:
Rigid thinking 有時候會覺得別人打小報告
常常念著卡通人物
Perception:
AH Denied VH ( - )
Drive：Sleep ：fair appetite fair
Somatic complaint: nil
JOMAC： impaired
Insight： absent
Risk: currently low risk of self-harm/suicide,
Risk: currently low risk of violence/homicide
<Review of system>
General: fatigue(-) anorexia(-) fever(-) chillness(-) body weight loss(-)
◎Head: headache(-) dizziness(-) trauma(-)
◎Eyes: visual acuity(normal) dry & soreness(-)
◎Ears: hearing impairment(-) earache(-) tinnitus(-) discharge(-)
◎Nose: nose discharge(-) obstruction(-) epistaxis(-) rhinitis(-) sinusitis(-)
◎Mouth: sore mouth(-) sore tongue(-) bleeding gum(-) toothache(-)
◎Throat: sore throat(-) tonsillitis(-) dysphagia(-) dry throat(-)
◎Neck: mass(-) neck stiffness(-) pain(-)
◎Respiratory System: cough(-) sputum(-) hemoptysis(-) wheezing(-) dyspnea(-)
◎C-V System: chest tightness or pain(-) palpitation(-) varicose vein(-)
orthopnea(-) pedal edema(-)
◎G-I System: nausea(-) vomiting(-) belching(-) heart burn(-) diarrhea(-)
constipation(-) hemorrhoid(-)
◎G-U System: dysuria(-) polyuria(-) nocturia(-) hematuria(-) incontinence(-)
abnormal urine color(-)
◎Neuromuscular System:
Motor: muscle atrophy(-) involuntary movement(-) weakness and soreness(-)
bilateral shoulders and hips atrophy(-)
Sensory: numbness(-) hyperesthesia(-)
◎Extremities: swelling(-) edema(-) deformity(-) stiffness(-)
◎Skin: pigmentation(-) itching(-) petechiae(-)
入院傳染病初篩:
發燒(-) 腸胃道症狀(-) 呼吸道症狀(-) 皮膚症狀(-)
F20.0 妄想型思覺失調症
<Management>
1. Establish rapport & collect more information.
2. Interview & Check Mental Status Exam.
3. Admission routine examination.
4. Close observation.
5. Medication： Risperdal 6 mg/day for s/s control
6. Arrange psychological assessment
7. Supportive psychotherapy & arrange Gr. Psychotherapy.
8. Behavior & activity therapy.
9. Psychiatric nursing care & special nursing care as needed.
10. Establish insight & medication adherence.
11. Psychosocial/family management.
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