Sunday, November 09, 2014

Of Delusions

I have told you that the five of us clerked a patient who was diagnosed with Schizophrenia last Friday oncall. The patient was a Malay female, aged 29. She was admitted on the same day we clerked her. She had history of delusion, hallucination and abnormal behaviour for one month duration. In her case, we thought that she had relapse due to non-compliant to medications.

What I am going to tell you is about her delusion. I was amazed by how her mind works. Upon questioning, she told us that she has black magic, where she can make anyone suffers by using her power. She believes that she is a royal person, coming from a wealthy family. Her parents are both prince and princess. She owns state of Pahang, and all of us are her people. Yes, all means including five of us. And even that hospital building, she owns it. That is grandiose delusion. She also believes that she had been on television and magazines, and they were all talking about her. That is delusion of reference. She believes that a famous singer (Radhi OAG) fell in love with her, and asked her to take care of his cat. They were in love with each other. That is amorous delusion. She believes that she is married to Radhi OAG and her boyfriend. Her boyfriend once used black magic on her. He also had strangled her, and wanting to kill her. That is persecutory delusion. She also believes that her thoughts are known to other people, and sometimes people can read her mind. That is thought broadcasting.

She believes that she gave birth to a cat named Koko and the cat is actually a snake. She taught her "cat" how to read everyday. She believes that all five of us are also her children. She even gave us names. She believes that she had been smoking cigarette since she was in her mother's womb. She believes that she has two personalities, one is Agung (a royal) and another one is a Pakistan mix with a different name. She has many mothers, and one of them is Santubong. That is bizarre delusion. And we all know, according to DSM-IV, only one Criterion A symptom is required to diagnose schizophrenia if you have bizarre delusion.

The five characteristics of delusion are:
1. False unshakable belief
2. Firmly held by the patient
3. Not consistent with cultural and social background
4. Always pathological
5. Cannot be corrected by reasoning

When we clerked her, my friend asked me to ask questions to "break" her belief. When she told us that she gave birth to a cat/snake, I asked "Can a human give birth to snakes?" She said "Yes". Then I asked "How is that possible?". She remained silent. Regarding her secret love with Radhi OAG, I told her that Radhi is already married, and have kids, how can he love her? Then she said, " Yes, we were in love, but we had to keep it in secret. Nobody knows." When she said that she was all over the television, I told her that she cannot be an Agung, since all of us have not seen her face on any TV channel. But she still said that she has been on TV. When being pushed further, she kept quiet.

When the patient talked about her black magic power, she was looking right into my eyes. I was sitting next to her, and I had a moment of fear. When she suddenly covered her mouth and giggled with no apparent reason in the middle of our conversation, we asked the reason why. She said that she had been hearing her boyfriend's voice. That, was enough to give me chills.

We tested her abstract thinking. "What is the similarity between a table and a chair?", I asked. She then answered, "A table and a chair are like siblings. They are similar, and very close to each other". I looked at my friend - she was trying very hard not to laugh.

So that's a bit about delusions in a schizophrenic patient. Interesting, right?

Oh its almost midnight. I better go to sleep.

Youu, have a good day...and goodnightt! :)

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