Clinical Abstract
Confidential Material
A report presented to Villa Herzon Mental Health Center in partial fulfillment of
the requirements for the Degree of Bachelor of Science in Psychology
Prepared by:
Bacud, Anh Nicole L.
Rizal Technological University
COE2: Cooperative Education in Clinical Setting, 2023
Submitted to:
Sir Albert Quitain Comedes Jr., R.N
I. Identifying Information
Name: ANC8
Age: 29
Sex: Female
Birthday: September 13, 1993
Civil Status: Single
Occupation: HR Assistant
Nationality: Filipino
Religion: Roman Catholic
Date of Evaluation: March 8, 2023
II. Reason for referral
Client ANC8 is a 29-year-old adult female who is diagnosed with (F. 31. 2) Bipolar
Affective Disorder, Manic with Psychotic Symptoms. She was referred for admission by
her step-sister due to non-compliance with medications. The client claimed that "Hindi
kabisado ang gamot" and lack of financial support was the reason why she was unable
to continue her medications. She was admitted to the National Center for Mental Health
(NCMH) for one night. Afterward, she was admitted to Villa Herzon Mental Health Center,
which she claimed that her admission was beyond her will.
III. Behavioral Observation
Behavior during Interview
Initial interview was conducted on March 8, 2023. The client was a 29-year-old
medium-built adult female with fair-colored skin. She was wearing decent clothes and
wearing eyeglasses. She is spontaneous and consistent in answering the questions
regarding her personal experiences and thoughts throughout the interview. On the last
day of the interview she claimed that "Yung mga tanong mo ngayon, diyan mo tinitingnan
kung consistent ba yung sagot ko and malalaman kung may mali ba sa akin." Her
responses are appropriate and relevant.
Moreover, it was clear that the client had no flight of ideas. However, the patient
tends to be evasive as tries to change the topic and avoids answering sensitive issues
and concerns.Client ANC8 was portraying her ability as an HR as she observed and made
a comment on the appearance of my ear, which she stated that it was a square shape,
and she also commented on the structure of my earrings.
Behavior during Individual and Group Activities
Client ANC8's behavior during individual and group activities showed
competitiveness, enthusiasm, and an eagerness to win in any group activities and games
that were conducted by the facilitators. In every group activity, she shared her ideas and
encouraged the group to win. This portrays her competitiveness in which she does not
want to lose in any games. In the course of the Client's occupational therapy, it appears
that she is focused and works in her own way. Particularly in occupational therapy of
making a bracelet. She showed that she was a woman who is smart and insightful when
it came to this kind of matter. The client suggested a different move and style for this
particular activity. However, she still followed the instructions that were given by the
facilitators. In a movie review of Luca, she stated how astonishingly beautiful the film is.
She noted an inner thought that was portrayed in the movie in which she relates to herself
and overcomes that kind of situation. Furthermore, in individual activities such as journal
writing, music therapy, and book reading, she showed perseverance and used great
choice of words as she described the answers to all questions. Therefore, she always
tried and pushed her best to be the best, even in the simplest type of activities.
IV. Presenting Problem and Case Background
Current Situation
ANC8 has been staying at Villa Herzon for one month and is diagnosed with F31.
2 Bipolar Affective Disorder, Manic with Psychotic Symptoms. Client ANC8 was impatient
and tried her best to be discharged and become an outpatient immediately due to her
impending complaint on NLRC. Due to her eagerness to be discharged, an argument
arises with the assistant administrator of the center, which resulted in her irritability
because of the confrontation. The client also shows delusional behavior of being a perfect
career woman. She may also show a narcissistic personality disorder which results from
attention seeker behavior and the desire for admiration and validation of other people.
She was building a good image of herself but was different from reality. This may lead to
detachment from the actual event and neglecting the emotional disturbances. With
regards to the inquiry of the current diagnosis of the patient, she was in denial about her
condition as she claimed that “Hindi ako bipolar patient.” According to the patient, there
were auditory hallucinations during 2014-2015, which pushed her to do unwanted actions
such as harming other people. However, in the present, the patient stated that there are
no longer any auditory hallucinations which were also proven during the sessions.
Family History
The client has four siblings, two males and two females. She mentioned that she
has a step-sister and a brother who has Down syndrome condition. The client claimed
that she has a good relationship with his brother, and she loves him with all her heart and
is willing to do everything in order to protect him from all the pain that he may experience
in life. However, the client does not have a good relationship with her step-sister since
according to her, the step-sister was the reason why she is administered in the facility. In
the first interview conducted, the patient stated that she developed depression and mental
disability due to the loss of her grandfather and grandmother. Her father also died recently
last February 25, during the pandemic season. With that being said, her exposure and
encounter with death had been her problem up until the present. Furthermore, she
claimed that her mother had been taking an anti-depressant. These were all the
information that was gathered about her situation and condition, which is conclusive for
her condition and the mental illness that she possesses.
Educational and Social History
The client studied at San Juan Elementary and finished high school at E.
Rodriguez Vocational High School, located in Manila. ANC8 claimed that she was a
graduate of a prestigious university which was the Polytechnic University of the
Philippines. She took Human Resource Management, applied to some restaurants and
worked for over a month, and pursued her career as an HR assistant for years. However,
on the contrary, based on the information that was indicated from the chart, she was
unable to finish her college degree which resulted in distress and affected her well-being.
Due to her condition, she was in a denial phase and is delusional about her achievements
as a coping mechanism from the reality of becoming a failure. The client enlisted her
achievements such as in grade 2, she was an honor student, and in high school, she won
a medal in a competition of Math Quizbee; she also stated that she facilitated on DENR
and had a third place certification on Dessert Plating Competition during her college life.
Through this, it showed how competitive and important academic validation is to the
patient.
The social history of the client, based on the gathered information, was active even
though she was the type of person who claimed as an introvert. The client stated that she
was involved in the community and listed all the organizations that she had; the Legion
of Mary on San Juan and St. Baptist Church, and also Charita's Scholar. She also
included that she was a blood donor of the Red Cross. She had a good relationship with
her friends, specifically from the PUP, and had a best friend who lives in the United
Kingdom as a nurse. The client claimed that she needed to be discharged right away due
to her papers regarding the complaint about her previous work. Due to this, last March
23, 2023, the client had an argument with one of the staff of the facility. The client claimed
that the assistant director stated she was the one who was delusional about the NLRC
complaint. It was stated that she is the problem and the one who is on observation
regarding the complaint about this matter. As for this, the client stated that "ako nga yung
nag co-complain bakit ako yung irereklamo."
She shared that she only stayed for two months in jail and was accused of something that
she did. The client claimed that there was a false accusation of "malicious act and child
abuse." She stated that she did not do those things and claimed that it was a setup by
her relatives.
Substance Abuse History
The client claimed that she did not use any drugs as well as nicotine or cigarettes.
The only substance that the client took was alcoholic beverages which started during
college season due to peer pressure. ANC8 claimed that "I only drink whenever I want
and occasionally lang." The information about this matter is accurate as per no records
of any other substances induced from the chart of the patient.
Medical History
Client ANC8 was a regular outpatient from 2014- 2015; she was diagnosed with
schizophrenia at the National Center for Mental Health. She claimed that she was seeing
a psychologist for counseling at Las Piñas. The reason why she was admitted to the Villa
Herzon Center is not taking medications regularly. In fact, she admitted that she had no
idea about the medicines, which is why in the last interview session, the patient claimed
that there was changes in the medications, which were the lithium in the morning and the
Olanzapine in the evening. However, the client claimed that there were side effects as
she took medicine, which is "nangangatog ang katawan." With this, it shows awareness
and improvement when it comes to knowing her own medications while she was staying
at the Center.
V. Test Administered
House Tree Person Test HTPT March 17, 2023
Sack’s Sentence SSCT March 17, 2023
Completion Test
VI. Testing Behavior
The client was cooperative during the tests and showed interest in the activity. She
also followed the instructions properly and appropriately given by the facilitators. During
the house-tree-person test, the client was fully engaged in the activity and was asking
questions frequently to the facilitators on whether she was performing the activity correctly
and if the drawing she made was good. She was also able to finish this activity within the
given time. Another test was conducted with the patient called SCCT. In this test, the
patient answered the questions of the facilitators in English and was spontaneous with
her answers. And lastly, during this test, the patient did not ask the facilitators any
questions, unlike in the house-tree-person test.
VII. Interpretation of Test Results
I. SACK’S SENTENCE COMPLETION (English and Filipino)
SCCT RESULTS AND INTERPRETATION
ATTITUDE TOWARDS INTERPRETATION
FAMILY MILDLY DISTURBED
SEX UNKNOWN, INSUFFICIENT EVIDENCE
INTERPERSONAL MILDLY DISTURBED
SELF- CONCEPT SEVERELY DISTURBED
I. Attitudes towards mother o The patient was mildly disturbed
and has emotional conflicts in this
area but appears to handle them
without therapeutic aid.
II. Attitudes towards Father o The patient was mildly disturbed
and has emotional conflicts in this
area but appears to handle them
without therapeutic aid.
III. Attitudes towards family unit o The patient has no significant
disturbance coin in this area.
IV. Attitudes toward women o The patient was mildly disturbed
and has emotional conflicts in this
area but appears to handle them
without therapeutic aid.
V. Attitudes towards heterosexual o The patient has unknown and
relationships insufficient evidence.
VI. Attitudes toward friend and o The patient has unknown and
acquaintances insufficient evidence.
VII. Attitudes towards people supervised o The patient has no significant
disturbance coin in this area.
VIII. Attitudes towards supervisors at
work/school o The patient has no significant
disturbance coin in this area.
IX. Attitudes towards work/school o The patient was mildly disturbed
and has emotional conflicts in this
area but appears to handle them
without therapeutic aid.
X. Fear o The patient was mildly disturbed
and has emotional conflicts in this
area but appears to handle them
without therapeutic aid.
XI. Guilt Feelings o The patient was severely disturbed
and appears to require therapeutic
aid in handling emotional conflicts
in this area.
XII. Attitudes towards own abilities o The patient was mildly disturbed
and has emotional conflicts in this
area but appears to handle them
without therapeutic aid.
XIII. Attitudes towards past o The patient has unknown and
insufficient evidence.
XIV. Attitudes towards the future o The patient was mildly disturbed
and has emotional conflicts in this
area but appears to handle them
without therapeutic aid.
XV. Goals o The patient has no significant
disturbance coin in this area.
Based on the answer of Client ANC8 on the SCCT, Attitudes towards Mother,
Father, Women, Work/school, Fear, Own abilities, Future has the same result which was
mildly disturbed and has emotional conflicts in this area but appears to handle them
without therapeutic aid. It appears that the answer of the client to the question has
something such as in Attitudes towards future which she stated that “Someday, my
parents would be proud of myself coz I buy them plenty of house and lots.” Which may
conclude that the patient was having hard time proving herself to her parents. In addition,
the attitudes towards own abilities in item number 32 has a result of mildly disturbed due
to the client’s statement of greatest weakness is workaholic which may lead to a possibility
that her condition was due to the restlessness and over worked can cause harm to your
health and mental well-being especially if the workplace was toxic.
As for the Guilt Feelings it has a result of severely disturbed which was on item
number 30 and 60 it was indicated that her greatest mistake was to never try to passed
an job application again. And in item 60 which was stated that the worst thing she ever
did was nothing or do nothing. This appears that the patient was creating a perfect image
for herself and trying her best not to become a failure specifically about work. Which was
manifested by all the claims and statement that she stated in an interview session. Lastly,
there are insufficient evidences that occur as she answer the questions in the SCCT such
as attitudes towards heterosexual and others.
II. HOUSE-TREE-PERSON TEST
HTPT RESULTS AND INTERPRETATION
A. Frame of reference
1. Striving for achievement Present
2. Intellectual need Low
3. Acquisitive need Present
C. Security
1. Feeling of insecurity Present
2. Free Floating anxiety Present
3. Comprehension for inner feeling of Low
insecurity
4. Need for inner balance and security Low
D. Traits
2. Flexibility
B. Seeking gratification activities Present
F. Strength
2. Ability to handle personal relationship Absent
tactfully
3. Open sociability Present
I. Hostility and Aggression
2. Aggression Low
3. Poor organization of resources for Present
seeking satisfaction from environment
4. Hostility for sexual matter Unknown
N. Schizoid and Schizophrenic signs Present
O. Anxiety Present
On the client’s house-tree-person test, the Frame of reference the striving for
achievement is present and dependence of thinking as a satisfaction source college
students is low and a compensatory physical prowess, acquisitive need. On security, the
feeling of insecurity and excessive marked degree of anxiety usually free floating is
present, and also the comprehension for inner feeling of insecurity was low and its need
for inner balance. On Traits, the ability to change concepts drawn represents the subject’s
adaptable and flexible nature. On strength, the ability to handle personal relationship was
absent and open in sociability was present. The hostility and aggression it shows poor
organization of resources for seeking satisfaction from environment was present. Through
this test, it shows that schizoid may be present and Anxiety was present. The patient’s
has a feeling of inadequacy and dependency upon authority figure. This also include the
inferiority feelings and a low expressive of helplessness. It also appears the
characteristics as normal or healthy adult drawings of a person. Through this, it can be
seen that the patient’s drawing displays and exhibit signs of inferiority and jealousy which
may lead to irritability and minimal in socialization as she pushed herself to her limits and
with this it matches the statements that was from her during an individual interview
session.
VIII. Intervention
- Psychotherapy
- Cognitive therapy
- Social Engagement with other people
IX. Recommendation
Since the patient is in denial about her condition, it can be recommended that she
undergo Psychotherapy and Cognitive Behavioral Therapy (CBT). Because according to
the patient, “hindi ako bipolar patient.” That being said, undergoing to these therapies will
help the patient to understand and accept her current situation. It is also recommended
that the patient engage more in social activities in order to practice empathy toward other
people since she also shows narcissistic behavior. The patient also claimed that she was
not on good terms with the former co-workers and did not disclose any further information
about this matter. Lastly, a regular check-up with the psychiatrist and proper intake of
medications are necessary in order to improve her condition.
Prepared by:
Anh Nicole L. Bacud
Clinical Counsellor
