sahabatku

  Dulunya seorang yang pendiam,tidak ramai kawan yang mengenalinya.Dek kerana bosan serta jemu dengan kehidupannya sebegitu lalu dipohonnya kepada sang pencipta" Ya Allah yang maha pemurah lagi penyanyang,berilah aku rezeki untuk berkawan,berikanlah rezeki untuk aku bersahabat".Tidak putus-putus doanya kepada sang penciptanya tanda kemahuannya yang begitu mendalam sekali, alhamdulillah maka diperkenankan doanya itu,tidak putus-putus sahabat mahu mengenalinya,kalau dulunya berseorangan kini berteman,tiadalah apa yang diucapkannya selain terus-menerus bersyukur kepada sang penciptanya.Dirasakan tuhan begitu baik sekali terhadapnya,bergenang airmatanya terkenang ada manusia yang ingin bersahabat dengannya.kalau dulu dia berduka,kini hatinya tidak henti-henti dihiburkan oleh sahabatnya,kalau dulu tiada siapa yang ambil kisah tentang dirinya,kini dirinya selalu disapa oleh teman-teman baiknya.Tidak sanggup dilukakan hati sahabat-sahabatnya kerna terlalu sayangkan rezeki yang diberi dari tuhannya, dari temannya dia pelajari erti tanggung-jawab,dari temannya juga dia pelajari erti kasih-sayang, dan dari temannya jugalah dia memahami erti persahabatan."Ya Allah terima kasih diatas rezekimu ini, dan aku mohon izinmu agar tidak diambil nikmat ini dariku"

      Gunakanlah segala apa yang ada dibadanmu dan segala apa yang ada disekelilingmu untuk menambahkan pahala mu disisi Allah s.w.t.
   

pengajaran buatku

     Alhamdulillah lega rasanya, kalau kepala ni boleh diselam didalam tanah,sudah lama diselam bagi menutup malu yang tak terhingga rasanya, berlebih-lebihan didalam satu perkara sehingga hilang ketenangan didalam ibadat mu, kemana perginya keseronokanmu ketika membaca al-quran,kemana keseronokanmu ketika membaca mathurat,kemana keseronokanmu ketika memnelaah buku-buku perubatan,sudah tidak kedengaran lagi siri-siri kuliah pengajian kitab didalam bilikmu,kemana perginya ketenanganmu ketika solat disepertiga malam, kalau dulu air matamu sentiasa membasahi tikar sejadah tetapi sekarang tiada lagi.berani kamu meletakkan sesuatu lebih tinggi dari cinta Allah, tak tahu malukah, nikmat yang diperolehi setiap saat, kemana pergi kesyukuran mu. Bangkitlah,bangkitlah,bangkitlah,dan tempuhlah semuanya dengan hati yang penuh bersemangat.Jangan diulangi kesilapan yang sama lagi,jangan diulangi kesalahan yang sama lagi.Tak sanggup rasanya nak menanggung malu dihadapan manusia serta lebih-lebih lagi dihadapan Allah s.w.t.(aku minta maaf ya Allah)

Menangis Takutkan Allah 2

   
       Neraka merupakan tempat dimana Allah s.w.t mengazab hamba-hambanya yang berbuat dosa. Diceritakan bahawa setiap kali api menyambar kulit serta daging mereka maka bergugurlah ia dari tulang sehingga mereka berubah menjadi makhluk yang sangat hodoh. Bibir bahagian atas akan menjulur hingga ke leher manakala bibir dibahgian bawah akan menjulur sehingga ke pusat. Nauzubillah!. Tubuh-tubuh ahli neraka akan dibesarkan seperti mana didalam hadis al-tirmizi daripada abu Hurairah, Rasulullah s.a.w bersabda:"gigi geraham seorang kafir pada hari kiamat sebesar gunung uhud,pahanya sebesar gunung al-Baida dan tempat duduk di neraka seluas perjalanan tiga hari ke al-rabazah. Tubuh mereka sengaja dibesarkan supaya azab yang ditanggung menjadi lebih pedih. Bagi orang kafir tiadalah jalan keluar mereka dari neraka itu, jeritan serta tangisan mereka tiada hentinya. Maka banyak-banyakkan lah bersyukur kita kepada Allah kerana diberi nikmat iman dan islam, mudah-mudahan ia menjadi perisai kita dihari kiamat. Maka berbuatlah bermacam-macam kebajikan tidak kira kecil(memberi sedekah senyum kepada sahabat) mahupun besar(keluar berjihad dijalan Allah). Mudah-mudahan ia dapat menyelamatkan kita dari azab Allah s.w.t yang maha dasyat.

bipolar mood disorder

A 35 years old male is brought in by his family because has been taking out various loan to start a few small business.Over the past 2 weeks,he come home at 3 a.m from work and leaves at 6 a.m. He often compares his business venture to those of bill gates. In the past he has had a few episode in which he felt hopeless and tried to commit suicide.

1) what is your provisional diagnosis
    - bipolar 1 disorder
2) list out 3 psychopathology that you see in this patient
    - decrease need of sleep
    - increase in goal directed activity
    - inflated self estemm
    DSM-IV criteria to diagnose bipolar 1 disorder
    - period of abnormal and persistently elevated,expansive,and irritable mood at least
      1 weeks, including at least 3 of this symptoms :
      - inflated self esteem and grandiosity
      - distractibility
      - talkative and pressure of speech
      - increase in goal directed activity
      - decrease need of sleep
      - excessive involvement in pleasurable activity
      - flight of idea
3) list 2 differential diagnosis for this patient
    - major depressive disorder
    - bipolar 1 disorder secondary to medication or substance use
      (somatic antidepressan,ECT,light therapy can cause manic)
4) principle of management for this patient
    - admit patient to the ward
    - pharmacotherapy
      - lithium,valproic acid, and carbamazepine(mood stabilizer)
      - a typical antipsychotic(olanzapine)
    - psychotherapy
      - supportive psychotherapy(onset of lithium is about 5-7 days)
      - family therapy(he may view differently after have psychopathology,must reduce the conflict and
        must help all family members understand each other)
      - group therapy(patient may gain insight into their own condition by listening to other)

Menangis Takutkan Allah

         "Tidak masuk neraka laki-laki yang menangis takutkan Allah s.w.t bandingannya seperti susu tidak boleh ke dalam kantung susunya semula". Didalam kitab Bahrul Al-Madzi,ulama menerangkan untuk menimbulkan rasa takut kita,rasa gerun kita terhadap Allah s.w.t adalah dengan beberapa cara. Antaranya ialah dengan cara kita mengetahui azab-azab serta  memikirkan kebesaan Allah s.w.t. Sekiranya kedua-dua elemen ini digabungkan serta dicanaikan didalam hati setiap hamba-hamba Allah s.w.t serta dipaterikan bersama sembahyang di sepertiga malam,insyaallah hatinya akan mudah lembut.Kita akan dapat lihat,bilamana dia sembahyang ataupun mendengar ayat-ayat al-quran,hatinya akan mudah sangat tersentuh dan sampai suatu tahap,air matanya akan mengurai membasahi pipi. Selain itu ulama juga mengajar bagaimana untuk memikirkan kebesaran Allah s.w.t didalam setiap benda yang diciptakannya dimuka bumi ini, ia adalah dengan cara berfikir berlapis-lapis. Sebagai contoh kucing,kucing amat percaya akan rezekinya,berbekalkan mulut,tangan,serta kaki dia bangun subuh-subuh pergi mencari rezeki Allah s.w.t. Didalam tong sampah,didalam longkang, takpun meminta kepada manusia,dia percaya kalau dia berusaha dengan nikmat yang Allah beri,dia pasti akan dapat rezekinya.hebat tak kucing,kekuatan aqidah yang ada padanya,tersangat hebat. ini merupakan tanda-tanda kebesaran Allah s.w.t yang wajar manusia ambik iktibar darinya.

panic disorder

A 22 years old single female without past medical or psychiatric case presented to A/E complaining of a 3 years history of episodic anxiety,increasing over the last 6 month. she describe the anxiety episode as a sudden episode of anxiety, dizziness, abdominal distress, and fear of losing control, which would self resolve after 5-10 minute.The anxiety attack occurred 2-3 times per weeks.The women denies noting any specific triggers for her anxiety.She also worried about having any additional attack and fear being outside alone.

1) what is the most likely diagnosis for this patient
    - panic disorder with agoraphobia

2) list 4 other related symptoms that would further support your diagnosis above
    - ask about it is she has :
      - palpitation
      - nausea,numbness(paraesthesia)
      - intense fear of dying or being crazy
      - choking,chest pain,chills
      - flushing,SOB,sweating,shaking
      - depersonalization,derealization

3) In relation to her anxiety symptoms give 2 differential diagnosis
    - substance induce anxiety disorder (amphetamine,caffaine,alcohol)
    - anxiety disorder secondary to general medical condition (hyperthyroidism,anemia,hypoglycemia)

4) Give principle management for this patient
    acute initial treatment of anxiety
    - give benzodiazepin and dose should tapered as treatment with SSRI is started
    - give paroxetin(paxil) and setraline(zoloft) for maintenance treatment and continue for 8-12 month
    - insight oriented psychotherapy
    - family therapy
    - cognitive therapy(identify and decrease the irrational thought that reinforce panic attack)
    - behavioral therapy(flooding and implosion)
    - supportive psychotherapy(listening,ventilation,explanation,advice,reassurance,suggestion)

major depressive disorder

28 years old female teachers was brought to hospital presented with low mood for the past 1 month. All this happen after her father was died due to motor vehicle accident. She said that she had daily crying spell, felt sad all the time, and also had difficulty sleep at the night. she also said that her father died because of her fault and she try fix the mistake by hanging her self. She claimed that she cannot teach her student because of poor concentration in class and her relationship with her husband also become very bad.

1) describe 4 type of psychopathology seen in this patient
    - low mood
    - insomnia
    - suicidal attempt
    - poor concentration

2) what is your provisional diagnosis
    - major depressive disorder

3) give 2 differential diagnosis for this patient
    - substance abuse(alcohol abuse)
    - schizoaffective disorder
    - post-psychotic depression(depression following the treatment of psychotic symptoms)

4) what other information would you like to have which be useful in making diagnosis
    - ask about is it she had loss interest in all activity that she like to do(anhedonia)
    - ask about weight loss,weight gain
    - ask about decrease or increase appetite
    - ask about that she have any restlessness(psychomotor agitation),slowed down(psychomotor retardation)
    - ask about loss of energy
    - ask about feeling worthlessness
      *all symptoms occur nearly everyday

5) give principle management for this patient
    - admit patient to the psychiatric ward(suicide,homicide,deliberate self-harm)
    - give anti depressant for example SSRI(fluvoxamine,fluoxetine,ecitalopram)
    - give behavioral therapy, supportive psychotherapy, family therapy
    - if patient have high suicidal risk give ECT

schizophrenia

     A 28 years old clerk was brought to hospital by her friends after being unable to function at place of work for the past 6 months. she had accused some of her office mate of spreading malicious rumors about her having an affair with the head of department. she claimed that the head of department had fallen in love with her, despite her having little interest in him. This was strongly denied by the head as well as other worker. She complained that her lover would send secret messages to her through sound wave which disturb her concentration. She also claimed that, as result of his affair, she was six month pregnant and cold feel active fetal movement. She also felt that her emotion were no longer under her control, making her moody and aggressive. At times, she felt that all her thought could be heard by others, as farway as China

1) describe 5 type of psychopathology seen in this patient
     - persecutory delusion
     - erotomanic delusion
     - thought insertion
     - somatic hallucination
     - somatic delusion
     - thought broadcasting
     - passivity phenomena
schneider's first rank symptoms
     - 3rd person halucination
     - running commentary hallucination
     - somatic hallucination
     - thought eco
     - delusional perception
     - thought insertion,broadcasting,withdrawal
     - passivity phenomena
2) what is your provisional diagnosis
     - paranoid schizophrenia
3) what other information would you like to have which will be useful in making your diagnosis
    - asked about hearing thought spoken aloud
    - asked about hearing any voice and how many voice she heard
    - asked her it is voice in the form of commentary
    - asked about is it her take any medication or subtance
    - asked about is it she have any medical illness
4) 2 type of medication useful in the treatment of this patient
    - typical and atypical antipsychotic medication to treat her psychotic symptoms
5) give 2 diffrential diagnosis
    - substance induce psychotic disorder
    - psychotic disorder due to general medical condition