GENERAL DATA Patient LA.ED., 27 years old, male, Filipino, Born again christian, born on Jan 06,1999, unemployed,currently residing in D-2 Pulpogan, consolacion, cebu city was seen for the first time in our institution on 27 July 2026. SOURCE AND RELIABILITY Mother: 80% CHIEF COMPLAINT SO: “Wala na siyay tarong huna-huna ug mahimong violent.” HISTORY OF PRESENT ILLNESS 10 months PTC, October 2025, the patient was reportedly living in Misamis Oriental with his wife and two children. According to his mother, the patient’s wife wanted a higher-paying job and asked permission to work in Cagayan. The patient initially agreed, believing she was only seeking employment. It was later discovered that she had developed a relationship with another man, resulting in their separation. The patient reportedly felt sad but continued to function without psychotic or behavioral symptoms. 9 months PTC, November 2025, the patient returned to Cebu with his two children. He did not disclose to his family the circumstances surrounding the separation nor his wife’s infidelity. His behavior reportedly remained normal. In the interim, mother claimed that patient would intermittently think about his wife. 1 week prior to consultation, the patient’s mother claimed that he became preoccupied with excessive thinking, appeared sad, complained of difficulty sleeping despite maintaining a good appetite, and began reporting hearing whispering voices. He was observed talking to himself, shouting statements such as “Makamove on ra lage ko” and “Ayaw lage mog panago.” His mother denied any suicidal or homicidal ideation. Four days prior to consultation, the patient reportedly took a neighbor’s motorcycle without permission and drove around until he reached Compostela. He was later apprehended because the motorcycle was newly acquired and unregistered. The patient reportedly walked from Compostela back to Mandaue. Following this incident, his mother noted worsening disorganized behavior, persistent self-talking, and continued auditory hallucinations. On the day of consultation, the patient reportedly picked up a hanger and challenged his step-father by saying “Ali diri, duol-duol,” while holding it in a threatening manner. Because of persistent hallucinations, behavioral changes, and increasingly aggressive behavior, he was brought to VSMMC-CMU for psychiatric evaluation. PAST PSYCHIATRIC HISTORY The patient had no previous psychiatric consultation, hospitalization, psychotherapy, or psychiatric medication use. The mother denied any history of suicidal ideation, suicide attempts, homicidal ideation, thoughts of harming others, or self-injurious behavior. She reported one recent episode of threatening behavior toward his father using a hanger. SUBSTANCE USE HISTORY The patient reportedly drinks alcohol occasionally during social gatherings. According to his mother, she began suspecting possible illicit drug use around December 2025 because she observed that the patient stayed awake at night, appeared unusually energetic, and had a wide-eyed staring look. The mother noted that these observations were reportedly present until approximately June 2026. However, the patient never admitted to using illicit drugs, and he was never caught using any substances. He denied cigarette smoking and vaping. He occasionally plays online scatter games. During periods of stress, he reportedly experiences decreased appetite and may eat only once daily. No caffeine or tea intake was reported. PAST MEDICAL HISTORY Childhood The patient reportedly completed his childhood immunizations and had no significant childhood illnesses. Adulthood His mother was unaware of any chronic medical illnesses. Patient underwent an appendectomy in October 2025, Eversley hospital. There was no history of seizures, stroke, traumatic brain injury, or other neurologic illness. According to mother, patient has no food and drug allergies and reportedly completed COVID-19 vaccination. FAMILY HISTORY Patient‘s mother is a 45-year-old housewife with hypertension maintained on Losartan 50 mg once daily. His father is a 52-year-old welder without known medical illness. The family denied any psychiatric illness, suicide, substance use disorders, or history of abuse among immediate relatives. There is a family history of hypertension on the maternal side. The patient is the eldest of six siblings, all reportedly healthy. According to the mother, family relationships are generally good, with only occasional marital misunderstandings between the parents that are usually resolved. DEVELOPMENTAL AND SOCIAL HISTORY Prenatal, Natal, and Postnatal History: According to the patient’s mother, she was 18 years old during pregnancy (G1P1). The pregnancy was unplanned but uncomplicated. The patient was delivered via normal spontaneous vaginal delivery at term without complications. There was no reported prenatal exposure to alcohol, illicit drugs, trauma, abuse, or neglect. The mother had no history of medical or psychiatric disorders during pregnancy or childbirth. Early Childhood (0–3 years): The patient’s primary caregiver was his mother, a housewife, while his father worked as a welder.Developmental milestones were reportedly attained at appropriate ages. He was exclusively breastfed for one year before complementary feeding was introduced. The mother denied any developmental concerns, tantrums, head banging, hand flapping, anxiety symptoms, or other unusual childhood behaviors. He had no illness or hospitalizations early in childhood. He was completely vaccinated. Middle Childhood (3–11 years): The patient started school at 6 years old . He reportedly stopped schooling during Grade 3 after the death of his grandmother, to whom he was very close, resulting in loss of motivation to attend school . He later resumed his education. He denied bullying, substance exposure, physical or sexual abuse, and learning difficulties. He reportedly maintained good relationships in school and had adequate family support. Later childhood to Adolescence (12 year or 18 year): Patient completed his high school through the Alternative Learning System (ALS). The patient reportedly had good academic performance and relationships with peers and teachers during high school without behavioral problems, bullying, or substance exposure. After graduating from high school, he immediately worked as a welder in Mindanao. Adulthood The patient worked as a welder in Mindanao, where he met his future wife. They eventually married and had two children. According to his mother, their relationship was initially stable but later became strained due to financial difficulties. His wife reportedly wanted him to earn more money and eventually left for Cagayan under the pretext of seeking employment, later entering a relationship with another man. Following their separation, the patient returned to Cebu with his children. Over the succeeding months, he gradually developed insomnia, social withdrawal, auditory hallucinations, disorganized behavior, and aggressive behavior, ultimately prompting psychiatric consultation. MENTAL STATUS EXAMINATION Patient appears lethargic. Patient claims okay rako but affect is blunted, soft voice with low volume. Patient was not oriented to person place and time. Further MSE was not obtained due to patient being uncooperative. Patient won’t answer questions PHYSICAL EXAMINATION BP: 140/90 mmHg RR: 21 cpm TEMP: 36.1 C HR: 98 bpm O2 sat: 99% at RA Ht: 164 cm Wt: 55 kg BMI: 20.4 kg/m2 PRIMARY IMPRESSION Methamphetamine induced psychotic disorder T/C Methamphetamine use disorder, severe DIFFERENTIAL DIAGNOSIS Please make your own PLAN PHARMACOTHERAPY: Haloperidol 5mg + Diphen 50mg as cocktail 1:1 now Olanzapine 10mg/tab, 1 tab ODHS NON-PHARMACOLOGICAL: Supportive therapy Psycoeducation Differential diagnosis