Brother: “ Want to get Neuropsychiatric evaluation for insurance claim” HISTORY OF PRESENT ILLNESS Patient is known case of Intelligent disability, moderate. The patient is an adopted female who was brought for psychiatric evaluation due to longstanding cognitive and adaptive functioning difficulties. According to her caregiver, developmental concerns became evident during early childhood. Her cognitive limitations continue to affect her daily functioning. She is unable to go to the market independently, manage money, or perform more complex household tasks. The patient prefers routines and becomes anxious or upset when promises made to her are not fulfilled. She was brought for consultation because she requires a government-certified neuropsychiatric evaluation stating her illness to support her insurance claim for financial assistance with her living expenses. Her brother accompanied her to the Vicente Sotto Memorial Medical Center – Center for Behavioral Sciences Outpatient Department (VSMMC-CBS OPD) for her first consultation on July 15, 2026. PAST PSYCHIATRIC HISTORY The Patient at the age of 7 she had her psychiatric consult for delayed cognitive development. She had noticed to have IQ of 3 year old at the age of 7. No Psychotropic medications had been taken. Patient had no history of suicidal or homicidal thoughts process in the past. SUBSTANCE USE/ ABUSE HISTORY Patient is non smoker, non alcoholic beverage drinker and no history of any known illicit drug. No abuse or bullying has been noted. No history of suicidal/homicidal thought noted. PAST MEDICAL HISTORY Patients denied previous Hospitalization or surgeries. The patient denied any chronic illness or taking maintenance medication. The patient has no hypertension, diabetes mellitus, bronchial asthma, thyroid or cancer issues. No drug or food allergies noted. FAMILY HISTORY The patient is the adopted daughter of her current parents. She has three biological siblings, who are also reported to have psychiatric or developmental conditions. She has four adopted brothers. Her family has not disclosed to her that she is adopted. Her biological parents are relatives of her adoptive family. The patient currently lives with her adoptive mother, her eldest brother, his wife, and their two children. Her adoptive father died in 2026 due to liver cirrhosis. According to her brother, the patient has a good relationship with all family members. A family history of hypertension and diabetes mellitus is present. DEVELOPMENTAL AND SOCIAL HISTORY Prenatal, Natal, and Postnatal History: Since the patient had been adopted her brother doesn't knew the mode of delivery and other parts of prenatal, natal and postnatal history. Early Childhood (0–3 years): The Primary Care giver for the patient was his mother. She had been adopted at the age of 3 months old. As all her adopted siblings are boys. The brother claims that she had been given formula milk. All her developmental milestones were on par started walking at the age of 3, could able to ride tricycle but had difficulty in speech. Middle Childhood (3–11 years): Her mother is the primary care taker. She started speaking at the age 4( like Mama, Papa). She was enrolled in Regular nursery academy Guimaras province. There she had been noticed to be different from other children. Always she requires additional care from the teachers. And had difficulty in learning and coping up with her grades. At the age of 9, the patient had stopped from going school. Later entrolled in SPED schools. Started writing at the age of 6. Brother claims that the patient get aggressive whenever she gets angry or if they forget to do what they had promised. Later childhood to Adulthood During her SPED schooling days, Patient had learnt how to cook ( boiling egg), painting and coloring she is good at this. She had her 1st menstrual period at the age of 13, patient had difficulty in changing in her napkins not knowing what is happening to her body. Later she had been taught by her mother slowing later she can able to do. She has difficulty in taking complex things to her mind. She couldn't go to store and get proper change. Brother claims she can only add single digit with another single digit. Has difficulty in adding up two digits. She has no friends. Patient uses her mobile phone allot and watch youtube videos. She is interested in singing KPOP songs and zumba. Patient’s brother claims she wasn't neither sad nor happy when she lost her father. She could understand his absence amd cause of death MENTAL STATUS EXAMINATION The patient is awake, alert, and cooperative throughout the interview. She is fairly groomed and dressed appropriately for her age. She maintains good eye contact. Her speech is slow, with decreased fluency and unclear articulation at times, but is relevant and coherent. She is aware of her surroundings and is oriented to person, place, but not time.Her mood is euthymic with a congruent and appropriate affect. There is no evidence of auditory or visual hallucinations, delusions, or other perceptual disturbances. Thought process is generally goal-directed but concrete, with no loosening of associations or flight of ideas. Thought content is unremarkable, with no suicidal or homicidal ideation. Attention and concentration are impaired. She is able to spell "DOG" forward but is unable to spell it backward. Immediate memory is intact, while recent and remote memory are grossly intact. Fund of knowledge is below that expected for her chronological age. She demonstrates impaired calculation, as she is unable to perform simple subtraction. Abstract thinking is impaired, and her responses are predominantly concrete. Judgment is impaired in practical situations, particularly regarding money management and independent activities of daily living. Insight is poor. PHYSICAL EXAMINATION BP: 120/80 mmHg RR: 20 cpm TEMP: 36.9 C HR: 97 bpm manually O2 sat: 99% at RA Ht: 156 cm Wt: 67 kg BMI: 27.5 kg/m2 (overweight) PRIMARY IMPRESSION Intellectual Disability, Moderate 3 best differential diagnosis according to dsm 5 TR and rule in and ruke out