Early intervention crucial when someone starts acting strangely

Dr Kenny stepped out of his clinic room to take a deep breath.

It was uncommon for him to do that, but after talking to his patients’ relatives that evening, he felt something was wrong.

He had a long conversation with the nephew and brother of Encik Kamal regarding the latter’s abnormal behaviour for the past 40 years.

Yet, no one in the family had the instinct or thought to bring him to seek psychiatric care when it started.

They only sought help when Encik Kamal started walking around naked, urinating at every corner of the house, and wandering in their neighbourhood in the middle of the night until a neighbour brought him home.

“We knew something was off, but we thought we could still manage him at home,” Encik Kamal’s nephew told Dr Kenny.

“The way he talked to himself seemed as if he was conversing with someone we hadn’t seen since I was five. He leaves some of his food so the ‘person’ would finish it.”

The nephew said Encik Kamal was never aggressive at home.

“When our late grandmother was alive, they lived together. He helped her with house chores. My father, his younger brother, cared for him for five years following our grandmother’s passing.

“We rarely spoke to him as we could not engage in conversation. He always replied with something totally unrelated to the topic,” his nephew added.

Dr Kenny was thinking about formulating Encik Kamal’s possible diagnoses.

It was not easy, as there were tons of things to consider due to his advanced age. This included the medical causes, not just the possible causes related to purely psychiatric illness.

Was it delirium, as Encik Kamal was not himself recently?

Or was it a longstanding history of untreated Schizophrenia? His family members said Encik Kamal’s psychotic symptoms started in his 20s.

Dr Kenny was also aware that aberrant behaviour could be part of the behavioural and psychological symptoms of dementia.

Were there any structural changes in the brain that they didn’t know of, or any trauma Encik Kamal’s family were unaware of?

It was a challenge getting his personal history as Encik Kamal didn’t reply to any of Dr Kenny’s questions, and the one who lived with him throughout his life had already passed away.

The fact that Encik Kamal also didn’t have any history of medical illness and previous hospitalisations made the situation more perplexing as they didn’t have any baseline or record of any investigations.

Questions and more questions ran through Dr Kenny’s mind. He needed to update his consultant to aid in the treatment and management approach for Encik Kamal.

“May I know why the family members didn’t bring him earlier? You mentioned such behaviour had been going on for the past 40 years,” Dr Kenny asked Encik Kamal’s nephew.

“We didn’t know he needed psychiatric treatment, doctor. We thought if he was never aggressive, there is no need to bring him to seek help,” his nephew sighed.

Encik Kamal’s nephew added that their family also lived in remote areas, and the elders did not possess higher education unlike his generation.

“All my uncle’s siblings were housewives. He was the only son in the family,” his nephew explained further.

“We thought it was due to people sending bad spirits to harm him. We have gone to many places offering traditional healing services. We didn’t know we should bring him to the hospital or a clinic.”

Dr Kenny nodded his head a few times before replying.

“We will give our best in treating Encik Kamal, but I would like to inform his family that getting delayed treatment may affect the outcome. He might not be able to carry out his daily activities, but we will investigate before deciding how to manage him accordingly.

“Prevention is better than cure. Early intervention would have likely helped a lot,” Dr Kenny informed Encik Kamal’s nephew.

“I really wish we knew sooner about the help available, doctor. I really do. And I would like to thank you for treating our uncle, Dr Kenny,” Encik Kamal’s nephew promised, adding he would also be present for the subsequent appointments.

“Let’s move forward and work together for the sake of Encik Kamal’s health, shall we,” said Dr Kenny.

The views expressed here are the personal opinions of the writer and do not necessarily represent that of Twentytwo13.

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