Psychology Case Record

UNDIFFERENTIATED SCHIZOPHRENIA: Mrs. M. was apparently normal 1½ years back, she was staying in her home, and carrying out her routine work. Her family members noticed that gradually she becomes dull and withdrawn and preoccupied, she started avoiding to interact with family members and in work place. And also she was found to be talking and laughing to herself. She would sit alone near the tree and would talk to herself. For which if she was questioned she would not reply anything. Her sleep is disturbed they noticed the frequent awakenings is night, she most of the time, she was found to be talking to herself in the night, she would spend most of the time alone not interacting with others. She stopped going for work. Not showing interest in doing house hold work and not maintaining herself. She would not show interest in taking care of her husband who was ill for past 2-3 yrs. 2 months later the family members have brought her to magico religious treatment. But the symptoms persisted. Her husband became very sick and hospitalised. But she did not visit him atleast once, though her husband wished to meet her in the terminal stage of illness. Her children forced her to meet him, but she refused, she didn't give any reason for that. Her husband Mr. Elumalai died in August 2009. Due to alcoholic liver disease. The day of her husband's death she did not worry about it, she did not show the normal emotional response for the death. She refused to participate in the formalities in the death ceremony. She did not interact with any relatives who visited the ceremony. She was found preoccupied and talking to herself. 16th day of death ceremony she thrown her husband's photo into the well and shouted that person is not her husband. PARANOID SCHIZOPHRENIA: Patient was apparently normal about 1½ years back living with his parents working as salesman in a private company and having good interpersonal relationship. Once he had a fight with people in a neighbourhood house regarding disposal of sewage which resulted in physical assault. The neighbour had threatened that he had political influence and would harm him. From then on the patient started expressing fear that the neighbor would harm him. Next day he and apologized to the neighbour and the issue was resolved by talks and the neighbour also apologized in return. But the patient was not convinced and he started saying that the neighbor was still trying to harm him. He used to tell that the neighbor is making gestures to several people indicating that he should be followed. The patient used to tell that wherever he went he was being followed by people set up by the neighbor to follow him and to report his activities. He started saying that he could hear voices of several unknown males and that of his neighbor discussing among themselves the different ways to harm him. He didn’t leave his room claiming that he would harmed and discontinued going to work. Gradually he started to bath and change his clothes less frequently about once in 2 to 3 days. He used to remain preoccupied and at times start shouting that people are coming to harm him and beg his parents to save him from them. He slept only about 4 to 5 hours in a day pacing inside the room or sitting in a place preoccupied. After one year of such behavioural disturbance he was taken to private psychiatrist and treated with tab.Risperidone 2 mg 1-0-2, tab.Benzhexol 2 mg 1-0-1 and tab.Diazepam 5 mg 0-0-2.With treatment his suspiciousness, hearing voices,sleep and self care improved within 6 to 7 months. He discontinued the drugs claiming that he was feeling tired and drowsy always. He didn’t go for work. For the past 6 months it was noticed that he was frequently washing his hands and on enquiry the patient explained that he felt when he touched certain articles in bathroom whether he would get the germs present in the objects. Gradually he started to wash his hands for about 10 to 15 minutes every time he touched any object in the house. He used to spend about 7 to 8 hours in a day involved in washing. For past 1 month he started saying that the neighbor was incorporating the germs in the objects so that he would be affected by life threatening illness. He started saying that the neighbor was coming to know of all his thoughts through by some unknown mechanism and gesturing at him in a mocking way. His sleep and self care also reduced. He was brought to IMH for treatment. No history of persistent sad mood / crying spells / suicidal ideas. No history of elated mood / excessive spending / tall claims. No history of substance abuse. BIPOLAR AFFECTIVE DISORDERMANIA WITH PSYCHOTIC FEATURES: Patient was apparently normal about 6 months back living with her daughter and having good interpersonal relationship. When it was noticed by the informant that the patient was talking excessively than before even with unknown people about various issues like politics, religions and that she had visited several foreign places. When enquired why she was telling lies she would laugh and say that she was simply playing with others. Gradually she started becoming easily irritated and would demand that she wanted several varieties of food to eat and that everyone should watch the TV programs that she wanted to watch. She would demand money about 1,000 to 2,000 rupees daily saying that she wanted to eat in hotels. She slept only for 2 to 3 hours in night and would spend the remaining time in watching TV in loud volume and sing songs. She started saying that she was the creator of the world and that she can destroy it in a second if she gets angry. She started saying that because of her powers some bad people were trying to kill her and continue with their bad works. As she started to assault others claiming that they were coming to harm her she was brought for treatment about 1 month back and started on T.sodium valproate 200 mg 2-2-2,T.Risperidone 2 mg 1-0-1 and T.Diazepam 5 mg 0-0-2. With treatment her symptoms has reduced in intensity. No history of sad mood / crying spells / suicidal ideas / suicidal gestures. No history of hearing voices / seeing images. No history of thoughts being known to others / being controlled by others. No history of substance use. No history of fever / head injury / seizures. MENTAL SUBNORMALITY ADJUSTMENT DISORDER: Mr. V 18 years old by apparently normal 3 years back. He started consuming alcohol introduced by his friends while he failed 10th standard. He started with 150 ml beer and developed tolerance upto 1800 – 2400 ml. He stopped alcohol for 2 months due to headache and vomiting. To overcome these affects he started smoking cigarate excessively. He had an affair with a girl, he was fully preoccupaid about her, he used to think about her atleast 20 hours in a day. So he could not able to concentrate in his study. He failed in +2. He was troubled by the girls brother, who apposed their love. Each of them fought. Issue was taken to police station. Past one year his parents noticed he has disturbed sleep, he falls in sleep around 2.30 a.m. slept for 4 hours. He was unable to concentrate in his studies. He keeps on think about her parents arguments. He could not go to sleep whole the night. His parents reported that he becomes disobedient not returning home in time. And spends all the time with his friends. He roaming purposeless. If they ask about him. He become irritable and abusing. He has runout from house twice in the past two years. Whenever he was scolded by his parents. He would become irritable and restless and make injurius in his body, like burning his arm, making cutting with sharp instruments. No H/O head injury/ LOC/ ENT Bleeding. No history of lauging to self / talking to self. No H/O crying spells. No H/O inflated self esteem. No H/O social problem. No H/O debts. Legal complication + No history of suicidal, ideation are attempt. No H/O of thought insertion / withdrawal and broadcasting. Nil Medical and Psychatric History. CHRONIC SCHIZOPHRENIA: Mr. G was apparently normal 20 years back. He has completed +2 after 4 attempts. He joint typewriting (lower) at the time he was dull and withdrawn. He was laughing to self at times. When question he was evasive. He showed lake of interest in his work. He was very lethargic. Considering his poor scholastic performance, his parents did not force him to pursue his studies further. He remained at home and spent his time watching TV. He begans to express suspicious ideas that somebody is watching him. Observing his actions. He began to talk to self. His father them took him is a neurologist and was giving him T. Hexidol tds for 2 years on the advise of neurologist. Then he stopped taking medications for the past 15 years. 2 years back he became very dull. He became poorly communicative. He did not interact with other family members. He had to be forced to take bath and to maintain her personal hygient when he is not forced, he would stay the same and would remain unclean 6 months before her father on the advice of one of his friends to him to SCARF foundation. He was receiving the drugs, he involves himself in some work has adequate sleep. He has been brought by his father to IMH to transfer his mother pension to him so that it would help him in future. No H/O suicidal attempts / crying to self. No H/O seizures. No H/O head injury. No H/O infection

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