EMOTIONALLY UNSTABLE PERSONALITY:
Patient was apparently normal till 11 yrs of age with mild hard of hearing. Around that age he stopped going to school due to financial problem &started to go to work. He maintained well with family members and others without any significant behavioural problems. At that time, once his uncle commented about his hearing impairment in front of others, which made him very much irritated; he left that place immediately. Even after reaching home, he continued to have extreme irritability and restless following which around 12.00 am at night. He went to his uncle’s place by walk which was 5kms away and assaulted him. His uncle sustained severe injury. He ran back to home as the neighbours and others rushed to the place seeing the incident. After this as they were relatives , they didn’t make much issue about that incident.
For the next 1 yr he started working as an unskilled labourer in his own village. He used to have a occasional anger outburst leading to quarrel in his work place and in his family circle either for trivial reason or if his hearing impairment being criticised by others.
Later, at 13 yrs of age, he came to Chennai with his elder brother and started working as an unskilled labourer in constructional work. He stayed along with his brother and other co-worker. At that time he was introduced to brandy by his friends, he used to consume about <90ml, once in 10-15 days.
By the end of April 2011, he was brought to IMH with c/o. Irritability, excessive anger outburst, binge drinking and increased sexual thought. From past 2months, he is not going for work telling he is sick and he is on regular treatment since then. He is on T.sertraline50mg110, T.Diazepam5mg001at present.
No h/o. Hearing voices/ seeing images.
No h/o. Pervasive low mood/ suicidal ideas/ suicidal attempt
No h/o. Violation of rules.
No h/o. Head injury/ Fever/ seizure/ loss of consciousness.
No h/o. Haematemesis/ malaena
No h/o. Withdrawal symptoms.
PERSISTANT DELUSIONAL DISORDER, SOMATIC TYPE WITH MODERATE DEPRESSIVE EPISODE:
Patient was apparently normal 2years back. He was working as a painter, regular to work. He was living alone as his parents expired and his sisters are married.
He noticed that his body weight is increasing gradually and he also noticed that his breasts are increasing in size gradually, after he noticed these changes he felt that his body is developing feminine features and slowly he is becoming a female.
He also felt that his body is becoming softer comparatively it was hard before. He felt his abdomen increasing in size and becoming softer as females, he feels even if abdomen size is increased in males it will be hard and not soft as females.
He also noticed that he is losing hair from his moustache, he has reduced his frequency of shaving his beard as it takes around 20 days to re grow and previously it grew within a week. He also felt he is losing hair from other parts of his body like chest, legs and arms. All these features made him think that he is acquiring female characteristics and day by day he is changing into a female gradually.
Following this he consulted sexologist in Chennai, he was told that till his 58 years of age his hormones might change and he has chances of converting in to female. He was advised blood investigations and asked to come back.
2 months back he again approached another astrologist and performed some rituals which didn’t improve his symptoms. He was advised by one of his friends to consult in IMH. So he came here.
No h/o. Hearing voices.
No h/o. Thought broadcasting/ withdrawal/ insertion/ echo.
No h/o. Excessive happiness/ fear/ anxiety.
H/o. Fall from ladder 6 months back, there was no loss of consciousness or any injuries. He consulted a doctor and was treated symptomatically for his pain.
No ENT bleed.
No h/o. Seizures.
No h/o. Recurrent thoughts or acts.
PERVASIVE DEVELEPMENTAL DISORDER WITH SEIZURE DISORDER:
Master Y ,10 years old male child second born for a 3rd consanguineous parents with history of mother taking abortifacient in the form of two tablets for three days at the 40th (11/2 month) of LMP, as she thought that her husband will not be able to give proper (financial) care for that pregnancy. He already had not given proper financial care for her even before the pregnancy.
During the same period she developed dental pain and she consulted private dentist. The dentist advised tooth extraction, but hesitated to do it because of her pregnancy and explained the possibility of abortion. She took the risk of abortion willingly and proceeded with extraction with the same dentist as she expected an abortion after tooth extraction and did not do so.
Then she consulted gynaecologist for termination of pregnancy. She went to the operation theatre as per the advice of the gynaecologist for D&C. As she was being prepared in the theatre and when she saw the instruments, became afraid and ran out the theatre then out of the hospital.
She went to her mother’s home, the pregnancy continued uneventfully. She delivered a male baby FTND in hospital without perinatal complications. After the baby was delivered with deformed Right pinna as like that his maternal Grand father. Cried soon after birth. Breast fed on the day of birth. Baby birth weight 3.2 kgs.
Even in the ward used to be hyper activity restless, not listening to ward staff and doctors, not co-operating to interview frequent running out the room. He used to carry wire basket with water bottle in it throught day and during night even when he is sleeping.
No h/o. Recurrant high fever.
No h/o. Projectile vomiting.
No h/o. Head injury with LOC.
No h/o. Jaundice.
No h/o. Unedible object eating.
DEPRESSIVE EPISODE:
Mrs. M was apparently normal 5 years back. She started to experience headache on both side occur in the temple region, and expanding to all over the scalp. It was mild in severity and was static throughout the day without obvious precipitating factor. She after experiences burning sensation over the palm and feet at times. As the headache was continuous, consulted general practitioner,
advised spectacles which didn’t follow.
She continued to live with headache and maintained self and family and starting from 7 months back, she heard some unknown male voices calling her by name at night during sleep. She would wake up and search for them in house. At times she would feel calling with gestures by their hand, while hearing voices and slapping her. She would continue to experience for most of the day in a month at night time.
4 months back, she started to hear the voices even when she awake. One night she wanted to search out of home as she continued to hear some 7 male voices calling her by name. Her husband needed to resist her.
From then she continued to hear voices irrespective of day or night.
3 months back, her son was admitted in a hospital following severe abdominal pain and was said to be operated for some growth in intestine which was later said to be normal in another hospital.
From that time she started to be dull and withdrawn. She had avoided interacting with other family members and would claim of feeling sad and would complain of burning sensation spreading from head down upper limb, back, genital region , lower limb and feet.
She would complain of lack of energy, when her husband asked to do maintain home and household work and simply sitting and lying in the bed.
She would not maintain her personal care and take food. Needed to feed, taking bath, brushing and even changing and adjusting clothes. She would simply sit and reply occasionally after continued questioning. She had expressed suicidal ideas on her own.
She continued like that for about 20 days and then was taken to Meenakshi hospital for general consultation, where she was investigated routine blood investigation including Thyroid Function which have said to be normal.
Then she was referred to Psychiatrist, where she was diagnosed as Acute Stress Reaction with Depression and treated with T.Dazide 50mg , T.Lorazep 0.5mg 102, T.Olanz 5mg 101, T.Nitrzepam10mg 001
For the last 2months, she had improvement in slowness of activities andspeech. She started to have the feeling of running out of home, getting suicidal ideas. She felt herself worthless to her, but hadn’t attempted to do so. Her sister used to console her whenever she expressed such ideas.
She could not involve in previously pleasurable activities and continued to have headache, not able to do household works.
She hadn’t heard voices for the last 1 month. As she was not affordable for medicine, she came here for consulation.
No h/o. Head injury / LOC /Seizure /fever.
No h/o tall claims /elated mood /excessive spending.
No h/o. Repetitive act
No h/o. Excessive fear /Tremor /sweating / palpitation.
SCHIZOPHRENIA- PARANOID SUBTY:
Mr. F was normal 6 years back. He was working as a car driver. He was regular at work, earned 500-600 rupees /day. ¼ th of money gives to the mother for household purpose, remaining money spent with his friends. After spending with his friends, went home late in the night regularly. Most of the time spend with his friends. During that time, he used smoking cigarettes and panparag,
super pakku and occasionally use cannabis and alcohol- six months once.
He slowly developed multiple somatic complaints like headache, ear ache, nasal block, mouth ulcers, body tiredness, weakness of limbs, abdominal pain, nausea and digastric problems. He took frequent consultation with frequent doctors treated symptomatically. He was not satisfied. Instead of that he also frequently took certain drugs (steroid, analgesics) over the counter for the same complaints.
One day he consulted one new physician for the same complaints. After finishing his clinical examination, he said these are the complaints also occur in HIV/AIDS patient. He enquired about any contact with a commercial sex worker. He accepted his contact with a commercial sex worker 9 years ago.
Doctor gave reassurance and advised regarding HIV awareness and precaution. He was apprehensive and preoccupied that he had HIV. He did a blood test to find out whether he had HIV, the blood result was negative. He was also worried as his parents were unconcerned about his marriage. Gradually he become dull and withdrawn, not going to work, sitting idly. His intake of food decreased. He neglected his self care. He had to be forced by his mother to take bath and change dress. He attempt suicide by using insect poison and oleander seeds. He never expressed these ideas to anybody, he not make a suicidal notes.
The attempt was made when no one was present. The attempt was made at afternoon (2pm). He vomited soon (1hr). His mother return back from work, she took him to the hospital. Then treatment was given. She brought him to IMH on 30.6.04. He was diagnosed as a case of Anxiety with Depression. He was treated with T.Amitriptyline5mg.
No h/o. Increased energy and activities.
No h/o. Spending spree.
No h/o. Colourful dressing.
No h/o. Repeated checking and washing.
No h/o. Excessive fear for particular place.
No h/o. Crying spells
