ADJUSTMENT DISORDER: BORDERLINE INTELLIGENCE:
Patient was apparently normal about a week prior to admission. Informants report that patient is not a good student and used to perform poorly in all his class exams. He was given pass marks by the school authorities in spite poor performance in all the exams. Once patient reached 10th standard, his school teacher apparently warned him that if he did not perform well in the forthcoming class tests, he would not be allowed to sit for his final exams.
Following this, patient got very upset and was found to be sitting depressed the whole day and expressed fearfulness. He also had crying spells, decreased concentration in his studies. Patient also expressed suicidal ideas and was found to sleep very less at night.
SUMMARY:
Patient obtained an IQ score of 75 indicating Border line level of Intellectual functioning.
SCHIZOPHRENIA:
Patient was apparently alright about 4 years back. He reported that his colleagues at his work place have made a plan against him and trying to get him removed from the job. He also reported that his parents are against him and his mother does not take care of him properly.
He accuses his mother of giving affection only for his elder brother and because of which he is in a very good position and become a lawyer. Patient also expressed suspiciousness that people in the neighboring streets talk about him and discuss about him. Parents report that patient would apparently pick up fights with a lot of people for this reason. He would be found smiling and muttering to himself at various times and would not have any explanation for the same. Parents also report that, patient would not take bath regularly, refuse to comb his hair, change clothes and had very poor personal hygiene. He has repeatedly changed jobs and has not held a single job for more than a month. Many times the patient was terminated from the job as he was not found to be efficient. He complained of disturbed sleep and parents reported that he would roam around in the night aimlessly.
SUMMARY:
Overall, testing showed the presence of formal thought disorder, possibly Schizophrenia.
DISSOCIATIVE MOTOR DISORDER:
Patient apparently got married about 9 months back. On the same day, she started complaining of having back pain which was of severe nature and lasting few minutes to 2 hours. She consulted many neurologists and orthopaedicians for the same. All the investigations were done and found to be normal. She was prescribed medications but she did not report any improvement in her back pain with them. Patient also had sleep disturbance for a week before coming to psychiatry OPD. She had told her family that she does to wish to live as she was unable to tolerate the pain. She was eating very little as she complained that intake of food worsened her pain. Two days before presentation to OPD, patient started having episodes of unresponsiveness for a few minutes. These episodes used to be accompanied by swirling movements of the body and patient was found lifting both her lower limbs. She reported complete amnesia for the episode. After 15 to 20 minutes patient used to become completely alright and no confusion was noticed.
SUMMARY:
Assessment is indicative of significant stressors in the form of unresolved conflicts. Affective symptoms are also present. Current dissociative symptoms can be possibly attributed to poor coping skills.
RECURRENT DEPRESSIVE DISORDER:
Patient was apparently normal about 5 days prior to admission. Her husband had been insisting that she should join for work, so she joined as a daily wager in a nearby mill. Following that, patient was found to have disturbed sleep. She was appearing sad all the time, not taking any interest in her daily routine work. She complained of feeling tired even on doing minimal work. Patient was not taking care of her children as before. She used to be preoccupied in her own thoughts and would be found sitting in the same place for long periods of time. She complained of hearing nonexistent voices which were commenting about her continuously. She expressed wishes to die on several occasions. Initially, patient was having less communication with family members but within two days she became completely mute, stopped eating food, after which she was brought to the hospital.
SUMMARY:
Overall, Testing is indicative of presence of Depressive features.
DEMENTIA:
Patient was apparently normal until 4 months back, following which, his family members noticed him to be repeating the same sentences many times. He had significant sleep disturbance and for the last two months, he stopped going for work. Family members report that many times he has failed to recognise his close friends and family members and has landed up calling them by some other name. On few occasions, he apparently forgot the way to his house and lost his way. He went on some other unfamiliar road and was brought back home by the family members. He talks irrelevantly at times saying that he is in his office when actually he would be elsewhere. At times he would apparently just sit in the same place and stare at the ground for long periods of time. Patient had to be repeatedly instructed by the family members to do his routine activities. He would ask for breakfast twice saying that he had not had it, when in fact, the family would have given the same some few minutes earlier. His sleep was found to be disturbed
