U. Sayeeda Bano 30 Year

SOCIO DEMOGRAPHIC DETAILS
The patient is 30 year old, unmarried Muslim male, 12 pass out from ruler areas
lives in joint family belongs to lower socio economic status. He was brought to
IMHANS by his brother’s.
CHIEF COMPLAINTS:
1)Restlessness.
2)Hopelessness.
3)Decreased sleep.
4)Suicidal attempts.
5)Suspiciousness.
TDI DURATION: 12 YEARS

EXCERATION 25 DAYS
NATURE OF ILLNESS
Onset: Insidious.
Course: Continuous.
Progress: Deteriorating.
PREDISPOSING FACTOR:
1)Family history of psychiatric illness in father, mother, niece.
2)Home atmosphere was disturbed.
PRECIPITATING FACTOR:
1)Stress intolerance.
2)Sleep deprivation.
PERPETUATING FACTOR
1. Poor insight.
2. Poor Compliance.
3. Social isolation.
HISTORY OF PRESENT ILLNESS:-

Patient was doing well till 2012, in 2012 the patient complaint of fever, for which
was given some medications by his family members, fever lasted for 6 days, after
which the patient complaint of throat being pushed down by stomach. For that he
visited multiple doctors, they advised multiple test which came out normal even
when done 2-3 times. From that time he complaint of body being burst, whenever
he would ask to do any work he would say I am tired, I have no energy. He would
say that my body is aching every time. He would spent most of his time in bed
complaining of low energy and would do nothing all the day except staying in bed.
He would every time complaint of some problem within his body and when taken
to hospital the doctor would tell he is fine. One complaint after the next, and was
every time taken to a doctor and would sometimes go to doctor by himself. On
one incident he started saying that he thinks his blood is not good, and have to
change it. For this he went to test his blood which came out fine. Then he would
say that no one even doctors can’t understand his problem. He will not get fine
and would have to spend like this rest of his life.
Few months before, when his brother was about to get married in few days, he
started to feel restless, he would move here and there in house. He would have
palpitations, couldn’t calm his mind, and was unable to feel asleep. He would have
weeping episodes and complaint that he is suffering a lot. He would say that his
body is burning, dead bodies are coming out of his body, his head is empty, he is
not a living person, his eyesight is getting lost, and bones are getting rigid. He
would most of the time close his eyes and would say that his eyes are taking the
load of the whole body. He would even say that when he close his eyes he could
see a face of a girl. He would punch his chest with fist, bang his head on walls and
would slap his face.
He would feel very helpless and would say that doctors won’t be able to
understand his problem nor he would be fine. He would spent most of his time
thinking about his condition and would feel that he had lost everything. He would
have a feeling of inappropriate guilt stating that I have spent a lot of money on
medicines and couldn’t continue my studies. His mood would remain very low
because of his condition.
His sleep had disturbed. He couldn’t sleep whole night and would stay awake
thinking about his condition. He would stay at just one place with closed eyes
whole day and night and would not talk to anyone.
He would wish for death every time and tell family members to give him poison.
He would most of the time think to kill himself which according to him would be
better for him and his family. Once, he tried to commit suicide by taking rat killer,
but luckily one of the family members saw him and stopped him at appropriate
time. Till now he tried to commit suicide 3 times.
The attendant also shared that in childhood, patient was told by his elder sister
that she will put him in a bag and would throw him in river which was merely a
joke but whenever the patient gets angry he would say that the family members
don’t like him because of which these things were told to him when he was a kid.
He feels that his parents like his elder brother more than him and he would always
compare himself with him.
That patient even suspects that his family members are always talking behind his
back, he thinks they are against him and don’t want good for him and even when
food is served he would always think that he is given less amount of food than
others. Whenever he see two people talking he would think that they are talking
about him, so because of which he would most of time stay aloof in his room and
would not come out.
His appetite was increased a lot, the patient would eat 5/6 meals per day which
was unusual for him
His sleep had decreased.
Because of the following symptoms his brothers brought him to IMHANS.
PAST PSYCHIATRIC AND MEDICAL HISTORY:-

The patient has diabetes from 2020 for which he was prescribed insulin Human
Mixture 40/U but the patient wouldn’t inject insulin every day. He would only
inject on those days when he feel the need to.
There is no history of psychiatric illness.
NEGATIVE HISTORY:-
No history suggestive of any
TREATMENT HISTORY:-
T. Lamotrigine 25mg OD
T. Triticale plus 1tab BD
T. Imipramine 75mg OD
Inj. Lopez 1/m BD
In Insulin SC 32U BBF
FAMILY HISTORY
30 years
Patient
MUTE te
Patient lives in a joint family, father (70 years), having psychiatric illness mother
(68 years) having psychiatric illness, elder sister (48 years) married, brother (45
years), sister (40 years) married, brother (38 years) CID married, brother (35 years)
shopkeeper married, brother (33 years) studying .The patient is seventh in birth
order and he is emotionally attached to his mother and one of his brother who
brought him to IMHANS.
The attitude of patients towards his family members is not good but the attitude of
family members towards patient tends to be caring and supportive despite of him
being irritable over small family matters due to his current illness. Family history is
further suggestive of psychiatric illness in a mother, father, in one brother and
niece.
PERSONAL AND SOCIAL HISTORY:-
BIRTH AND DEVELOPMENTAL HISTORY:-
Patient is born out of non-consanguineous marriage and born out of full term
normal delivery. Patient is seventh in birth order. There were no peril natal and
post-natal complications. Patient achieved his normal developmental milestones
at appropriate time. There were no developmental delays reported. He cried
immediately after birth.
CHILDHOOD HISTORY:-
The patient’s primary caretaker were his parents. He was and obedient, shy child.
He would never harm anyone. The home atmosphere was disturbed. Most of the
family members used to get mentally ill at times. His father would physically abuse
him which left an impact on his mind. Patient used to think that his father will
never get it well and was embrace because of his illness.
EDUCATIONAL HISTORY:-
He was admitted in a government school at the age of 6 years in 1 st class. He was
good at studies in his childhood. His school was of Urdu medium and couldn’t pass
10th class in 1st attempt. In 12th he was admitted in IT but he left that course. He
passed 12th class with difficulty. He studied up to 2nd year only on persuasion by his
family members. Patient’s brother was admitted in a private English medium
school. Patient felt discriminated by family. When in 10 th he failed in his first
attempt he felt a grudge against his family members. After that he started to
remain aloof in his room not interacting much.
PLAY HISTORY-
Patient had a lot of friends from school and from his neighborhood of his age with
whom he used to spend his time. He loved to play cricket and volleyball and would
sometime roam around with his friends in the neighborhood.
OCCUPATIONAL HISTORY:-
At the age of 25 in 2017 he started to learn how to make pashmina shawl. He
worked under a guidance of a master. But he discontinued it because of his
illnesses within a year.
PREMORBID HISTORY:
The patient is shy by nature and finds it difficult to interact with others because of
which he spends most of the time in solace. The patient was always dependent on
others whether it is financially are any other work. The patient has been sensitive
to criticism. The patient was irritable and quick tempered and preferred solitude
over company.
USE OF LEISURE TIME:-

He used to spend his time playing with friends or doing home chores.
PREDOMINANT MOOD:-
The patient is pessimistic and could not express his feeling of love, anger,
frustration or sadness. His mood would remain irritable.
ATTITUDE TOWARDS SELF:

The patient was passionate in past, there were no shortcomings in him. He was
helping by nature and would try to help those in need.
ATTITUDE TOWARDS WORK AND RESPONSIBILITY:-

He would feel overwhelmed by work and responsibilities and would do every work
wholeheartedly.
RELIGIOUS BELIEF AND MORAL ATTITUDE:-
The patient was able to distinguish between right and wrong and would pray 5
times daily prayers. The patient like to be as neat and clean every time. He also
used to offer his prayers he religiously beliefs was not strong at all
FANTASY LIFE:-
His dream was to get a good Government job so as to help his family members
financially.
ALCOHOL AND SUBSTANCE HISTORY:

No significant substance use history was found.
MENTAL STATUS EXAMINATION

GENERAL ATTITUDE AND BEHAVIOUR:-
The patient was moderately built with average height and was minimally kempt.
He looked appropriate as the stated age. He was dressed as per culture and
climate. His nails were clean and cut. The patient took time to initiate eye contact,
but was maintained afterwards. It took time to establish rapport.
ATTITUDE TOWARDS EXAMINER:-

The patient was anxious and hesitant at first, and was comfortable afterwards.
RAPPORT
Easily established.
PSYCHOMOTOR ACTIVITY:-
Psychomotor activity was increased. The patient shake his body during all the time
of conversation.
SPEECH:-
The speech was audible in intensity. Quality was soft. Rate of speech was
decreased. Moreover, there is decrease in volume and pitch with increase reaction
time. The patient spoke only when questions were asked. It was relevant and
coherent.
MOOD AND AFFECT:-

Mood: The patient verbalized his mood as “abhor them ha”.
Affect: The intensity of affect was normal with easily altered fluctuation range was
expansive with congruent to mood.
THOUGHT:-
Stream and form:-
Stream: Flight of ideas
Form: congruent
The thought process were relevant to the questions asked, but depressive
cognition was noticed in the patient, worthless, helplessness and hopelessness
was also found in the patient.
COGNITION: - Oriented to T/P/P

CONCIOUSNESS AND ORIENTATION:-
The patient was fully aware and conscious and was orientated to time, place and
person.
ATTENTION AND CONCENTRATION:-

Patient was asked to repeat two digits, he could repeat the digits but when asked
to repeat three digits. He couldn’t repeat it. Furthermore, when asked to repeat
two digits backwards, he couldn’t repeat the digits recited to him. His
concentration was checked by asking him to repeat name of days backwards which
he was able to recite.
MEMORY:
Immediate memory: Intact.
Recent memory: Intact.
Remote memory: Intact.
INTELLIGENCE:-
The patient was asked about the current leaders of the country, the name of state
where he lives which he could adequately answer.
JUDGEMENT:-
Social judgement: Intact
Test judgement: Intact
Personal judgement: Intact
Impression: Intact.
PERCEPTION:-
The patient denied any abnormal perception. No evidence was found for the
presence of hallucinations, Illusions and misinterpretations,
depersonalization/decreolization
Insight: - Grade 4
PROVISIONAL DIAGNOSIS
With MDD 30 years old Muslim unmarried male, belongs to joint family with
lower socio-economic status present with a duration of illness 25 days with
onset insidious with complaints of restlessness, hopelessness, decreased sleep,
suicidal attempts, and suspiciousness with insight grade-4.

U. Sayeeda Bano 30 Year

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U. Sayeeda Bano 30 Year

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SOCIO DEMOGRAPHIC DETAILS

TDI DURATION: 12 YEARS

HISTORY OF PRESENT ILLNESS:-

PAST PSYCHIATRIC AND MEDICAL HISTORY:-

USE OF LEISURE TIME:-

ATTITUDE TOWARDS SELF:

ATTITUDE TOWARDS WORK AND RESPONSIBILITY:-

ALCOHOL AND SUBSTANCE HISTORY:

MENTAL STATUS EXAMINATION

ATTITUDE TOWARDS EXAMINER:-

MOOD AND AFFECT:-

COGNITION: - Oriented to T/P/P

ATTENTION AND CONCENTRATION:-

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