Case study I: Beauty Mutale, Female 18

The parents to Beauty complained that Beauty has had abnormal behaviour for 6 years.
Beauty has had several admissions for the same problems.
‘It is not that the behaviour is all the time there, no, but comes from time to time, on several
occasions she disappears with men and only to return sometimes several days later alone’.
Occasionally, when the problem starts, she behaves stiff with an abnormal posture and
would often sleep immediately and would be very weak afterwards; often, the type of
leaving home presents.
Beauty admitted to hearing voices, the voices command her to ‘play’ with them and
sometimes would be having conversation which Beauty listens to.
Patient is a school dropout at grade nine.
She is a smart girl, lamented the grandfather, ‘but I have a feeling she has been bewitched’.
There is a positive history of hypertension and epilepsy in the family.
The grandfather recalls that she had been on Haloperidol and a small tablet as well as some
injectable given monthly.
Interaction:
a. What do you elucidate to be wrong with Beauty? 2 Marks
b. Explain what is wrong based on what you have given in a. above. 4 marks
c. Discuss Beauty’s prescription above. 4 marks
d. If you were able to get developmental history, what would be your focus in this
history? 2 marks
e. Mange Beauty adequately. 8 marks

Case Study II: Laston Mwansa Male 23 years

‘He has been fairly well until about a week ago when we noticed that he had become thin,
had this thin hair and was slow on doing things. When we looked at him, his skin had been
peeling off around the neck’.
He often stands still in one place for hours, talks to himself in a manner of mumbling.
He urinates on himself when he is still, however gets aggressive sometimes to the extent
that we would require to tie him up. We notice his hands were peeling off as well.
He has had this swelling of the face in the morning.
He was staying with his brother when the parents died more than 11 years ago. He started
selling items in town and stopped school in grade 9.
He had been using alcohol a lot and he smokes; we actually got him from this Bar where he
had been working when we heard complaints that he wasn’t behaving well. It was observed
that he drinks any kind of alcohol from morning to evening without eating anything. It’s like
alcohol is more important to him.
Interaction:
a. Discuss the source of what afflicts Laston. 2 marks
b. What are the comorbid diagnoses do you see in Laston. 4 marks
c. Manage Laston adequately. 12 marks

Case Study III: Christine Nkumi, Female 15 years

We live in Kawama, here in Kitwe, the problem we have is Christine; 3 months ago she
started gathering rubbish and throwing it in the house, often time defecating in the house.
She would laugh away happy and would start dancing.
She often would be taking about things, but we could not understand what she was saying
and had disturbed sleep, in the night would wake up and start throwing pots around. She
feeds on solid foods only, no fluids.
Interaction:
a. From this presentation above, what would be the diagnosis? 1 mark
b. Observe ICD10/ DSM 5 explain the diagnosis above. 6 marks
c. Manage Christine adequately. 13 marks

Case Study IV: Bertha Chanda, Female 49 years

Bertha was referred from Mushibili Clinic for further management to Kabwe Hospital for
irrelevant talking for 3 days.
The problem started when Bertha discovered that her daughter was pregnant, and she
called the man said to have been responsible who declined responsibility. From that
meeting Bertha started behaving strange and talking irrelevant. In fact she showered
obscenities on the man and his family.
‘Bertha had been having conversation with people we couldn’t see, what was discussed with
those invisible people was business. Bertha increasingly became restless. However in a few
instances Bertha was withdrawn, with low emotion expressions, watching TV alone. The
progression of illness had been too fact, suddenly we noticed she couldn’t walk, we had to
start supporting her and only do minimal activities of self-care.’
This is the second admission, the first was when her husband died in 2009. She behaved in a
similar manner.
She had been on HAART since 2016.
MSE revealed blunt affect with delusions of persecution and jealous.
CNS was intact. No loss of power in all muscle groups.
Interaction:
a. Speculate on Co morbid conditions seen in Bertha. Give at least one reason for each
speculated condition. 6 marks
b. One of the conditions given above would be definite, what are your concerns over
this condition. Stage the condition according to WHO. 4 marks
c. Manage Bertha adequately. 10 marks

Case Study V: Joyce Chibende Female 37 years.

‘This is Joyce, we brought her to hospital because she drunk weed killer 4 days ago. We took
her to our local clinic in Makululu where she was attended and discharged but 2 days ago
she started talking irrelevant, complaining of stomach aches, chest pain and headache. The
irrelevant talking was directed at her husband’.
‘She stopped taking her medication for this common disease’.
‘The husband disappeared with money the family raised from a fish sale. He eloped with his
girlfriend and he has stopped answering his phone.’
MSE revealed blunted affect with no insight.
CNS examination was unremarkable.
Interaction:
a. List two co morbid conditions or differential diagnoses in Joyce. 2 marks
b. If you were found at the local clinic, how would you have helped Joyce when she
presented first? 6 marks
c. How do you want to manage Joyce going forward? 12 marks

Case study VI. Mary Kamukwamba F 30yeras

Mary Kamukwamba, female estimated 30 years presented to your clinic one day looking
worried but could say what she was worried about.

On direct inquiry, she tells you that she was pregnant and concerned about the baby. You
want to ask more questions but she is not willing and looked down, not talking anymore.

Suddenly she begins to cry and saying it was better if she had died, not to live like this.
You beg her for an examination and hesitantly gets on the examination bed.

You notice that she had no recollection where she stays and what date that was. You notice
scratch marks around the neck and that she was of bad odour, her hair initially wrapped in
head dress was exposed and had mud and twigs in it.

She trembled a little as you see spots of healed abscesses on her gluteal regions and upper
limbs, some wounds were fresh with central areas that looked like tiny insect bite sites.
These sites where linear, more like following contours of veins.

The abdomen showed a height of fundus of 28 cm and there ware palpable moving foetal
parts intrauterine.

Interaction

a. Discuss Mary’s management adequately. 20 marks

Case study VII. Isaac Sichika Male 46 years

He had been beaten by a mob, explained the police who had picked him facing mob justice.
You however are mandated to attend to him, explained police.
Indeed you look at him, he did not look conscious and was forming at the mouth, he had
multiple bruises and his clothes were torn.
You, indeed do a good job and after 6 hours he regains consciousness and you asked him
some questions.
“I’m Isaac Sichika, I’m 46 years old and I live in Kabudolo compound here in Kabwe. I have
no recollection what happened, all I remember is, I entered a shop in the morning and now
I’m in hospital”.
You encourage him to continue telling you more and he is willing, and he says, ‘yes, I have
been to hospital before, I was seeing strange things during the day and I used to have
difficulties sleeping, but I don’t collect medication anymore because my mother died’.
Having been convinced that he could require mental health management you decide to
keep him in the mental health unit until Police come in the morning.
In the morning, the Police informed you that, that was not the first episode of mob justice,
he had picked up goods from a shop before and similar events ensured and that he has a
tendency of wondering about, he is known by police.
Interaction:
a. Discuss Isaac adequately, taking into consideration what he suffers from.
20 marks

Case study VIII. K William Male 18 years old

William presented to your clinic with irrelevant talking for 5 days.
This is the first time this had occurred.
He was take to progress Hospital here in Kitwe and everything was said to be Normal except
the Liver, and he was given medication for the liver and referred to here because there are
no mental health facilities at progress hospital, said William’s Mother.
He has been accusing people of crazy things, this morning he accused the maid of being a
witch and he tore up her Chitenge.
He complained of his strained relationship with the mother, since she divorced his father
and married this stranger, as much as he now has these siblings after him.
‘My relationship with this man, step dad is not nice, I just don’t like it. You see, I seem to
have this liking for males and want relationships with them, but I need children in future’.
History of alcohol and other drug use was unremarkable.
William has had episodes of self-isolation and wondering about, especially at night and was
caught once by police for loitering.
He looked agitated, with bright coloured clothes, and had multiple tattoos on the arms and
neck.
He was too overfamiliar with everyone, gave running commentaries about everything, and
would shift from topic to topic without stopping. He had a high tone.
Interaction
a. Speculate on Differential Diagnoses or co morbid conditions possible in William.
4 marks
b. Amongst the Differential Diagnosis, which diagnosis do you think is the primary
Diagnosis? Give reasons for this choice of Primary Diagnosis.
4 marks
c. Manage William adequately. 9 marks
Case study IX. Rachael Mhango Female 70 years
Rachael presented to your clinic in Kitwe on referral from Ndeke Clinic for wondering about,
easily forgetting things, inability to perform daily tasks and talking irrelevantly for over one
month.
On direct inquiry, the relatives confirmed that these problems had been there for over 4
years but now had become worse.
This started like a joke, she would be cooking and would leave food on the fire to burn,
would go from morning until evening, sometimes to visit friends. She started leaving change
at every store she went to buy goods from, and eventually started collecting a lot of plastics
and bringing such home.
She would demand to visit her daughter and the moment you get there she would demand
to see her son. She started talking about her parents, and how they used to live and where
and many occasions demanding to visit such places.
She had been on Antihypertensive drugs, Enalapril.
Many times she claims to be hearing people calling her and she obliges, in some instances
would see the people calling her, including her parents.
Her Blood pressure reading on that day was 183/86 mm/Hg
Interaction
a. List any four differential diagnosis or co morbid conditions seen in Racheal.
4 marks
b. Manage Rachael adequately explaining adequately why you are making decisions
for such management. 16 Marks

Case study X: Japhet Monde Male 7 years

Japhet Monde male 7years presented to your clinic with complaints of chronic
cough.
Apparently he was brought in by his parents who said he had been coughing for 3
weeks.
All this while, Japhet had been in the arms of his father and Japhet never looked
concerned nor interested in the activities you were doing nor where he was.
You asked the parents to put Japhet down and indeed when they comply, he had to
be supported to sit on one of your office sofas.
Japhet made no attempt to communicate with you.
‘Hello Japhet’, you call to him.
He just looked unconcerned.
The parents intercepted, ‘oh, Japhet was born like this, we care for him as it is, he is
our child, and he does not walk, talk nor sit. If he communicates, he does that with
his eyes only. See now he is looking at you and now you can say hello’.
Indeed you say, ‘hello Japhet’. Then his eyes fixed on you.
Interaction
a. Manage Japhet adequately, taking into account the diagnosis there of. 20 marks