Submitted by:- Deepanshi Vashishtha 09/07/2020

Provisional diagnosis :

In this case, provisional diagnosis according to ICD-10 is (F13.22) i.e. mental &
behavioral disorder due to use of sedatives, dependence syndrome (controlled
dependence) and (F13.0) acute intoxicity.

Defend the diagnosis:

According to ICD-10 in this patient has fulfilled the criterion of dependence syndrome:
1. She has sense of compulsion to take the substance (benzodiazepines or sleeping
pills).

2. A physiological withdrawl state – when substance use is ceased or reduced or use

of the same substance with the intention of relieving or avoiding withdrawal
symptoms.
In this given case patient fulfill this criterion as well because she is using the
sleeping pill as prescribed by her doctor with intention of reliving or avoiding
withdrawal symptoms.

3. Progressive neglect of alternative pleasure or interest because of substance use.

In this given case patient also fulfilled this criterion because she wants to
conceive but due to some reason she was not able to conceive to avoid that she
use sleeping pills.
4. Acute intoxicity because she is increasing the level of dose continuously from last
1-2 months.

Mental State Examination :

Appearance: - Ms. S came to the center with her husband, she is dressed up properly
wearing neat and clean black kurta and legging. She seems to be tired, confused and
worried by her face. She has long black colour hair tie properly. Her fingernails and toes
cut properly but she painted them with different shades of nail paint.

Movement & behaviour: - she has no abnormal movement pattern. She seems very
inactive, seems drowsy. Her eyes like that she wants to sleep. Her gait is very slow in
speed. she is not able to make eye contact with the therapist. Rapport not established
adequately because patient not responding appropriately, she tried to sleep on table in
between the conversation. She sits on the chair idle in whole conversation.

Mood: - her mood is sad, depressive and apathetic as per her history. Her husband
explained that at home she sits idle not talk anybody and just think about only thing why
she not able to conceive.

Affect: - she has no concern with family members and children. Her children are doing
good in their academic or not? she has no concern about them. She not responds
appropriately when ask her about her children, who is taking care of them? who used to
go with them to park?

Speech: - her speech is slow and monotonous

Cognitive function:

Her orientation to person and place is intact because when ask about herself she able to
explain that and when asked her, where is she name of place? she able to responds that

She is not oriented to time because not able to tell which months is this, today date?

Her long term memory and short term memory is preserved when ask her, when is your
marriage anniversary? What you eat in breakfast today? she able to answer all these
question.

Her concentration is impaired not able to recall the words cat, bat, tat, mat, vat in
backward sequence she answered vat, tat, mat, cat, rat after two attempts.

Her ability to recall new words is impaired only recall two out of five words after two
attempts and her ability to describe discriminate and similarities between spinach and
tomatoes after tell the colour not able to generate more ideas.

Her ability to interpret proverb not preserved. Ask her, naach na jaane aangan tedha.

Judgement: - her ability to judgement is declined either personal or social. Personal

judgement ask her, why she still wants to conceive if her health is not good? she
answered I just want means want.. no logical reasoning. For social judgement asked her,
you are going to market but on the roadside you saw a woman fall down unconsciously.
What will you do? She responds I will go my way someone else will help her.

Insight: - her level of insight is level 5.

Further elicit information:-

Why you want to conceive third time as son? Even your husband is saying no, financial
burden will increase and your health is also not good.
Are you use any type of other drugs also or alcohol earlier?