MINISTRY OF HEALTH PROTECTION OF UKRAINE

KHARKIV NATIONAL MEDICAL UNIVERSITY

CASE HISTORY OF MENTAL PATIENT:

WORKBOOK

Student:
Group , course

Харків, 2019
 Затверджено вченою радою ХНМУ
Протокол № 1 від 24.01.2019

Схема історії хвороби психічного хворого: Робочий зошит для студентів

медичних вузів із англійською мовою навчання /Упор. В.М.Сінайко, І.М.
Стрельнікова, І.В. Лещина, Л.Д. Коровіна. – Харків: ХНМУ, 2019. – 26 с.

Копіювання для поширення в будь-якому вигляді частини або повністю

можливо тільки з дозволу авторів навчального посібника.

3
 Introduction

Skill to establish contact and examine mental patients is the most important
and necessary for a doctor of any specialty. Thus it is necessary to take into account
features of mental diseases, which determine all originality of a psychiatric case
history: features of conversation with mental patients, presence of objective
anamnesis, allowing to estimate a condition of the patient more precisely, descriptive
(instead of ascertaining) character of formulation of the mental status, in which
should be reflected not only symptoms of mental disorder, but also features of speech
and behavior of the patient.
The workbook contains scheme of examination of mental patients and
psychiatric case history. For simplification of work with the patients, there are
samples of questions to patients in Ukrainian, Russian and English languages in the
manual, and also exemplary scheme of the description of the patient’s mental status.
The manual is intended for students of medical high schools of Ukraine with
the English language of teaching, but it can be useful both students with Ukrainian
and Russian language of training.

General scheme of case history

1. General information (demographic data).

2. Patient’s complaints.
3. Anamnesis.
3.1. History of the present disease (anamnesis morbi) according to the patient.
3.2. Past history (anamnesis vitae) according to the patient.
3.3. Objective anamnesis according to the parents, relatives, colleagues,
documents.
4. State of the patient at the moment of inspection.
4.1. Somatic status.
4.2. Neurological status.
4.3. Psychical status.
5. Conclusion on materials of primary inspection, preliminary diagnosis (syndrome).
6. Results of additional examinations of the patient (blood test, urine test, X-ray
examination, tomography etc.).
7. Results of experimental psychological examination.
8. Differential diagnostics.
9. Ascertainment and substantiation of the final
diagnosis. 10.Treatment.
11.Prognosis for life, recovery and ability to work.
12.Epicrisis. The medical and social recommendations.
 General information (demographic data)

It is necessary to find out the basic demographic data (surname, first and second
name (father’s name), age, sex, age and year of birth, place of work or study,
profession, home address, the date of admission to the hospital). This information
should be received by interrogation of the patient, it is possible to specify it from the
available documents (passport, medical cards etc.), from the relatives, people who is
accompanying the patient, or medical staff. Already at this stage it is possible to
make the first conclusions about the mental state of the patient (about his availability
to speech contact, orientation in a place, time, own personality, state of his memory,
thinking etc.).

Samples of questions:

Українська мова Русский язык English

Ваше прізвище, ім'я та по Ваши фамилия, What is your full
батькові? имя, name?
отчество?
У якому році В каком году When were you born?
Ви Вы
народились? родились?
Скільки Вам років? Сколько Вам лет? How old are
you?
(What is your age?)
Хто Ви за фахом? Кто Вы по профессии? What do you do?
What is your
occupation?
Who are you?
Де Ви працюєте? Где Вы работаете? Where do you work?
Ви на пенсії? Вы на пенсии? По Are you on a pension?
По інвалідності або инвалидности или по Are you on a pension
за віком? возрасту? because of your age or
your health?
Ви інвалід? Вы инвалид? Are you an invalid?
Ви інвалід якої групи? Вы инвалид What type of invalid
какой are
группы? you?
Ваша домашня адреса? Ваш домашний адрес? Your home
address
please?
Коли Ви поступили в Когда Вы поступили в When were
лікарню? больницу? you
admitted to
the
hospital?
Як Ви поступили в Как Вы поступили в Which way were you
лікарню (самостійно, больницу admitted to the
(самостоятельно, hospital
машиною машиной «Скор (independently,
«Швидкої допомоги» та ой
ін.) помощи» и др.) by ambulance etc.)?
 Patient’s name (FML) – John Riley
Age – 36 Date of birth – 05.04.1984_
Occupation – not working
Job place ___________________________
Invalidity (if any)
Date of admisstion – 18.11.2020 primary hospitalization/rehospitalization

Patient’s complaints (present)

It is necessary to find out, what exactly has resulted the patient in psychiatric
hospital. It is important to collect the complaints not only on mental, but also somatic
health. Each complaint must be specified and described in details (circumstances of
occurrence, onset, course). At some conditions patient can’t formulate his complaints,
therefore doctor should listen to the patient patiently and find out, what exactly
disturbs him. Sometimes patient considers himself healthy and does not state any
complaints. In this case it is necessary to make the appropriate record in the case
history.

Samples of questions:
Українська мова Русский язык English
На що Ви скаржитесь? На что Вы жалуетесь? What are your complaints?
Що трапилось з Вами? Что случилось с Вами? What is the matter?
Що Вас непокоїть? Что беспокоит? What is wrong with you?
Що привело Вас Что Вас привело в What's brought you to the
до лікарні? больницу? hospital?
Як Ви себе почуваєте? Как Вы себя How do you feel?
чувствуете?
Є ще якісь скарги? Есть еще какие- Any other problems?
нибудь
жалобы?

On admission: low mood, constant melancholy, sleep disturbance, depression, anxiety,

sadness, apathy, unwillingness to communicate with anyone.
At the time of supervision: for decreased appetite, sleep disturbance.
 Past history (anamnesis vitae)
Anamnesis vitae is found out according to the patient (subjective anamnesis),
according to the persons, who knows him well, and from the official characteristics
and other documents (objective anamnesis). Collecting anamnesis it’s necessary to
pay attention on somatic and mental heredity, life condition and education, features
of physical and mental development, progress at school, behaviour in collective,
diseases and traumas during patient’s life, features of character. Military service,
labour activity (age of a beginning of labour activity, attitude to work, serviceability,
frequency changing of work place, reason), last place of work, attitude to it, working
conditions should also be taken into account. It is necessary to find out the marital
status, attitudes between the members of family, psychological climate at work and in
family, presence of harmful habits (use of alcohol - frequency, doze, age of a
beginning of abusing, smoking).

Samples of questions:
Українська мова Русский язык English
Де Ви народились? Где Вы родились? Where were you born?
Скільки років Сколько лет было Вашим How old were your parents
було Вашим родителям, когда when you were born?
батькам, Вы
коли родились?
Ви народились?
Ваші батьки живі або Ваши родители Are your parents living or
померлі? живы, dead?
умерли?
Від чого вони От чего они умерли? What caused their death?
померлі? В At
В якому віці? каком возрасте? what age did they die?
У Вас є брати, сестри? У Вас есть братья, Do you have brothers or
сестры? sisters?
Вони здорові? Они здоровы? Are they healthy?
У Вашій сім'ї були (є) В Вашей семье были Do you have
психічно хворі? (есть) психически any
больные? psychiatric patients in your
family?
У Вашій сім'ї У Вас в семье были Did you have any cases of
були случаи suicide in your family?
випадки самогубства? самоубийства?
Як Как What was the history of
your mother’s pregnancy
перебігала вагітність протекали беременность and delivery?
та пологи у Вашої и роды у Вашей матери?
матері?
Як Ви розвивались у Как Вы развивались в What was your mental
дитячому віці? детском возрасте? and physical
development
 in
childhood?
У Вас були дитячі У Вас были Did you have child's
нічні страхи, детские ночные night- mares, did you
сноговоріння, страхи, speak or walk while
сноходіння, сноговорение, sleeping; did you have
night urinary
нічне ночное incontinence, any
нетримання недержание episodes
of convulsions or
сечі, мочи, stammer?
напади приступы

судом, заїкання)? судорог, заикание)?

У якому віці Ви пішли В каком возрасте At what age did you go to
до школи? Вы school?
пошли в школу?
Яка була успішність у Какая была успеваемость How did your progress at
школі? в school?
школе?
Які предмети Какие предметы Which subjects do you like
Вам Вам most of all?
найбільше нравились больше всего?
подобались?
Скільки класів Сколько классов How much classes have
Ви Вы you
закінчили? закончили? finished?
Чи були друзі у Были ли друзья в школе? Did you have any school-
школі? Сколько? mates? How many?
Скільки?
Чи легко Ви заводите Вы легко заводите Do you make
друзів? друзей? friends
easily?
Які у Вас були Какие у Вас были What kind of relationships
взаємні відносини із отношения с родителями, did you have with your
батьками, товарищами и parents, friends and
товаришами учителями? school-
teachers?
та
вчителями?
Де Ви працювали Где Вы работали Where did you work after
після закінчення после окончания leaving school (on
школы (вуза)? graduating
школи (вузу)?
from
university)?
Чому Почему поменяли Why have you
работу? changed
змінювали your work?
роботу?
Які у Вас умови Какие у Вас What are your
праці? условия work
труда? conditions?
Ваша робота Ваша работа связана с Is your job connected
пов'язана із вредными with unhealthy
шкідливими умовами условиями conditions
праці? труда? of
work?
Вам подобається Ваша Вам нравится Do you like your job?
робота? Ваша
работа?
Які умови У Какие условия у Вас What are your
Вас дома? home
вдома? conditions?
Хто ще живе з Вами? Кто еще живет с Вами? Who else lives with you?
Ваші взаємні Ваши взаимоотношения Your mutual relation with
відносини із с другими членами other members of family?
іншими семьи?
членами
сім'ї?
Яким за характером Каким Вы были What kind of character did
Ви по you have in childhood?
були у дитинстві? характеру в детстве?
Яким зараз Ви Каким по характеру What kind of character did
є Вы you have now?
характером? являетесь сейчас?
У якому віці у В каком возрасте у At what age
Вас Вас menarche
з'явились менструації? появились месячные? happened?
Ви Вы замужем (женаты)? Are you married?

заміжня
(одружений)?
У Вас були вагітності? У Вас были Have you had
беременности? pregnancies?
У Вас були аборти? У Вас были аборты? Have you had abortions?
Якими хворобами Какими болезнями What diseases have you
Ви Вы болели в had in the past?
страждали у прошлом?
минулому?
Які хвороби Какие болезни What diseases did you
Ви Вы have
перенесли у перенесли в детстве? as a child?
дитинстві?
Ви Вы болели Have you ever had a
венерическими venereal disease (syphilis,
хворіли болезнями gonorrhea)?
венеричними
захворюваннями (сифилис, гонорея)?
(сифіліс, гонорея)?
Ви хворіли на Вы болели туберкулезом, Have you ever had
туберкульоз, хворобу болезнью an infectious
Боткіна чи менінгіт)? disease
Боткина, менингитом)? (tuberculosis,

hepatitis, meningitis)?
У Вас були У Вас были Have you had
черепно- черепно- brain
мозкові травми? мозговые травмы? injuries?
Ви коли- Вы когда-либо Have you ever
небудь теряли lost
втрачали свідомість? сознание? consciousness?
Ви переносили Вы переносили Have you had
операції операции под ever
під общим наркозом? operations under
general
загальним наркозом? anaesthetic?
У Вас є алергія У Вас есть Do you have allergy to any
до якихось ліків? повышенная drugs?
чувствительность к
каким-
нибудь лекарствам?
Ви палите? Вы курите? Do you smoke? How many
Скільки Сколько cigarettes a day do
сигарет протягом доби сигарет в течение дня Вы you smoke?
Ви випалюєте? выкуриваете?
Ви вживаєте Вы употребляете Do you use
спиртні спиртные alcoholic
напої? Як часто та в напитки? Как часто и drinks? How often and
якій кількості? в каких how much?
количествах?
Яким Какие спиртные What alcoholic drinks do
 спиртним напитки Вы you prefer?
напоям Ви предпочитаете?
надаєте
перевагу?
Чи виникає у Возникает ли у Have you had “hang-over
Вас Вас syndrome”?
похмілля? похмелье?
Скільки потрібно Вам Много ли Вам How much alcohol should
випити, щоб сп'яніти? нужно выпить, you drink to get
чтобы опьянеть? tipsy
(drunk)?

Otherwise, heredity is not burdened. The patient was born 1 child, in physical and mental
development he did not lag behind her peers. He suffered from measles and colds. By
nature - extremely suspicious, indecisive, taciturn, calm, restrained, the mood is always
even. Graduated from high school, technical school.
Conversation with a patient (2nd admission): he has known his wife for about 10 years.
By nature, he is calm, balanced, touchy, she used to be sociable, but in recent years he has
complained. He Has not been treated anywhere. He Has 2 children. They live in a
communal apartment. The condition worsened for about 3 months, she began to complain
that she was doing poorly at work. Family relationships are stable, there are troubles with
the mother-in-law.
 History of the present disease (anamnesis morbi)
In anamnesis morbi the first attributes of disease, feature of its beginning, negative
factors, directly preceded to disease (trauma, infection, intoxication, change of a vital
situation etc.), time of influence of negative factors before occurrence of first
attributes of mental disease, development (sharp, gradual), treatment at therapeutist,
neuropathologist and in psychiatric hospitals, its efficiency, reason of the present
hospitalization, which way he (she) was delivered in hospital must be described. With
the help of objective anamnesis all of earlier listed data are specified.

Samples of questions:
Українська мова Русский язык English
Коли з'явились Когда появились When did you notice the
перші ознаки первые признаки first symptoms of
психического mental
психічного заболевания? disease?
захворювання?
Як давно Ви хворієте? Как давно Вы болеете? How long have you
been
ill?
Як почалось Как началось How did your
Ваше психічне Ваше mental disease
захворювання? психическое begin?
заболевание?
Хвороба Болезнь возникла Did the illness arise
остро sharp
виникла или постепенно? or gradually?
гостро чи поступово?
Із чим Ви С чем Вы What are possible
пов'язуєте початок связываете начало causes of the onset
захворювання? заболевания и его of your
обострения? illness?
Ви самі Вы сами Did you decide to call a
вирішили решили doctor yourself?
звернутись до лікаря? обратиться к врачу?
Ви Вы лечились по Were you treated for
поводу своей you illness? Where?
проходили лікування болезни? Где?
з
причини
своєї хвороби? Де?
В чому В чем состояло лечение? What did the treatment
полягало consist of?
лікування?
Чи було Наступало ли Did you have a
полегшення улучшение relief
після лікування? после лечения after the treatment?
Як часто Ви Как часто Вы проходили How often were you
проходили лікування в лечение в treated in the
психіатричному психиатрическом psychiatric hospital?
стаціонарі? стационаре?
Коли Ви виписались із Когда Вы были When did you
лікарні минулого выписаны из больницы leave hospital
разу? в прошлый last time?
раз?
Що було Что было причиной What was the reason of
причиною Вашей your
Вашої нынешней
госпитализаци present
теперішньої и? hospitalization?
госпіталізації?
He has had 2 previous suicide attempts, where his auditory hallucinations (God) told him
to that the cure for cancer would be discovered once he sacrificed himself. He overdosed
on tablets and alcohol. He was behaving the same way he is now and his mother is terribly
concerned he might attempt suicide again. Mr Riley has lost 7kg, refusing to eat because
"he doesn't need to, I'm too busy doing my important work". His strengths appear to be a
supportive family (Mr and Mrs Riley) and he is quite intelligent, enjoys problem solving
the difficult mechanical issues at work.
 State of the patient at the moment of inspection
(somatic, neurologic, psychical status).
The inspection of a patient conditions includes the following.
Somatic status: a constitution, skin, condition of internal organs (under the general
scheme of examination accepted in somatic clinics).

The general condition is satisfactory. Consciousness is not clouded. Active position.

Hypersthenic type of constitution. The posture is slouching. T body 36.70C. The skin is
pale pink, clean, moderately moist. Turgor is reduced. Visible mucous membranes of
normal color, clean, moist. There is a horizontal scar on the forehead 2 cm long. received
in childbirth. Hairiness is female, the hair on the head is gray. Nails of normal shape, pale,
no fungal lesions. The sclera are white. The subcutaneous fat is overdeveloped, the places
of the greatest deposition of fat on the abdomen. The thickness of the skin fold on the
anterior surface of the abdomen is 4 cm. On examination, the lymph nodes are not visible.
On palpation, single submandibular lymph nodes are determined, equally pronounced on
both sides, the size of a small pea, soft-elastic consistency, mobile, painless, not welded to
each other and surrounding tissues. The skin and subcutaneous tissue adjacent to the
lymph nodes are not changed. Other groups of lymph nodes (occipital, behind the ear,
parotid, chin, superficial cervical, supraclavicular and subclavian, thoracic, axillary,
elbow, inguinal, popliteal) are not palpable. The muscles are well developed, the tone is
preserved. Bones and joints without deformations. Expansion of the veins of the chest, no
visible pulsation and swelling of the veins of the neck, abdominal wall and extremities.
Neurological status: a condition of brain nerves, motor sphere (volume of movements,
tone of muscles, condition of reflexes, pathological reflexes, statics and coordination of
movements); sensitive sphere (pain, condition of superficial and deep sensitivity);
vegetative nervous system (cyanosis, edemas, lability of pulse etc.).

General examination of the muscles of the limbs and trunk, muscle atrophy,
hypertrophy, pseudohypertrophy, fibrillar and fascicular twitching were not revealed.
Khvostek's and Trousseau's symptoms are negative. The range of active and passive
movements is complete both in the upper and lower extremities. Muscle strength in all
muscle groups of the arms and legs is preserved. Deep reflexes were normal. There are
no pathological reflexes. She is stable in the Romberg position. Performs finger-nose
and heel-knee tests. There are no pains and paresthesias. A state of superficial
sensitivity, deep and complex types of sensitivity without disturbances.
Cranial nerve functions
1 pair (nn.olfactorii) - the sense of smell is preserved, there are no olfactory
hallucinations.
2 pair (n.opticus) - visual acuity is reduced, there is no limitation or loss of visual
fields, color perception is preserved.
3,4,6 pairs (n.oculomotorius, n.trochlearis, n.abducens) - the shape and size of the
pupils are normal, the movements of the eyeballs are in full, the reaction of the pupils
to light is preserved S = D.
5 pair (n.trigeminus) - superficial and deep sensitivity on the face is normal, corneal
and conjunctival reflexes are preserved.
7 pair (n.facialis) - wrinkling of the forehead and closing eyes is normal.
8 pair (n.vestibulocochlearis) - hearing acuity is normal, no nystagmus and no
dizziness.
9, 10 pair (n.glossopharyngeus, n.vagus) - painless swallowing, impaired voice
formation.
11 pair (n.accessorius) - turns of the head to the sides and down without difficulty.
12 pair (n.hypoglossus) - tongue in the midline, no atrophy of the muscles of the tongue
Mental status:
a. Degree of contact of the patient with the doctor (productive contact, formal
contact etc.);
b. Orientation at place, time, the own personality, persons around (condition of
consciousness). The level of insight.
c. Infringement of perception (metamorphopsias, illusions, hallucinations,
description of their character on analyzers, on complexity, in relation to the
patient, behavioral signs of hallucinations);
d. Disorders of memory (hypermnesia, hypomnesia, amnesia, paramnesias);
e. Infringement of thinking and speech: on tempo (acceleration, inhibition, delay
of thinking), on coherence (splitting of thinking, paralogism, reasoning, detailed
elaboration, incoherence, perseveration, echolalia), on the contents (obsessive,
supervaluable, delusional ideas), contents of delusional ideas, their
systematization, delusional behaviour, dementia (character of dementia),
oligophrenia;
f. Disorders of emotions: mood, emotional reactions during examination (non-
adequacy of emotions, ambivalence etc.); infringement of emotions on force
(strengthening, weakening), infringement of mobility of emotions;
g. Infringement of will: a condition of attention, purposeful activity - strengthening
(excitation), weakening, distortion (catatonic symptoms, obsessive, insuperable
movements and actions), condition of inclinations (strengthening, weakening,
distortion).

The note: all psychopathological manifestations should be illustrated by direct

speech, statements of the patient, description of his behaviour, mimicry etc.

Samples (underline, cross out or Describe if nessessary):

1. Appearance: patient, neat, combed. The vocabulary is large, because expresses his
thoughts without hesitation. The pose is natural, behavior, facial expressions and
pantomime are adequate to the situation.
2. The patient is correctly oriented in place, in time, in her own personality.
3. Consciousness is not darkened.
4. Quantitative (hypesthesia, hyperesthesia, anesthesia) and qualitative (paresthesia,
senestopathy) disorders of sensation were not revealed. Qualitative (illusions,
hallucinations) disorders of perception have not been identified.
5. The pace of thinking is accelerated; in form, in harmony, purposefulness, productivity,
thinking is not disturbed.
Count test (assess attention): 100-7 = 93,86,79,72,65,48,41,34,27,20,13,6. Assessment:
she gave answers quickly, practically without pauses, answered correctly, but made a
mistake once, then corrected her mistake on her own. Conclusion: Attention is
concentrated enough.
Test "Comparison of concepts": cow - horse ("both pets, eat grass, but the cow gives milk,
and the horse to ride"); pilot - tanker ("both military men, differ in dress code"); skis -
skates (“these are all sports shoes, but they ski on the track, and skate on the ice”); tram -
bus (“all this is transport, but the tram runs on rails, and the bus on the road”); lake - river
("all this is water where you can swim, but there is a current in the river, but not in the
lake"). Assessment: the patient, thinking, explains what is common in words and how
they differ.
Test "Essential signs": river - shore, fish, fisherman, mud, water ("water, shore)"; city -
car, building, crowd, street, bicycle (“crowd, building”); barn - hayloft, horse, roof, cattle,
walls (“roof, wall”); cube - corners, drawing, side, stone, wood ("side, corner"); division -
class, dividend, divisor, pencil, paper ("dividend, divisor"); reading - eyes, book, picture,
print, word (“eyes, book, print”); game - cards, players, penalties, punishment, rules
(“cards, players, rules”). Assessment: non-criticality and non-directional thinking were
not identified, resonant, confused judgments were not noted.
Test "Exclusion of the fourth superfluous": table, chair, floor, bed ("the floor is
superfluous, because people walk on it, and all other words are furniture, you cannot walk
on furniture"); lamp, lantern, sun, candle ("an extra word is the sun, because it is a natural
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source of light, and all other words are artificial sources of illumination"); reward, prize,
order, prize ("an extra word is an order", but she could not explain her choice); French,
Italian, vegetarian, Spaniard (“vegetarian is superfluous, because it’s a way of life, and all
other words are nationality”); Assessment: the ability to compare, analyze and generalize
the selected signs is not impaired, lack of vocabulary.
Test "Simple analogies": hear the ear - see teeth, heal, mouth, brush, chew ("chew teeth");
horse foal - cow pasture, horns, hammer, calf, bull ("cow calf"); thin fat - ugly beautiful,
fat, dirty, ugly, cheerful ("ugly beautiful"); heavy lead - hard down, feather bed, feathers,
light, chicken ("light down"); spoon porridge - fork butter, knife, plate, meat, dishes ("fork
meat"). Assessment: I learned the order of solving the problem after the first example,
there is no difficulty in the intellectual process.
Test "Explanation of metaphors and proverbs": Iron character - ("strong man"). Heart of
stone - ("cruel, bad man"). Strike while the iron is hot - ("we must hurry"). Don't get into
your sleigh - ("But all the gold that glitters - (" for example, when you clean the samovar,
it also shines like gold "). cases, you go thoughtlessly "), I remembered this proverb
myself, I also remembered the proverb“ measure seven times, cut once ”and explained
that it is better to think several times before doing something. mental activity is not
disturbed.
6. Complains about memory loss (indicates that she has begun to forget everything),
however, remembers all life events very accurately, names the date, names and surnames
of people present at certain events in personal and social life. Preserved professional
skills, stock of knowledge and everyday ideas, horizons. During a conversation, I was not
distracted by extraneous noise, I concentrated my attention when performing tests.

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 Conclusion on materials of primary inspection, preliminary diagnosis
(syndrome).
Based on anamnesis of life, anamnesis of disease, general examination we can put the
diagnosis: “Bipolar disorder. Manic phase”
 Results of additional examinations of the patient
Set of additional research methods depends on somatic and mental status of
psychiatric patient. It includes:

Data from additional research methods without pathology

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Differential diagnostics.
Ascertainment and substantiation the final diagnosis.

Differential diagnostics with diseases having a similar clinical picture is carried

out. It is necessary to allocate common features of diseases and clinical features of
the patient. On the basis of differential diagnostics the symptoms allowing to
establish the final diagnosis are determined.

The following disease should be differentiated:

1. Involutional melancholy (involutional depression begins in typical cases at the age of
45-55 years. A distinctive feature of psychosis is the predominance of anxiety. Unlike
MDP, the condition of patients largely depends on the surrounding situation.Placement of
a patient in an unfamiliar environment (hospitalization) leads to an exacerbation of the
disease, increased confusion and excitement.
2. Reactive depression. Its occurrence and clinical manifestations are closely related to
severe mental trauma caused by the situation of emotional loss. The depth of reactive
depression can be different, however, the somatic components of depression and motor
retardation are usually somewhat weaker than with MDP; daily mood swings are not
typical. Hallucinations may occur (the patient hears the voice of the deceased, his steps).
Convalescence is associated with the gradual deactivation of psychotrauma. Repeated
seasonal attacks of the disease are not common.
3. Affective endogenous psychosis must be differentiated from schizophrenia (circular
form), in which depressive or manic states can be observed at the onset of the disease.
However, in schizophrenia, there is no development of a clinical picture typical of
affective psychoses with a feeling of "vital melancholy", daily fluctuations in mood, while
characteristic disorders of thinking with "breakage" of thoughts, "parallel thoughts"
appear, and subsequently psychosis develops with phenomena of mental automatism and
symptoms "First rank" (and: K. Schneider). The further course of the progressive
endogenous process with the presence of affective disorders leads to a gradual increase in
deficit symptoms, the formation of "pure remission" does not occur. Premorbid features in
schizophrenia are characterized by the predominance of schizoid traits, while in MDP and
cyclothymia, the personality prior to illness is defined as hyperthymic or having features
of emotional instability.
Treatment

It’s necessary to determine the scheme of treatment proceeding from etiology and
pathogenesis, patient’s mental and somatic status, disease’s course (type of onset,
duration), results of past treatment.
The treatment must be complex, but it’s necessary to avoid the prescription any
medicine for no reason whatever.

1. Mode-3.
2. Diet - ATS.
3. To eliminate manic arousal, neuroleptics are prescribed:
Rp. Aminazini 100 mg
D.t.d. No. 50 in dragee
S. 2 pills 3 times a day orally after meals.
4. In hypomanic conditions, tranquilizers are effective:
Rp. Diazepami 10 mg
D.t.d # 50 in tab.
S. 3 tablets per day.
5. Antidepressants are effective for depression:
Rp. Amitriptylini 50 mg
D.t.d. №50 in tab.
S. 2 tablets 3 times a day.
6. Rp. Lithii carbonatis 0.3
D.t.d. №50 in tab.
S. 1 tablet 3 times a day after meals.
7. Rp. Dragee "Sonapax" 100 mg
D.t.d No. 60
S. 1 tablet 2 times a day.
8. Psychotherapy.
 Prognosis

Should be determined prognosis separately for life, recovery and ability to work.
They can be good (favourable) or bad (unfavourable).
Describe prognosis and recommendations for the patient below:

Prognosis: the prognosis for this patient is not favorable: an episode of mood disorders is
detected, has repeated exacerbations. The patient is maladjusted in professional, social
and family life and has an increased risk of suicide.

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