NATIONAL POST GRADUATE MEDICAL COLLEGE OF NIGERIA

(CASE SUMMARY)

# Candidate’s information
1 Surname: ADELAJA Other names: ADENIKE SILIFAT
2 Training institution: ABUTH ZARIA
3 Rotation institution (if different from the training institution): Click here to enter text.
4 Supervising consultant for the rotation: DR. AUDU. I.A.
Period of rotation: 6 MONTHS
5 From m/d/y: 9 To m/d/y:
6 Posting: GENERAL PSYCHIATRY

Patient information
7 Initial: F.M.

8 Date admitted Date discharged m/d/y:

m/d/y:

Details: 400-500 words (Remember to anonymized the Sociodemographic and other relevant data)
9 25-year single male Kanuri Muslim who hails from Zaria and reside in Kawo,
Kaduna.
He was brought 2days ago by his father when he presented with;
= abnormal beliefs
= undue suspiciousness
= hearing voices of unseen persons of 3 months duration
Background use of Cannabis, 5 years duration
HPC – he was in his usual state of health until 3 months prior to presentation when he
suddenly began to think he is a robot and not even human. This occurred to him
because he realized unknown forces controlling his actions for example, he sometimes
speaks not by his intention but being controlled.
Also, he experiences the control with his thought as he would think of going to a place
but same forces are responsible for such thoughts.
Other times, he would have his thoughts removed leaving his mind empty.
However, he does not hear his thought echoing loud and does not think other people
are aware of his thoughts.
About the sometime after mentioning the above experience to his family, he began to
distrust them thinking they are out to hear him for no apparent reason, this made him
to start isolating from them and keeping to himself. He sometimes rejects their meal as
he says they may be up to something.
Moreover, he also started hearing the voices of unseen males and females in clear
consciousness, with only a lady in his work place that is familiar speaking somethings
he cannot discern, but he once heard the female saying ‘’suck my dick” which he
ignored although distressing to him, other times he blocked his ears to the voices. He
last heard the voice 3 days on admission.
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 NATIONAL POST GRADUATE MEDICAL COLLEGE OF NIGERIA
(CASE SUMMARY)

The above complaints have been ongoing in the past 3 months with no period of relief
beyond hours.
He also thinks he is somebody on a mission but doesn’t know what he is set to
achieve.
He is not aware of having special abilities different from others. No history of seeing
images unseen by others in clear consciousness. No persistent change in mood or
energy level.
These is associated suicidal thoughts as he kept saying he wants to go out of existence
by committing suicide but never mentioned how or attempted to act on it. No verbal
or physical aggression.
He has also been using Cannabis in the past 5 years, this he got to know via internet
that it has health benefits and so went to buy it.
He started with a wrap when he said made him happy, but despite the experience he
only takes it occasionally and the highest number he has taken is 3 wraps when he was
very sad, and it was not associated with strange experiences. Also, patient has never
taken the substances and exhibited abnormal behavior. He has no unusual experience
in the absence of the cannabis. He funds the habit from the income he sources as a
photographer. Patient claimed the use of cannabis has not affected this relationship
with people {his family} though his mother asked him to stop and he told her, it has
health benefits.
He last took cannabis 2 days prior to presentation {1 week ago). No history of use of
other psychoactive substances.
He has been able to do his photography job despite the illness, but he closes early as
he described himself to be under pressure.
He was in this facility 3 weeks ago for treatment but patient refused taking the
medication became more suspicious, had to be brought for in patient management. No
other intervention before presentation.
Past psyche: index is the first presentation which has been ongoing in the past 2
months.
Past med hx: had road traffic accident at the age of 9 with associated loss of
consciousness, less than 24 hours. No any chronic medical condition or past
hospitalization.
Family history:
He is the 4th of 4 children, father died 9 years ago (diabetes) when he was at the age of
11. Mother works with ministry of education under the local government.
The 1st sibling is Danjuma – single 36 years old radiographer works under someone
lives in Kaduna.
The 2nd sibling is Isah – single 33 years old Banker, also lives in Kaduna.
The 3rd sibling is audu– single manages hotel in Katsina.

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 NATIONAL POST GRADUATE MEDICAL COLLEGE OF NIGERIA
(CASE SUMMARY)

He is closest to the elder and immediate elder no known family history of mental
illness.
Personal history: he is not aware of his perinatal childhood child hood history.
He completed primary school in Zaria, 2009. Secondary school in same Zaria in 2015.
Currently a 300-level biology student of Kaduna state university.
He attained sexual maturity at the age of 14 years evidenced by development
secondary sexual characteristics like public hair, sexual information first obtained via
movies heterosexual orientation, first sexual intercourse was at the age of 18,
protected and consensual with his 2nd girlfriend.
He is currently in relationship with his 4th girlfriend for 2 years but not sexual in
nature.
Forensic history – no his of arrest or detention by the law enforcement agencies.
Drug history: as stated above
Current living circumstances – he currently lives with his mother, elder brother and
cousin sister in a family house in Sabo Tasha Kaduna has a room. The mother is his
main financial support.
Premorbid personality: described himself as an optimist easy going, keeps to himself,
not religious, cheerful, careful, who copes with stress using cannabis.
MSE: A young man appropriately dressed, not well groomed (uncombed hair) co-
operative with good eye to eye contact, no psychomotor excitement or retardation.
Speech: spontaneous, coherent, relevant, some irrationality as he thinks he is a robot,
normal volume & tone.
Mood: euthymic
Affect: appropriate
Thought: Stream-normal
Form -normal
Content- persecutory delusion, delusion of control, thought insertion /
withdrawal.
Possession – nil of note
Perception: no auditory hallucination, depersonalization or derealization.
Cognition: conscious, oriented.
Attention and concentration, secured and sustained evidenced by
serial 7 in 5 places.
Memory Immediate-good
Recent - good
Remote -good
Arithmetic - good (7+7) and also abstraction good as he identifies orange and banana
to be both fruit and has a good find of knowledge as he mentions both the president of
Nigeria and Governor of Kaduna State.

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 NATIONAL POST GRADUATE MEDICAL COLLEGE OF NIGERIA
(CASE SUMMARY)

His judgement is poor as he copes with stress through the use of cannabis.
He has partial insight as he is aware of his symptoms, know them to be abnormal but
unsure what it could be attributed to.
He is at precontemplation stage of change as he is aware of any disadvantages of the
psychoactive substance and so no thought of change.
Mild risk for suicide (Male)
(Cannabis)
(Ideas)
Not ill looks Afebrile, not Pale not in any form of distress.
Weight 55kg, BMI 20kg/m2
CNS: Conscious, no focal neurological deficits.
CVS – 70bpm BP – 110/70mmHg
RS: RR – 18cm, resonant percussion in all fields no added sound
Abd: Full, moves with respiration
No palpable organomegaly
Summary:
23yr old male, single, undergraduate who presented with 3 months history of a
thinking he is a robot not trusting people hearing voices of unseen persons in clear
consciousness with background history of use of cannabis of 5 years duration and no
abnormality in physical examination
Items of phenomenology:
23yr old male, single, undergraduate with;
1. Delusion of control
2. Persecutory delusion
3. 2nd person auditory hallucination
4. Use cannabinoid
5. Thought insertion
6. Thought withdrawal
Multi axial classification
Axis 1 - Paranoid schizophrenia with comorbid substance (cannabinoid use)
Differential – Mental and behavioral disorder due to use of cannabinoid with
psychotic disorder schizophrenia- like
Axis 2- Personal - 2
Family - 3
Occupational - 3
Society – 3
Axis 3- Contextual factors
Predisposing factors – no family history
- Head injury
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 NATIONAL POST GRADUATE MEDICAL COLLEGE OF NIGERIA
(CASE SUMMARY)

- Use of cannabis
Precipitating factors - look down stress
Precipitating factors – substance use
- Poor insight
Investigations
Bio psychosocial model
Biological- FBC, urinalysis, LFT, urine toxicology
Psychosocial – in conjunction with the social work would like to investigate the
family dynamic via visit and consultations to identify more predisposing and
precipitating factors for the illness. To also get additional history that would aid
management.
Treatment
Stepwise, multidisciplinary yet individualized in the short term (remission of
symptoms and work on his insight for full insight), in the long term (relapse
prevention and reintegration back to the society)
Again using the bio psycho social model
Bio – pharmacotherapy using antipsychotics haloperidol, effective in positive
symptoms, cost effective in the long term.
Psychosocial – educate patient and family on nature and treatment of disease
including role of the family.
On the cannabis use;
If dependence is not established from more additional history. I would detoxify the
patient, give him brief intervention educating him on further risk of dependence and
interference with illness and treatment.
Prognosis
Good Poor
1. Types of schizophrenia (paranoid) 1. Male
2. Acute onset 2. Younger age at onset
3. Short duration of untreated psychosis 3. Comorbid substance
4. Positive symptoms 4. Partial insight
5. Good social support
6. Good level of education
7. Absence of family
8. Good premorbid adjustment
Over all good prognosis

10 Attestation: ☒I attest that this report is a correct representation of my clinical

encounters with the patient in reference.

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 NATIONAL POST GRADUATE MEDICAL COLLEGE OF NIGERIA
(CASE SUMMARY)

11 ☒I attest that my supervising consultant previewed this write-up

before upload.

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