CASE PRESENTATION ON

CANNABIES INDUCED
PSYCHOSIS
[Document subtitle]

SUBMITTED TO –

Madam. Kalyani Saha

Professor SUBMITTED BY –
Apollo College of Nursing, Kolkata
Shubhrima Khan
M.Sc. Nursing 2nd year
Apollo College of Nursing, Kolkata

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IDENTIFICATION DATA:

Name: Chiranjit Ghosh

Age: 33 years
sex: Male
Father/spouse: Mitali Ghosh (Wife)
Hospital Reg. No.: 36370
Address: Vill: Laskarpur, PO: Laskarpur, PS: Narendrapur, Pin: 700153
Education: Graduate
Occupation: Driver (uber)
Income: Rs. 20,000/ month
Religion: Hinduism
Marital status: Married
Name of hospital: Antara Mental Hospital
Date of admission: 16.04.2022
Under doctor: Dr. J. Maity
Name of Informant: Manju Ghosh (Mother)
Relationship with Informant: Son
Reliability of information: Reliable
Diagnosis: F12 (Mental and behavioral disorders due to use of cannabinoids)

PRESENTING CHIEF COMPLAINT:

According to patient:
Kichui valo lagtona, ekta eka thakte ichhe korto  8 months ago
Bonduder sathe ba kokhno eka mod ganja khetam  8 months ago
Barite Karor sathe kotha bolte valo lagtona, birokto lagto  8 months ago
Barite ese asanti kortam, gali galaj kortam  8 months ago
Rege giye wife ke mardhor o kortam kokhno kokhno  8 months ago
Kono kotha mone rakhte partam na, sobkichu vule jetam  8 months ago
Kono kaj korte ichhe kortona  8 months ago
Hat paa jhin jhin korto, kanpto  last 15 days
Ratre thik kore ghum hotona, hotat kore ghum venge jeto, babar swapno dekhtam  15 days
Matha vari vari lagto  last 15 days
Choker samne sob ondhokar lagto  last 15 days
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Khabar Khete ichhe kortona, khelei bomi bomi lagto, kokhno bomi kore feltam  last 15 days

According to Family member:

Chup chap thakto, karor sathe kotha boltona  11 months ago
Khawa dawa kome gechlo ekdom  11 months ago
Sobsomoy mon mora hoye thakto  11 months ago
Kokhno kaje jeto, kokhno jetona  11 months ago
Nesha kore suru korlo, prai protidini nesha korto  11 months ago
Onno meyeder disturb korto  8 months ago
Amra kichu bollei amader kei kharap kotha bolto  8 months ago
Boumar gaye hato tulto  8 months ago
Sob kotha vule jeto, eki kotha barbar bolto  8 months ago
Kokhno kokhno nijer monei kotha bolto  8 months ago
Tarpor chikitsa koranor por valoi chilo majhe, gario chalachhilo. Akhn ei ek mas dhore abar
Vulval bokchilo, nijeke vogoban sathe tulna korto  1 months
Barbar or babar kotha bolchilo  1 months
Hat kanpto  1 months
Kotha gulou pariskar kore bolte parchilona, joriye jeto  1 months
Khawa dawa, ghum ekdom kome geche  1 months
Ja khachhe tai bomi kore dichhe  1 months

HISTORY OF PRESENT ILLNESS:

 Duration: 11 months
 Onset: Gradual
 Course: Continuous
 Intensity: Increasing
 Precipitating factors: His nice left him
 Predisposing factors: Family conflict, lack of children, no job satisfaction
 Perpetuating factors: Relapse treatment, father’s death
 Description of present illness: Patient was apparently well before 11 months when his
elder brother shifts to another house with his wife and daughter. The patient did not have
his own child and he was very close to his niece. After his niece left him, the patient became
very sad, he always wants to stay alone, did not want to talk to anybody, stopped going to

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 work. Gradually he used to take cannabis in regular basis. After 3 months of taking cannabis
in regular basis his psychological symptoms were appeared. The symptoms started with
sudden anger outburst, aggressive behaviour towards the family members, used abusive
languages without any reason, disturbing other, mainly females, physical assault to his
wife, forgetfulness, irrelevant talk, muttering of self. After that he was taken to a private
neurologist by his father and treated there for 6 months. There was slight improvement in
his condition. 2 months ago, his father passed away and he discontinued the treatment. For
the last 1 month he is showing the withdrawal symptoms like tremor and tingling sensation
at limbs, heaviness in the head, neglects personal hygiene, irrelevant talk, pretending
himself as lord Krishna, slurred speech, dreaming and talking about his father, decreased
sleep and appetite, nausea, vomiting, weakness. After that the patient was taken to the
Antara Hospital by his mother and wife and he got admitted in Deaddiction ward (MTC)
of Antara hospital and currently treated there.

ADDICTION HISTORY

Alcohol
 Duration of use: 5 years
 Frequency: Occasional drinker
 Cause: Pleasure seeking
 Last use: Before 1 year

Cannabis
 Duration of use: 1 year
 Frequency: Daily basis
 Cause: To relief stress
 Last use: 15 days before admission

HISTORY OF PAST ILLNESS

 Past psychiatric history: Once he was treated by a private neurologist for 6 months from
August, 2021 to march 2022.
 Past medical and surgical history: He has no such history of diabetes, hypertension,
tuberculosis or any other major medical or surgical illness.
 Allergies: Nothing significant
 Past history of injury/accident: Nothing significant

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TREATMENT HISTORY

 Drugs
Tab. Risdone LS 2+2 1/2 – x – 1/2
Tab. Divaa OD 250 mg 1–x–1
Tab. Zapiz 0.5 mg x–1–1
Tab. Nicotex 2 mg 1–1–x
Tab. Boyantin 150 mg x–1–x
 ECT: Not given
 Psychotherapy: Not given
 Family Therapy: Not given
 Rehabilitation: Patient was involved in Group activities and Occupational activities twice
a week at Day care unit of Antara.

FAMILY HISTORY:

 Type of family: Nuclear

 No. of family members: Three
 Name of head of family: Manju Ghosh (Mother)
 Total monthly income: Rs. 20,000
 Source of income: Pension of father, contribution from elder brother
 History of illness among family members: No psychiatric illness in family, no history of
diabetes, but patient’s mother has history of Hypertension and she was under treatment.

There is a nuclear family in Garia, Kolkata. Total number of family member is three. The
patient’s father died of heart attack, 2 months ago at 66 years of age, he was alcoholic. His
mother is still alive, 60 years old and has a pension. She earns a total 12,000 per month. The
patient has one elder brother and a younger sister. They are married and lives separately. By
profession the patient was a driver (own uber) but now he is unemployed due to illness. He is
married for 6 years. His wife is a house maker, 30 years old. They do not have their child. The
patient does not have good relationship with his family members and he also had marital
conflict. As per genogram patient father was also alcoholic but was undiagnosed.

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FAMILY GENOGRAME

Natural death Natural death Natural death Natural death

Grand Grand
r Father mother

Uncle Father Uncle 60

years
died at 66 years (2021)
due to heart attack

Father- Mother
32 Brother, Sister, in-law -in-law
years 38 years 26 years

Self, 33 years
Wife, 30 25 21
years years years

PERSONAL HISTORY

Perinatal History-
Antenatal Period-
Intranatal period-
Birth-
Birth cry-
Birth defects-
Postnatal complications-
Nothing significant
Normal delivery
cried immediately after birth
Noting significant
Noting significant

Childhood history
Primary care giver- Mother
Feeding- Breast feeding started after birth
Age at weaning- 6 months
Developmental Milestones- Normally achieved
Behavior and emotional problems- Nothing significant
Illness during childhood:

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Educational History
Age at beginning of formal education: 6 years
Academic performance: Good
Extracurricular achievements, if any: Playing cricket
Relationships with peer and teachers: Good
School phobia: Absent
Look for conduct disorder: No
Reason for termination of study: Not found
Play history
Games played (at what stage and with whom): At childhood with siblings and
neighbours
Relationships with playmates: Good

Emotional Problems during Adolescence: Nothing Significant

Puberty:
Age at appearance of secondary sexual characteristics: 14 years
Anxiety related to puberty changes: Nothing significant
Age at menarche: Not applicable
Reaction to menarche: Not applicable
Regularity of cycles, duration of flow: Not applicable
Abnormalities, if any: Not applicable
Obstetrical History-
LMP:
Number of children: Not
Any abnormalities associated with pregnancy, delivery, puerperium: applicable
Termination of pregnancy, if any:
Menopause (including any associated problems):

Occupational History-
Age at starting work: 23 years
Jobs held in chronological order: Driver
Current job satisfaction: Satisfactory
Whether Job is appropriate to patient’s background: Inappropriate
Sexual and Marital history-
Type of marriage: Arranged

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 Duration of marriage: 6 Years
Interpersonal and sexual relations: Not satisfactory
Extramarital relationship if any: No
Premorbid Personality
Interpersonal relationships: Introvert
Family and social relationship: Satisfactory
Use of leisure time: Watching Tv, Playing game
Predominant Mood: Normal
Usual reaction to stressful events: Normal
Attitude to self and others: Good, used to interact well with others.
Attitude to work and responsibility: Responsible
Religious beliefs and moral attitudes: She belief in God
Fantasy Life: Nothing significant
Habits
 Eating patter: Normal, non-vegetarian
 Elimination: Regular
 Sleep: Adequate
 Use of drugs, tobacco, alcohol: Alcohol (occasional drinker), Cannabis
for 3 months.

MENTAL STATUS EXAMINATION

GENERAL APPEARANCE AND BEHAVIOUR:

 Appearance: Looking one's age

 Facial expression: Anxious
 Level of grooming: Normal
 Level of cleanliness: Adequate
 Level of consciousness: Fully conscious and alert
 Mode of entry: Come willingly
 Cooperativeness: Normal
 Eye-to-eye contact: Maintained eye to eye contact properly, intermittently
 Psychomotor activity: Normal
 Rapport: Spontaneous

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  Gesturing: Normal
 Posturing: Normal
 Other movements: Not present
 Other catatonic phenomena: There is no other catatonic phenomena.
 Conversion and dissociative signs: Not present
 Compulsive acts or rituals: Nothing significant
 Hallucinatory behaviour: Self-muttering, smiling without reason

SPEECH

Nurse: Why you came to this hospital?

Patient: ‘Amar mod, ganja er nesha chilo, majhe khawa chereo diyechilam, tarpor amaro nek
problem hochhilo, setar chikitsar jonnoi ekhane asa’
 Initiation : Speaks when spoken to
 Reaction time : Delayed
 Rate : Normal
 Productivity : Pressured
 Tone : Normal variation
 Relevance : Relevant
 Stream : Normal
 Coherence : Fully Coherent
 Others : Nothing significant

MOOD AND AFFECT

Nurse: How are you feeling today?

Patient: “valo achi.”
Subjective: patient said his mood is good.
Objective: Patient seems anxious
 Predominant mood state: anxious
Inference: Affect is incongruent to mood and appropriate to situation

THOUGHT

Nurse: How many members are there in your family?

Patient: ‘Tinjon. Maa, ami r amar wife’

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Form: Thought formation is normal.
Stream: Thought progression is normal.
Content
 Delusion:
Nurse: Do you think that anybody wants to harm you?
Patient: ‘Na’
Nurse: Have you ever felt that some people are gossiping about you?
Patient: ‘Na’
Nurse: Have you felt that you are being controlled by someone?
Patient: ‘Na’

 Ideas:
Nurse: Do you ever feel that your life is worthless?
Patient: “haa mone hoi majhe majhe”
Nurse: Do you ever thought to take your own life?
Patient: ‘Na’

 Thought Alienation Phenomena:

Nurse: Do you think that someone is inserting though in you or withdrawing your
thought?
Patient: “Na”

 Obsessive Phenomena:
Nurse: Do you have any thought that comes to your mine repeatedly?
Patient: “Na”

 Phobia:
Nurse: Do you have any fearful feeling about some object or anything else?
Patient: “Na.”
Inference: He has worthleeness ideas and obsessional taught, phobia is not found.

PERCEPTION

Illusion: Nothing significant

Hallucination:
Nurse: Have you seen anything which has not seen by others?
Patient: “Ha.”

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Nurse: Have you smelt anything which has not smelled by others?
Patient: “Na.”
Nurse: Have you heard anything which has not heard by others?
Patient: “Ha.”
Nurse: Have you feel anything moving on your skin?
Patient: “Na.”
Inference: Patient has auditory and visual hallucination.

COGNITIVE FUNCTION

 Consciousness : Fully conscious

 Orientation :
Time:
Nurse: What time of the day it is?
Patient: ‘Akhn sokal 10: 00 baje’
Place
Nurse: Where are you now?
Patient: ‘Antara Mental Hospital’.
Person
Nurse: Who am I?
Patient: ‘Nurse’
Inference: She is oriented to time place and person.

 Attention
Nurse: I will tell you few numbers, you have to repeat them after me. Say 1, 3
Patient – ‘1, 3’
Nurse: Now say 1,3, 5
Patient: ‘1, 3, 5’
Nurse: say again 1,3,5,7
Patient: ‘1, 3 ,5, 7’
Inference: Attention is aroused normally

 Concentration
Nurse - subtract 3 from 40 and repeat 5 times?
Patient – ’37, 34, 31, 28, 25’
Inference: Concentration is normally sustained.

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 Memory
Immediate memory: -
Nurse: I will tell you 5 words, you have to repeat them after 5 minutes: Tree, leaf,
flower, fruit, bird
Patient: ‘Gaach, pata, ful, fol, pakhi’
Recent memory: -
Nurse- what did you take in dinner last night?
Patient- ‘Ruti, potoler sobji r doodh’
Remote memory: -
Nurse: Do you remember your niece’s birthday?
Patient: 8th December, 2009
Inference: Immediate, Recent and Remote memory is intact.

 Intelligence
Nurse -Who is the chief minister of West Bengal?
Patient – ‘Mamata Banerjee’
Nurse: Tell me the answer of 11 × 2 + 78?
Patient – ‘100’
Inference – her Intelligence level was good

 Abstraction
Nurse: Explain the phrase, “Grapes are sour”
Patient: “nije kono jinis na pele, sei jinis kei dos deoa”
Nurse: Do you able to say one similarity between an orange and an apple?
Patient: ‘Dutoi fol’.
Nurse: What is the dissimilarity between an orange and a ball?
Patient: Lebu khawa hoi r ball diye khela hoi’.
Inference: Her abstract thinking ability was intact.

 Judgement

Personal:
Nurse: what you think about your future?
Patient – ‘chaichi to nesha chere sustha vabe banche, kintu etar way out tai to bujhte
parchina’

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 Social judgement:
Nurse: What you will do if some guest will come to your house?
Patient: ‘tader sathe bose golpo gujob korbo’

Test judgement:
Nurse – What you will do seeing fire in a place?
Patient – ‘Fire brigade e khobor debo.’
Inference: Her personal, social and test judgement were intact.

INSIGHT

Nurse - Why are you come to this hospital?

Patient – ‘Amar mod, ganja er nesha chilo, majhe khawa chereo diyechilam, tarpor amaro nek
problem hochhilo, setar chikitsar jonnoi ekhane asa’.
Inference – She has grade 6 insight about her illness. She is aware about the symptoms
that bring changes in her behaviour or personality.

DISEASE WITH ICD CODE:

History revealed that the patient was apparently alright at childhood and adolescent period. He
was good in study and had good relationship with his friends and family. After graduation he
discontinued his study, but the reason is not found. She belongs to a nuclear family. His father
also had alcoholic history and 2 months ago he passed away. By profession the patient was a
driver and he had no job satisfaction as it was inappropriate to his background. He also had
marital conflict as he does not have any child. He always possesses an introvert personality.
His psychological problems were started before 11 months when his elder brother shifts to
another house with his wife and daughter. The patient did not have his own child and he was
very close to his niece. After his niece left him, the patient became very sad, he started living
alone, became addicted to alcohol and cannabis. Mental status examination revealed that he
had hopelessness, worthlessness ideas and auditory and visual hallucination but he did not have
any impairment in attention, concentration, memory, judgement and she had true insight about
her illness. According to ICD 10 his present problems are similar to the symptoms of substance
induced psychosis and he was diagnosed with cannabis induced psychosis by Psychiatrist.

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 PHYSICAL EXAMINATION

Central nervous system 16.04.22 17.04.22 18.04.22

Level of consciousness (alert/conscious/drowsy Conscious Conscious Conscious

/comatose)
Orientation
Time – Oriented Oriented Oriented
Place –
Person –
Speech (aphasia, slurred, relevant, irrelevant) Relevant Relevant Relevant
Paralysis (hemiplegia, paraplegia, hemiparesis, Absent Absent Absent
quadriplegia, others)
Respiratory system
Chest shape-Normal/ Barrel Chest Normal Normal Normal
Chest movement-Bilateral/ Lt. Lateral/ Rt. Lateral Bilateral Bilateral Bilateral
Respiratory pattern- Normal/ Tachypnea/ Normal Normal Normal
Bradypnea/ Dyspnea
Respiratory rate- 22 breath/ min 21 breath/ min 18 breath/ min
Respiratory sound- Stridor/ Wheezing/ Granting Normal Normal Normal
Chest drain- Present/Absent Absent Absent Absent
Cardiovascular system
Blood pressure 110/70 mmhg 120/80 mmhg 110/60 mmhg
Heart rate 68 beats/min 76 beats/min 80 beats/min
Heart sound – S1 And S2 S1 And S2 S1 And S2
S1 Audible Audible Audible
S2
S3
S4
Pulse –
Carotid
Temporal
Brachial Present Present Present
Radial

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Femoral
Dorsalis pedis
Popliteal
Posterior tibial
Clubbing- yes/ no No No No
Cyanosis- yes/ no No No No
Pallor- yes/ no No No No
Neck vein distention- yes/ no No No No
CRT < 3sec < 3sec < 3sec
Chest pain No No No
E. N. T
Eye- clean/ discharge Clean Clean Clean
Sclera Whitish Whitish Whitish
Conjunctiva Pink Pink Pink
Periorbital edema- yes/ no No No No
Ear- clean/ wax/ blood / cerumen/ others Clean Clean Clean
Nose- clean/ epistaxis/ others Clean Clean Clean
G.I system
Lip- moist/ crack/ dry moist moist moist
Teeth- clean/ plague/ decay/ others Clean Clean Clean
Mouth- clean/dirty/others Clean Clean Clean
Halitosis- yes/no No No No
Tongue- clean/coated/ dry/moist/others clean clean clean
Nutritional route Oral Oral Oral
Nausea No No No
Vomiting No No No
Constipation No No No
Diarrhea No No No
Melaena No No No
Genitourinary system
Voids- freely/ catheter freely freely freely
Urine –

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Colour Straw Straw Straw
Appearance Clear Clear Clear
Sedimentation No No No
Hematuria No No No
Retention / incontinence No No No
Integumentary system
Skin- intact/ break down/ rash/ blister Intact Intact Intact
Wound- incisional / injury Absent Absent Absent
Site NA NA NA
Condition-redness/discharge/apposition/ NA NA NA
edema/healthy/others
Invasive line- central/ peripheral Absent Absent Absent
Site-
Patency- NA NA NA
Pain-
Musculoskeletal system
Joint- mobile/ contracture/ painful/ stiff Painful Painful Painful
Bed sore
Site- Absent Absent Absent
Condition-
Degree-

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 DESCRIPTION OF THE DISEASE

INTRODUCTION

Disorders due to psychoactive substance use refer to conditions arising from the abuse of
alcohol, psychoactive drugs and other chemicals such as volatile solvents. These are classified
under F1 in ICD 10.

The term substance is used in reference to any drug, medication, or toxin that shares the
potential for abuse. Addiction is a physiologic and psychologic dependence on alcohol or other
drugs of abuse that affects the central nervous system in such a way that withdrawal symptoms
are experienced when the substance is discontinued.

DEFINITION

Addiction: It is a physiologic and psychologic dependence on alcohol or other drugs of abuse

that affects the central nervous system in such a way that withdrawal symptoms are experienced
when the substance is discontinued.
Abuse: It refers to maladaptive pattern of substance use that impairs health in a broad sense.
Dependence: It refers to certain physiological and psychological phenomena induced by the
repeated taking of a substance.
Tolerance: It is a state in which after repeated administration, a drug produces decreased
effect, on increasing dose are required to produce the same.
Withdrawal state: A group of signs and symptoms recurring when a drug is reduced in amount
or withdrawn, which last for a limited time.
Intoxication: substance intoxication is defined as the development of reversible syndrome of
symptoms following excessive use of substance.

CLASSIFICATION:

According to book In my patient

F10-F19: Mental and behavior disorders due to F12 - Mental and behavioral disorders due
psychoactive substance use to use of cannabinoids.
F10: Mental and behavioral disorders due to use of
alcohol

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F11: Mental and behavioral disorders due to use of
opioids
F12: Mental and behavioral disorders due to use of
cannabinoids
F13: Mental and behavioral disorders due to use of
sedatives or hypnotic
F14: Mental and behavioral disorders due to use of
cocaine
F16: Mental and behavioral disorders due to use of
hallucinogens.

ETIOLOGY

According to book In my patient

Biological Factors
1. Genetic vulnerability: Hereditary factors appear to be involved in the Father was
development of substance use disorders, especially alcoholism. Children of alcoholic
alcoholics are four times more likely to become alcoholics than other
children. Twin studies have demonstrated that monozygotic twins have a
higher rate for concordance of alcoholism than dizygotic twins. Research
estimate that genetics account for 40 to 60 percent of a person's
vulnerability.

2. Biochemical factors: Role of dopamine and norepinephrine have been

implicated in cocaine, ethanol and opioid dependence. Abnormalities in
alcohol dehydrogenase or in the neurotransmitter mechanism are thought to
play a role in alcohol dependence.

3. Neurobiological theories: Drug addicts may have an inborn deficiency of

endorphins. According to another neurobiological theory, enzymes
produced by a given gene might influence hormones and neurotransmitters,
contributing to the development of a personality that is more sensitive to
peer pressure.

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Behavioral Theories
 Behavioral scientists view drug abuse as the result of conditioning or Nothing significant
cumulative reinforcement from drug use.
 Drug use causes euphoric experience perceived as rewarding, thereby
motivating user to keep taking the drug.

Psychological Factors Loneliness as his

 Sense of inferiority nice separated
 Poor impulse control from him, family
 Low self-esteem conflict, no job
 Inability to cope with the pressures of living and society. satisfaction
 Loneliness, unmet needs
 Desire to escape from reality
 Desire to experiment
 Pleasure-seeking
 Machoism
 Sexual immaturity.

Social Factors
Peer pressure
 Religious reasons
Poor job
 Peer pressure
satisfaction
 Urbanization
 Unemployment
 Overcrowding
 Poor social support
 Effects of television and other mass media
 Occupation: Substance use is more common in chefs, barmen, executives,
salesmen, actors, entertainers, army personnel, journalists, medical
personnel, etc.

Easy Availability of Drugs

 Taking drugs prescribed by doctors (for example, benzodiazepine
dependence)

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 Taking drugs that can be bought legally without prescription (for example,
nicotine, opioids)
 Taking drugs that can be obtained from illicit sources (for example, street
drugs).

Psychiatric Disorders

Substance use disorders are more common in depression, anxiety disorders

(particularly social phobias), personality disorders (especially antisocial
personality) and occasionally in organic brain disease and schizophrenia.

CLINICAL FEATURES

According to book In my patient

Acute Intoxication  Decreased sleep
 Mild intoxication: It is characterized by mild impairment of  Poor appetite
consciousness and orientation, tachycardia, a sense of floating in the air,  Weakness
euphoria, dream-like states, 'flashback' phenomena, alteration in  Poor interaction
psychomotor activity, tremors, photophobia, lacrimation, dry mouth with others
and increased appetite.  Lack of interest in
 Severe intoxication: It causes perceptual disturbances like work
depersonalization, derealization, and hallucinations.  Irrelevant talk
Withdrawal Symptoms  Self-muttering
 They are mostly found in the first 72 – 96 hours and include increased  Heaviness in head
salivation, hyperthermia, insomnia, decreased appetite and loss of  Dizziness,
weight. drowsiness
 Sadness of mood
 Tremor and tingling
sensation in limbs

INVESTIGATIONS AND DIAGNOSES

According to book In my patient

 Serum electrolyte analysis e.g.-  Psychiatric history: marital conflict, lack of children,
sodium, potassium, calcium, separate from niece, loneliness
chloride.  Physical examination

20
 Blood alcohol level to rule out degree  Mental Status Examination (auditory and visual
of alcoholism (ethanol test). hallucination, worthlessness ideas)
 Hematology Total Blood Count:
 Hb: 13.9 gm, RBC: 3.99
 Liver function test.
 TLC: 10200
 Pancreatic enzyme test: amylase,  Platelet: 242000
lipase, alkaline phosphate.  DC: N – 68, L – 25, E – 02, B – 01, M – 04
 Magnesium test, it can be low in  ESR: 18
Blood Glucose:
those who are alcoholic due to
 FBS: 84
insufficiency dietary intake and loss  PPBS: 101
by the kidney. Kidney function Test
 Comprehensive metabolic panel to  Bl. Urea: 26.44 mg/dl
 S. Creatinine: 1.5 mg/dl
evaluate organ or liver function.
Liver function test
 CDT (carbohydrate deficient  Total bilirubin: 1.51
transferring) is a collection of various  Conj. Bilirubin: 0.51
isoforms of the iron transport protein  Unconj. Bilirubin: 1
 SGOT: 38
transferring. Alcohol consumption
 SGPT: 19
above 50-80 g/dl for 2-3 weeks  ALP: 126
appears to increase serum  GGT: 17
Total protein: 6.93
concentration of CDT.
A: G: 1.22:1
 Physical examination. TSH: 1.4
Imaging test. Urea: 8.56 
Creatinine: 0.55
Electrolyte Estimation
 Serum Na+: 136 mmol/L
 Serum K+: 3.9 mmol/L
Serology: Non-reactive
HbsAg: Non-reactive
RTPCR: Negetive
Urine R/E, M/E
 RE: ketone body (+)
 ME: pus cell: 1 – 2/ ul, epithelial cell: 2 – 3/ul
ECG – LVH
 HR: 99
 QRS: 89
 QT/ QTC: 358/459

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 TREATMENT:

According to book In my patient

Pharmacotherapy: Drugs:
 Antidepressants: Selective serotonin reuptake inhibitors are the class Tab. Risdone LS 2+2
of antidepressants that works very effectively on the serotonin 1/2 – x – 1/2
neurotransmitter system. The medicines that belong to the class of Tab. Divaa OD 250 mg
SSRIs to treat OCD are – citalopram (Celexa), escitalopram 1–x–1
(Cipralex/Lexapro), paroxetine (Paxil), sertraline (Zoloft), fluoxetine Tab. Zapiz 0.5 mg
(Prozac), fluvoxamine (Luvox). x–1–1
 Anxiolytics: benzodiazepines Tab. Nicotex 2 mg
1–1–x
Congnitive Behavior therapy:
Tab. Boyantin 150 mg
 Exposure and response prevention: This is vivo exposure procedure
x–1–x
combined with response prevention techniques. For example,
compulsive handwashers are encouraged to touch contaminated
Behaviour therapy
objects and then refrain from washing in order to break the negative
reinforcement chain.  Activity scheduling

 Thought stoppage: thought stopping is a technique to help an is done

individual to learn to stop thinking unwanted thoughts. Following are  Relaxation

the steps in thought stopping: techniques (deep

 Sit in a comfortable chair, bring to mind the unwanted thought breathing exercise,

concentrating on only one thought per procedure progressive muscle

relaxation,
 As soon as the thought forms, give the command 'Stop!' Follow
meditation)
this with calm and deliberate relaxation of muscles and diversion
of thought to something pleasant  Group activities

 Repeat the procedure to bring the unwanted thought under control.  Occupational

 Relaxation technique: It includes deep breathing exercise, progressive activities

muscle relaxation, meditation, imagery and music.

Other therapies:
 Supportive psychotherapy
 ECT: for patients' refractory to other forms of treatment.

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 NURSING CARE PLAN

Assessment Nursing Goal Planning Intervention Evaluation

diagnosis
Subjective Risk for injury STG:  Patient should be placed in a  Patient is kept in close Patient did not
data: related to To help the client room near to the nurse's station or observation experience any
Heavy ness in hallucinosis, to protect himself where the staff can observe the  patient is frequently observed for physical injury.
head substance from injury patient closely. withdrawal symptoms
Drowsiness withdrawal as  Patient's sleep pattern should be
evidenced by  Patient's sleep pattern is
LTG: monitored; he may need to be
Objective drowsiness, monitored
restrained at night if confused or
data: tingling To prevent if he wanders or attempts to climb  Vital signs should be checked in
inability to sensation in infection and out of bed every 15 – 30 munities.
identify limbs, inability disability
 Vital signs should be checked in  Environmental stimuli are kept
potentially to identify every 15 – 30 munities. minimum (bright lights,
harmful potentially  Environmental stimuli should be television, visitors).
situations. harmful kept minimum (bright lights,  Seizure precautions are instituted
situations. television, visitors) when the (padded tongue blade and airway
patient is restless, irritable or at bedside. raised side-rails, etc.)
tremulous
 Institute seizure precautions  Patient is reoriented to person,
(padded tongue blade and airway time, place and situation as
needed
at bedside. raised side-rails, etc.)
 Patient should be reoriented to  Simple, direct, concrete language
person, time, place and situation are used while talking to the
as needed patient.
 Talk to the patient in simple,
direct, concrete language.

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 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective Ineffective STG:  Patient is to be encouraged to  Patient is encouraged to explore Patient achieve
data: individual To increase the explore options available to deal options available to deal with the ways to bring
use of coping related to ability of the client with stress, rather than resorting stress, rather than resorting to control over
substances to impairment of to bring control to substance use and practice substance use and practice those substance taking
reduce stress adaptive over the substance those techniques. techniques. activities
behavior and taking activities.
problem-  The client should be helped to  The client is helped to set realistic
Objective
solving abilities, set realistic goals. goals.
data: LTG:
evidenced by
Verbal use of To develop  The client should be helped to  The client is helped to identify the
expressions of substances as adaptive coping identify the areas or activities areas or activities need to be
having no coping strategies. need to be controlled. controlled.
control over the mechanisms.
substance  Client should be helped to  Client is helped to identify the
taking identify the alternative ways alternative ways
activities.
 Positive reinforcement should  Positive reinforcement is given
be given for performance of for performance of each positive
each positive activities. activities.

 Patient and family should be  Patient and family is taught that

taught that alcoholism is a alcoholism is a disease that
disease that requires long-term requires long-term treatment and
treatment and follow up. follow up.

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 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective Disturbed STG: Patient will  At first the types and  The types and characteristics of  Patient
data: sensory characteristics of hallucination hallucination are identified. actively
 interact with
Auditory and perception should be identified. participate in
others.
related to
concentrate on  
visual A trustworthy therapeutic A trustworthy therapeutic group

hallucination possible genetic relationship should be relationship is developed with the activities
his task and
factors, developed with the patient. patient.
care
Objective psychological  Hallucinatory behaviour should  Hallucinatory behaviours are  His
data: distress as be interrupted by calling patient interrupted by calling patient by hallucinating
LTG: To help the
evidenced by by his name. his name. behaviours
Self-muttering patient
changes in his  Frequent discussion of  Frequent discussion of are reduced
problem-  to demonstrate hallucination with the patient hallucination with the patient is some extend.
solving pattern, decrease should be avoided. avoided.
muttering of hallucinations  Precipitating factors of  Precipitating factors of
self  to deal with hallucinating behaviour should hallucinating behaviour tried to
hallucinations be identified. identify by taking detail history.
if they occur  Patient should be encouraged to  Patient is encouraged to
participate in group activities participate in group activities
 Positive reinforcement should  Positive reinforcement is given
be given for performance of for performance of each positive
each positive activities. activities.
 Techniques (whistling, saying  Techniques (whistling, saying go
go away) should be taught to the away) are taught to the patient to
patient to dismiss hallucination. dismiss hallucination.

25
 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective Altered family STG:  Role of the patient within the family  Role of the patient within the Family process is
data: process related to To improve should be assessed. family is assessed. improved.
Quarrels and family history of family process
conflict with substance,  Role of the others family members  Role of the others family
family inadequate coping LTG: should be identified members is identified
members skill, recent death
To provide the
in family,
patient with a  Patient should be encouraged to  Patient is encouraged to discuss
Wiling to stay breakdown in discuss her feelings and conflict to her feelings and conflict to the
healthy family
alone family dynamics the family members. family members.
environment
as evidenced by
Objective marital conflict,  Patient should be encouraged to  Patient is encouraged to explore
data: loneliness, explore the available options for the available options for changes
Verbal dependency on changes her behaviour and practice. her behaviour and practice.
expressions of psychoactive
loneliness substances.  Positive reinforcement should be  Positive reinforcement is given
dependency on given for ability to resume role for ability to resume role
psychoactive responsibilities. responsibilities.
substances.
 Information about patient’s illness,  Information about patient’s
the treatment regimen and illness, the treatment regimen and
prognosis should be given to the prognosis is given to the family
family members. members.

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 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective Imbalanced STG:  Nutritional status should be  Nutritional status of the patient is Patient eats meal
data: nutrition, less than To help the assessed. assessed. adequately and
Loss of body patient to shows
requirements,  Patient’s like and dislike regarding  Patient’s like and dislike improvement in
appetite improve his
related to food should be identified. regarding food is identified. weight.
Poor intake of intake of diet
inadequate food
food and fluid and fluid intake  High-protein, high caloric,  High-protein, high caloric,
LTG:
secondary to nutritious diet should be provided. nutritious diet is provided.
Objective To improve
spending
data: nutritional  Patient is to be encouraged to take  Patient is encouraged to take
excessive time in
status meals timely. meals timely.
Weight loss ritualistic
Weakness behaviour as  Small amount diet is to be given in  Small amount diet is to be given
evidenced by frequent interval. in frequent interval.
weight loss,
weakness,  Food should be served in a pleasant  Food should be served in a
anorexia environment. pleasant environment.

 Sit with patient while she eats.  Sit with patient while she eats.

 Body weight should be checked  Body weight is checked regularly

regularly

27
 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective data: Impaired sleep STG:  Patient’s sleep pattern should be  Patient’s sleep pattern is Patient feels
Decreased sleep at rest pattern To help the assessed. assessed. comfortable at
night, Early morning related to patient to get  Plan daytime activities according  Daytime activities are
night and
awakening anxiety, adequate duration of sleep
to the patient's interests, do not performed by the patient.
hospitalization sleep at night is increased.
allow him to sit idle.
Objective data: as evidenced by  A quiet and peaceful
difficulty in  Ensure a quiet and peaceful environment is ensured when
Drowsiness LTG:
falling asleep, environment when the patient is the patient is preparing for
early morning To help the preparing for sleep. sleep.
awakening and patient to  Provide comfort measures.  Comfort measures are given.
drowsiness develop a
regular sleep  Environmental stimulus should  Environmental stimulus is
pattern be kept minimum. kept minimum.
 Patient should be encouraged to  Patient is encouraged to
practice free hand exercise in day practice free hand exercise in
time. day time.
 Patient should be taught to avoid  Patient is taught to avoid
caffeine beverage at late evening caffeine beverage at late
evening
 Mild anxiolytic should be
administered if necessary.  Medications are provided as
per advice.

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 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective data: Knowledge STG:  At first the knowledge level  At first the knowledge level is The patient
Discontinuation of deficit related to To help the should be assessed assessed verbalizes the
treatment. mental illness, patient to understanding of
treatment  Proper information regarding  Adequate information therapeutic
Frequent asking of understand
protocol and the course of treatment, regarding the course of needs.
question regarding the his own
outcome of expected outcome should be treatment, expected outcome
illness and treatment condition and
treatment as given to the patient. are given to the patient.
outcome. therapeutic
evidenced by needs
Objective data: frequent asking  Patient should be encouraged to  Patient is encouraged to
of question, perform the healthy practices perform the healthy practices
Relapse treatment
Noncompliance LTG: and to maintain healthy habits at and to maintain healthy habits
Noncompliance to
of treatment home. at home.
medicines To help the
patient to  All the questions ask by the  All the questions ask by the
participate in patient should be answered with patient are answered with
his treatment proper explanation proper explanation
programme.
 Patient should also teach about  Patient is taught about the
the drug compliance, prognosis drug compliance, prognosis
and complications of the illness. and complications of the
illness.

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PSYCHOEDUCATION

Psychoeducation was given regarding the following points:

 For people with anxiety disorders, the goal is effective management of stress and anxiety,
not the total elimination of anxiety. Learning anxiety management techniques and effective
methods of coping with life and its stresses is essential for overall improvement in life
quality.
 The stress related techniques such as relaxation, guided imagery and meditation, should be
taught to the patient to encourage him to practice regularly.
 The patient is taught about medications and lifestyle changes like, exercise regularly, eat
well-balanced meals, get enough rest and sleep.
 The patient should be educated about the physiology of anxiety, early symptoms of anxiety
so as to prevent it from escalating (for example, sweaty palms, racing heart, difficulty
concentrating or attending).
 Educate the patient and family about medications (therapeutic dose, frequency of
administration, side effects, untoward effects) and the importance of compliance.
 Patient is taught to identify stressors and situations that promote or exacerbate anxiety and
to avoid them as much as possible.
 Teach the patient and family how to access community resources and support groups,
reliable educational sources on the internet.
 Informed the client and the family about the importance of taking the medicines regularly
and not to discontinue the drug until the doctor tells. And also, the side effects and sign of
toxicity of antipsychotic drugs and the need to seek medical attention immediately.
 Patient is advised to come for follow up. Follow-up interventions are helpful especially for
anxiety disorder patients. During follow-up meet the patient and family members to discuss
realistic expectations for the patient.

CONCLUSION

Drug use and addiction cause a lot of disease and disability in the world. Recent advances in
neuroscience may help improve policies to reduce the harm that the use of tobacco, alcohol,
and other psychoactive drugs impose on society. Drug dependence and mental illnesses often
affect the same individuals. The cost-effective treatment and management of drug dependence
can save lives, improve health, and reduce costs to society. So, it’s better to early identification
and treatment of such patients.

30
BIBLIOGRAPHY

1. Morgan Karyn I, Townsend Mary C. Psychiatric Mental Health Nursing. 9th Edition. New
Delhi: JAYPEE the Health Science Publisher;2020. Page no 400 – 450.

2. Kapoor B. Textbook of Psychiatric Nursing. 2nd Edition. Delhi: Kumar Publishing House;
volume II. 2001. Page no 392 – 400.

3. Sreevani R. A Guide to Mental Health & Psychiatric Nursing. 3rd Edition. New Delhi:
JAYPEE Brothers Medical Publishers (P) LTD; 2010. Page no 240 – 258.

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