A Report Submitted For Partial Ful Llment of The Requirement

Rhythm Neuropsychiatry Hospital and Research Center
Mental, emotional problems, mental illness, loneliness, frustrations, stressful life, drugs and
alcohol abuse, migration for better income and partially supported family structure are
increasing in Nepal. Existing Neuropsychiatric services are more focused in clinical OPD
services, based solely on mental illness as a problem and medications as a part of solution
without addressing psychological and support-based system.
In fact, many people may not have mental illness but have problems and issues in life. They
may have break-up or relationship problems, humiliation, anger, low self- esteem, shyness,
and neglect, difficulty concentrating, memory and sexual issues and many more where they
need help. They have coped with their problems by dropping from schools, going into drugs,
alcohol, clubs, fighting and behavioral disturbances and landing in further problems. These
are handled in rehab centers and prison which lacks expertise.
The area of overlap of neurology and psychiatry e.g. Headaches, sexual problems, epilepsy
and seizure disorders, tiredness, sleep disturbances, weakness, personality changes,
memory disturbances are treated without learn work of Neurologist and Neuropsychiatric.
Therefore, there is a need for holistic care system focusing on problems and illness under
same roof. Rhythm neuropsychiatry hospital is a specialized 25 bedded hospital focusing on
comprehensive aspect of care ranging from psychiatric and psychological services, dealing
with emotional issues, strengthening personality, de addiction services (drugs and alcohol)
and allied neurological services under single umbrella with well qualified team. We exist to
bridge this gap, to provide quality services of all under a single umbrella to bring back
rhythm of your life (Hospital).
Rhythm Neuropsychiatry Hospital and Research Center Private is a pioneer neuropsychiatric
hospital in Nepal, established by the private sector and registered as per the Company Act
2063. It has been into operation since 1 st September 2015. The main motto of this hospital is
to provide comprehensive quality mental health care services which are within the
affordable range of the public. lt is the first neuropsychiatric, alcohol and drug related
hospital run by the private sector, accredited by the Department of Health Services, Ministry
of Health and Population, Nepal.
Rhythm Neuropsychiatry Hospital is run by a team of qualified professionals. It is the first
and the only 25 bedded psychiatric hospital of the private sector in Nepal. Follow up,
excellent communication skills, empathy and compassion, professionalism, removing ego
from the equation in care and prioritizing what is in the best interest of the patient is the
main motto.
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The Objectives of RHYTHM are as follows:
 To provide comprehensive, quality mental health services at a cost affordable to the

general population
 To increase awareness related to mental health in the general population by
organizing mental health camps and community awareness programs through use of
mass media
 To initiate teaching learning activities and academic programs in disciplines related
to mental health
 To provide environment for conducting research activities related to mental health
 To initiate new services related to mental health in Nepal
The Special Features of RHYTHM includes the following:
 24 hours admission facility for patients with mental illness and substance use
disorders and 24 hour Emergency Services
 Doctors available round the clock
 Attendants not needed for inpatients. Inpatient care is done by the hospital staffs
 Prime Location (500 meters from Ekantakuna Ring road)
 Peaceful and pleasant surroundings
There are a wide range of services available in the hospital. Some of the available services of
the hospital are as follows:
Specialized outpatient psychiatric care services (Specialized OPD)-
a) For all psychiatric disorders — Schizophrenia, Mania, Bipolar disorder, Depression,
Anxiety, Drug and alcohol related problems, Psychosexual disorders, Somatoform
Disorders, and Childhood onset mental disorders.
b) For Neuropsychiatric conditions — Dementia, Epilepsy, Chronic headaches and
Chronic Pain Syndromes, other organic psychiatric conditions.
The services of the hospital are:

1. 24 hours Psychiatric Emergency Service: RHYTHM NEUROPSYCHIATRY HOSPITAL
AND RESEARCH CENTRE PVT. LTD. is the first hospital that is exclusively providing the
first 24 hours neuropsychiatric, alcohol and drug related emergency service in Nepal.
The centre provides excellent service in any neuropsychiatric emergency conditions.
2. Mobile Crisis Team: RHYTHM NEUROPSYCHIATRY HOSPITAL AND RESEARCH CENTRE
PVT. LTD. has developed a mobile crisis service, to help those patient and families
who are in such difficulty that they are unable to come to the hospital for
assessment/treatment and require assistance. Working in collaboration with doctors
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and mental health professionals of the hospital, the staffs are able to go to the
patient’s home on their family invitation and assess and assist their transfer by
ambulance to Rhythm Neuropsychiatry Hospital, in case of a crisis/emergency
situation. Community mental health services and referral centre: RHYTHM
NEUROPSYCHIATRY HOSPITAL AND RESEARCH CENTRE PVT. LTD. has built link with
different organizations for outreach mental health clinic, specialist neuropsychiatric
consultation service, specialist referral, emergency referral, training of the available
manpower in issues related to mental health.
3. Pharmacy: RHYTHM NEUROPSYCHIATRY HOSPITAL AND RESEARCH CENTRE PVT.
LTD. now have a DDA approved specialist pharmacy in the hospital that is dedicated
to stocking full range of neuropsychiatric medications, so that the patients will no
longer have to search high and low for pharmacies that reliably stock the latest
medications that are prescribed.
4. Outpatient Services (OPD): RHYTHM NEUROPSYCHIATRY HOSPITAL AND RESEARCH
CENTRE PVT. LTD. have well renowned Consultant Neuro psychiatrist to handle
outpatient services in a pleasant and silent environment. The OPD team is always
ready to help persons with problems and difficulties.
5. Inpatient Services: 25 bedded inpatient unit (15 beds for males and l0 beds for
females) with internet protocol-based surveillance facility.
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CASE- I
BIODATA OF THE PATIENT

Name: MBK Shrestha
Sex: Male
Age: 65 years
Address: Gorkha
Education: illiterate
Occupation: Self owned shop
Religion: Hindu
Ethnic group: Newar
Marital status: Married
Diagnosis: BPAD/ Bipolar Affective Disorder (Manic)
Date of admission: 2073-10-11
INFORMANT’S INFORMATION
Name: MRK Shrestha
Age: 40 years
Relation: elder son
Intimacy: close relationship
Length of acquaintance: since birth
Reliability of information: reliable
Adequacy of information: adequate
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PRESENTING COMPLAINTS
Considering the patient party, complaints since l month are:
 restless
 self-murmuring at night
 decreased sleep
HISTORY OF PRESENTING ILLNESS

Total day of illness: 36 years
Onset: insidious
Course: continuous
Severity: moderate
Precipitating factor: intake of alcohol
According to the informant (elder son) patient was apparently well 36 years back when
while running a tea shop in Gorkha, he developed symptoms like cooking up at night. He
used to be restless and used to do household works at the middle of night. He used to take
shower and fetch water. The patient was not aware of the time. Gradually the sleeping
pattems got changed and gradually sleep decreased. The alcohol intake was increased and
finally reached the excessive level. There was a periodic change on the mood from high
aggression to silent. The patter of alcohol consumption was excessive but on the gap of 10-
15 days.
Then, he was taken to Dr. BB Shanna. After the observation by psychiatrist the patient was
under medication and became symptom free for short span of time (app. 2-3 months). He
acted normally as usual on the symptom free time. Since then he was under psychiatric
observation and medication. But before admitting to this hospital, he showed the unusual
symptoms like crying loudly without any reason, restlessness, insomnia, murmuring, talked
on irrelevant topics etc. Due to his restlessness the patient stumbled on the stairs and was
taken to the clinic of BB Sharma and for further treatment was referred to Rhythm.
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HISTORY OF PAST ILLNESS
Medical and surgical history: There is no history of any medical problems, hospitalizations,
surgeries or evidence of head injuries.
But patient has been inhaler for breathing difficulties as per suggested by villagers rarely.
Psychiatric history: There is no history of any psychiatric problems.
FAMILY HISTORY
Type of family: Joint family with mother and his family
Total no of family member: 8 members
Not any significant disease in the family.
Index
Patient
Male
Female
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BIOLOGICAL SYMPTOMS
Sleep: Decreased
Appetite: Altered
Weight: Well built
Bladder: Habit is as usual. There is no history of buming sensation and difficulties in
urination.
Bowel: Habit is as usual, there is no history of loose stools and constipation.
Libido: Low
Personal care: Not well maintained
Work Performance: Difficulty on socio-economic functioning.
Personality: Personality has been significantly changed with the onset of illness. He has
been aggressive sometimes and act anti-socially.
PERSONAL HISTORY
Perinatal history
Patient while birth was a full termed baby born with a normal delivery at home. There were
no such complication noted during birth. Antenatal period was neither supervised nor
vaccinated. Other information about the perinatal period is not available.
Childhood history
Detail regarding childhood history was not available. As per the patient’s knowledge
childhood development was average and not any type of neurotic symptoms were not
present.
Educational history
Not attended the formal education.
Sexual history
Unavailable
Work history
Owned his own small business i.e. shop on local areas along with famiing
Substance abuse
No history of Substance abuse but has the history of alcohol intake.
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PRE-MORBID PERSONALITY
Traits
The prominent traits were found to be social.
Interpersonal relationship: He had good IPR among his family members and fiiends
He used to work on his own shop.
Use of leisure time: Involved in no other activities than his usual works.
Pre-dominant mood: Worries on his farming and business.
Attitude to self and others: Sometimes feels shy regarding his problem.
Attitude to work and responsibilities: Dedicated to his work and always respectful towards
his responsibilities and sincere towards his duties.
Religious beliefs and more attitudes: Theist
Habit: Smoking and alcohol uses but left back 6 yrs.
EXAMINATION OF PATIENTS
PHYSICAL EXAMINATION
Restless and disoriented to time, place and person. (Seen)
All physical examination was done and was nonnal in findings.
MENTAL STATUS EXAMINATION

Appearance: Age appropriate
Facial expression: Blunted
Level of grooming: Decrease
Level of cleanliness: Inadequate
Level of consciousness: Drowsy
Behavior: Normal
Eye-to-eye contact: Not maintained
Rapport: Good But not enough
Gesturing: Normal
Posturing: Normal
Hallucinatory behavior: Present
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SPEECH
Initiation: Minimal and speak when spoken to
Reaction time: Delayed
Rate: Normal
Volume: Normal
Tone: Normal
MOOD AND AFFECT

Subjective: Thik cha aahile
Objective: General warmth
Predominant mood state: Worried about his farm and continuity of his left business.
THOUGHT
Stream: There is any thought blocked, flight ideas, unclear thinking
Form: Circumstantiality, tangentiality.
Content of thought: No delusion, obsession, phobias and preoccupation present.
PERCEPTION
Illusion: Present
Hallucination: Auditory hallucination present
ATTENTION AND CONCENTRATON

Attention was aroused and concentration was sustained as tested from serial subtraction
test. He could not perform the serial subtraction 100-7 test and 40-3 test correctly. He could
not tell the days of week, and, months of the year forward and backward.
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ORIENTATION
Sometimes the orientation was good and sometimes he could not specify.
MEMORY
Immediate: Impaired as he could not count to 5 digits forward and backward correctly
Recent: Was not intact as, he could not remember the meals eaten in the morning and last
night.
Remote: Was not intact, he could not tell his birth date, date of marriage and birth date of
his child correctly.
INTELLIGENCE
Considering his level of education and work performance and ability to tackle novel
situation, he is assumed to be of poor intelligence.
JUDGEMENT
Social judgment: Poor as observed during the course of interview.
Test judgment: Poor
ABSTRACTION
He was asked to find out the difference between apple and orange, but he murmured with
himself.
INSIGHT
Absent
DIAGNOSIS
F30-F39
MANAGEMENT PLAN
Pharmacological treatment
Psychological: Cognitive behavioral therapy, Meditation, aversion therapy, Family
intervention
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CASE II

Name: MS BK
Sex: Male
Age : 22 years
Address: Myagdi
Education: Upto class 10
Occupation: Foreign Employer
Religion: Hindu
Ethnic group: Dalit
Marital status: Unmarried
Diagnosis: Paranoid Schizophrenia
lNFORMANT‘S INFORMATION
Name: K BK
Age: 45 years
Relation: Mother
Intimacy: Close relationship
Length of acquaintance: Since birth
Reliability of information: Reliable
Adequacy of information: Adequate
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According to patients
Self-talking
Aggressive towards other employee friends
Excess alcohol intake
History of cannabis intake

Total day of illness: I5 days
Onset: Acute
Course: Continuous
Severity: Started for 15 days
Precipitating factor: Intake of bhang and alcohol
According to the informant he was apparently well 15 days back working as a painter in
Qatar, where gradually self-talking symptoms developed. On his communication with his
mother he had the intense sadness of his low income which apparently fed his mother. In
the meantime the level of aggression directed towards friends was increased. Along with
the intake of alcohol he developed the habit of becoming quarrelsome with peers and
quarreled more times. Subsequently, he was deported back to Nepal. His friend, on a phone
call taken by the MO of the hospital addressed that the patient had taken intense cannabis
with the purpose to release from the tense mood.

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FAMILY HISTORY
Type of family: Nuclear family with parents and sister.
Total no. of family member 4 members
Not any significant disease in the family.
Index
Patient
Male
Female
Death
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BIOLOGICAL SYMPTOMS
Sleep: Disturbed
Appetite: Normal
Weight: Well
Bowel and Bladder: Good
Libido: No change in sexual interest.
Personal care: Well-maintained during the course of illness.
Work performance: Disturbances in socio-economic functioning.
been withdrawn, isolated, disturbed and aggressive.
PERSONAL HISTORY
Perinatal history
no such complications noted during birth. Antenatal period was neither supervised nor
Childhood history
Fine as normal children.
Educational history
His schooling was started around 4 years in a governmental school. His performance was
average. He continued his schooling up to class l0. However, he had to help his parents at
work. So, he would have very hard time at study.
Sexual history
N/A
Work history
He worked as a painter abroad in Qatar.
Substance abuse
He had habits of drinking alcohol and cannabis consumption.
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Traits
The prominent traits were found to be extrovert. He used to avid arguments as far as
possible.
Interpersonal relationship: He had good IPR among his family members, friends and
colleagues. Being extrovert he was more interactive.
Use of leisure time: Enjoy friend’s company.
Pre-dominant mood: Optimistic
Attitude to self and others: Laborious and helpful.
Attitude to work and responsibilities: Responsible to self and work.
Fantasy life: He did not share anything about habit of fantasizing or daydreaming.
Habits: Engaged with friends in outing.
Conscious, comfortable and lying in bed. The weight height ratio is appropriate and all the
physical functioning is good.

Appearance: Age Appropriate
Facial expression: Pleasant
Level of grooming: Normal
Level of cleanliness: Adequate
Level of consciousness: Fully conscious and alert
Behavior: Normal
Cooperativeness: Not Co-operative
Eye-to-eye contact: Not maintained
Psychomotor activity: Normal
Rapport: Spontaneous
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Gesturing and Posture: Normal
Hallucinatory behavior: Absent
SPEECH
Initiation: Spontaneous
Reaction time: Normal
Rate: Decreased
Productivity: Poor
Volume: Normal
Tone: Normal variation
Relevance: Fully relevant
Coherence: Fully coherent
MOOD AND AFFECT

Subjective: kei xaina man ma, Tapailai kina chahiyo
Objective: Anxious and dominant
Predominant mood state: Pleasant
Discrepancies between the affect and emotion
THOUGHT
Stream: Not any thought blocked, flight ideas and unclear thinking
Form: Normal
Content of thought: Absence of delusion, obsession and preoccupation.
PERCEPTION
Illusion: Absence
Hallucination: Presence of Auditory Hallucination.
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Attention was aroused, and concentration was sustained as tested rom serial subtraction
test. He could not perform the serial subtraction 100-7 test and 40-3 test correctly. He could
not tell the days of week, and, months of the year forward and backward.
ORIENTATION
Good. He was oriented to time, place and person. He could correctly tell the year, month,
day, date and time as 2073-10-12. He said that he is in Neuropsychiatric Hospital Jawalakhel
and he was staying in male ward.
MEMORY
Immediate: Intact as he could to 5 digits forward and backward correctly
Recent: Intact in every measure.
Remote: Was intact he could tell his birth date, date of marriage and birth date of his
children correctly.
INTELLIGENCE
situation, he is assumed to be of poor in intelligence. When asked about a young girl
handling an unexpected guest at home, he replied “she should open the door n invite”.
JUDGEMENT
Social judgment: Appropriate according to his behavior during interview.
Test judgment: ln well-stamped envelope test, he said he will try to find out the concerned
person; otherwise he will leave in police office. In house on fire test, he said that he will call
on emergency number and try to control it which was correct.
ABSTRACTION
He was asked to fund out the difference between apple and orange. but he continually said
the similarities between them as they were both juicy n fruits. Abstract was impaired.
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INSIGHT
Insight is rated on a point 6(Emotional insight). His understanding about his problem as a
type of mental illness because of lots of alcohol consumption and is aware of need of
medical help. He is ready to control alcohol.
DIAGNOSIS
F30-F39
MANAGEMENT PLAN
Psychological: Cognitive behavioral therapy, Meditation, aversion therapy
Family intervention
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CASE -III

Name: MPCB
Sex: Male
Age : 29 years
Address: Baitadi
Education: CMA
Occupation: Own medical shop
Religion: Hindu
Ethnic group: Brahmin
Diagnosis: lmuplsive Personality Disorder(ll’D)
Date of Admission: 2073-10-9
lNFORMANT’S INFORMATION
Name: MDRB
Age: 32 years
Relation: Brother
Length of acquaintance: Since childhood
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According to informant
 Physically abusive to second wife

 Does not talk to anyone and stay alone
 Does not listen to others advice
 Does whatever he wants
 Aggressive
 Act antisocially

Total duration of illness: l3 years
Onset: Insidious
Course: Continuous
Severity: Started from the age of 17
Precipitating factor: intake of Marijuana, Alcohol and misuse of medicine like propanolol,
clonazepam.
According to the informant, patient was apparently well 13 years back. Then he fails 10
class. He passed SLC after giving back paper exam. Then after SLC he joined CMA. He used to
take marijuana regularly. He failed CMA exam. His elder brother beat him for failing the
exams. But there was guilt within him. He did not used to accept his habits.
He used to follow girls and be with them, used to establish sexual contact with them. Again.
the patient joined CMA class and at last he passed exam. Then after he went Mumbai for 2-3
years. In Mumbai he worked as a waiter. Then he came back home. His father owned a
medical shop in Baitadi, he started to look after the shop. In every 2-3 days to he used to
close the shop and run away from home and again come back home after l week. He used to
have physical relationship with multiple girls. When he was questioned about his escape,
then he would give many false excuses. He had an affair with a girl in Dolakha. He acted
against the family rituals where he eloped the girl before his elder brother's marriage.
Patient with the girl resided away from home and became contactless for 2 years. He did
not want to meet the other family members saying that he was dead. On multiple appeal
from the family member he finally agreed to get back home with his wife. His wife was
pregnant of 5 months. In such condition the patient sent his wife to her father's home and
married the next girl.
He had the relation with multiple girls and change girls frequently. To show the heroism he
used to change his vehicle frequently. He never used to admit his mistake. Sometimes he
use to shiver and said that he has deities power and the god resides within him. He used to
act accordingly with the person i.e. good with those who accept and bad with those who
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reject his notion. 3 months back his father died due to cardiac arrest and during the time of
mourning he acted differently like talking frequently on phone with unknown. Despite the
objection for not carrying the Barakhi from his elder brother he insisted to carry out Barakhi
for 1 year. On the course of Barakhi, within the month of his father’s death he eloped a girl.
Knowing this, his elder brother consulted police and searched him. They got caught but he
succeeded to escape again and ran away towards jungle. Policeman took the girl to the
custody. After some time patient in search of the girl come to police station with the help of
policeman and in co-ordination with the family member he was brought in this hospital.
Sedenafil citrate tab was found with him. In between that period he 3159 used to take
clonazepam and propanolol.

FAMILY HISTORY
Type of family- Joint family with mother and brothers.
Total no. of family member- 10 members
No any significant disease in the family.
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Index
Patient
Male
Female
BIOLOGICAL SYMPTOMS
Sleep: Decreased
Appetite: Normal
Weight: Appropriate
Absence of bowel and bladder syndrome.
Libido: Increased sexual interest.
Personal care: lt has been maintained throughout the course of illness
Work performance: Poor socio-occupational functioning.
been aggressive, anti-social.
PERSONAL HISTORY
Perinatal history
Childhood history
Detail regarding childhood history were not available. As per the patient’s knowledge
present.
Educational history
average. He continued his education up to diploma then he discontinued his education.
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Sexual history
Unable to take sexual history
Work history
He started working after CMA but he was not sincere in his work. His father opened a
medical shop for him but he used to closed shop for 2- 3 days and ran away from home.
Substance abuse
He had the habits of drinking alcohol and intake of marijuana. Sometime he took
clonazepam and propanolol.
Traits
The prominent trait were found to be social.
Interpersonal relationship: He didn't have good IPR among his family members, friends and
colleagues. He is an extrovert and more deceptive.
Use of leisure time: He used to enjoy with friends.
Pre-dominant mood: He was joyful and social
Attitude to self and others: Like to work and helpful
Attitude to work and responsibilities: He was not sincere and responsible in his work
Religious beliefs and more attitudes: Supposed to be highly religious
Fantasy life: Unshared
Habits: He had habit of social drinking and taking marijuana.
All Physical examination is being done and is found normal

Appearance: Fine
Facial expression: Blunted
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Behavior: Normal but aggressive sometime.
Cooperativeness: Not cooperative
Eye-to-eye contact: Maintained
Psychomotor activity: Increased
Rapport: Difliculty establishing
Gesture, Posture and other Movement: Normal
SPEECH
Initiation is minimal and speak when spoken, reaction time is delayed but rate, productivity,
volume tone, relevancy and coherency are all normal.
MOOD AND AFFECT

Subjective: thik cha, Jail ma rakheka xan
Objective: General Warmth
Predominant mood state: Blimted, aggressive and depressed.
THOUGHT
Stream: there is no any thought blocked, flight ideas, unclear thinking
Form: Normal. There is no any circumstantiality, tangentiality.
Content of thought: Absence of delusion, flight of ideas, phobias, preoccupation but
presence of obsessional thoughts.
PERCEPTION
Absence of illusion and hallucination.
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test. I-le could perform the serial subtraction 100-7 test and 40-3 test correctly. He could tell
the days of week, and, months of the year forward and backward.
ORIENTATION
He was oriented to time, place and person. He could correctly tell the year, month, day,
date and time as 2073—l0-l2. He said that he is in Neuropsychiatric Hospital Jawalakhel and
he was staying in male ward. He recognized me as a medical person student and his family
member correctly.
MEMORY
Immediate, recent and remote memories are all intact.
INTELLIGENCE
situation, he is assumed to be of average intelligence. When asked about a young girl
handling an unexpected guest at home, he replied “she should ask who they are and may
called their parents”.
JUDGEMENT
Social judgment: Appropriate as per the interview observation.
Test judgment: ln well-stamped envelope test, he said he will try to find out the concerned
person; otherwise he will leave in police office. ln house on fire test, he said that he will call
ABSTRACTION
He was asked to find out the difference between apple and orange, but he continually said
the similarities between them as they were both juicy n fruits. Abstract is impaired
INSIGHT
Insight is rated on a point 5(emotional insight). His understanding about his problem as a
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DIAGNOSIS
F60-F69
MANAGEMENT PLAN
Family intervention
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CASE IV

Name: MBKS
Sex: Male
Age: 42 years
Address: Nuwakot
Education: Upto class 6
Occupation: Hotel owner
Religion: Hindu
Ethnic group: Newar
Diagnosis: Alcohol Withdrawl Syndrome (AWS)
INFORMANT’S INFORMATION
Name: MRKS
Age: 33 years
Relation: Wife
intimacy: Close relationship
Length of acquaintance: After marriage
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According to patients
 Self- talking, self- laughing

 Seeing things which other do not see
 Visual hearing same sound for repeated time
 Tremor of whole body also observable
 Decreased sleep

Onset: Insidious
Course: Continuous
Severity: Started since 2 months
Precipitating factor: Alcohol intake
Patient was apparently well 9 years hack, then he started drinking alcohol almost regularly.
There was not observable symptom back 4 months. From 4 months onward the patient
started complaining epigastric pain, left food and gradually became lean and thin. On
doctor’s consultation he took tonic and left alcohol for 2 months.
After leaving the alcohol consumption, tremors started on the patient’s body. The body
shivered on leaving the alcohol. He used to get tremors at the time when he did not drink
alcohol. 2 months back after his mother’s death, he stopped taking alcohol. 6 days back as
he days of alcohol consumption he started showing the symptoms of self-smiling,
unreasonably laughing and shouting without the obvious reason. He started hearing some
sound repeatedly for several times. That was followed by the tremors and disturbances in
sleep.
For these symptoms his visitor consulted Dr. BBS and he referred him to this hospital.

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FAMILY HISTORY
Type of family- Joint family with mother and brothers.
Total no. of family member- 10 members
Index
Patient
Male
Female
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BIOLOGICAL SYMPTOMS
Sleep: Decreased
Appetite: Normal
Weight: Gradual decrease of weight decreased weight.
Bladder and Bowel: No changes good.
Libido: N0 specific change in sexual interest.
Personal care: Maintained throughout the course of illness.
Work performance: His socio-occupational function has been significantly disturbed. He was
unable to carry out daily routine of his life since one month.
Personality change: Personality has been significantly changed with the onset of illness He
has been withdrawn, isolated.
PERSONAL HISTORY
Perinatal history
Childhood history
Detail regarding childhood history were not available. As per the patient’s knowledge
present.
Educational history
average. He continued his schooling up to class 6. He had to help parents. So he had very
hard time at study.
Sexual history
Unable to take sexual history
Work history
He is working as a hotel owner before his marriage.
Substance abuse
He had habits of drinking alcohol. Probably once a month, on family occasion, and on
friends meet. He had the habits of chewing tobacco. Gradually he started drinking daily.
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Traits
The prominent trait were found to be extrovert. He used to have avid arguments as far as
possible.
Interpersonal relationship: Good IPR with all family members and colleagues.
Use of leisure time: Playing cards enjoying with friends.
Pre-dominant mood: Cain; and quiet since childhood.
Attitude to self and others: Helpful and hardworking.
Attitude to work and responsibilities: He was a responsible person towards his work. He
used complete all tasks assigned to him since his earlier days. He used to take major
decisions only after consulting his family members. He is flexible, ambitious, but not a
perfectionist.
Religious beliefs and more attitudes: Belief in god
Habit: He had habit of social drinking and chewing tobacco.
PHYSICAL EXAMINATIONS
Conscious, comfortable and lying in bed.
Vitals:
PR: 86/min RR: 22/ breaths Temp.: 97.6 0F BP: 120/80 mmHg
Systemic Examination
Chest, CVS and P/A: Normal
CNS: Cranial nerves intact
Motor: Tone was normal Reflex: Gait: (N)
Signs of meningeal irritation was absent
Examination Findings: TSH was normal, urine R/E and M/E, CBC, PT/INR, LFT,RFT
RBS, ECG serology was normal, Abd/pelvis USG done, protein albumin also done
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Appearance: Age Appropriate
Level of consciousness: Conscious and alert
Behavior: Normal
Cooperativeness: Cooperative
Gesture, Posture and other movement: Normal
Hallucinatory behavior: Absent
SPEECH
Rate. Volume. Tone etc. are normal.
MOOD AND AFFECT

Subjective: thikai cha
THOUGHT
Stream: Absence of any thought blocked, flight ideas and unclear thinking.
Form: Normal. There is no any circumstantiality, tangentiality
Content of thought: Absence of delusion, obsession, preoccupation.
PERCEPTION
Illusion: Absence
Hallucination: Auditory and Visual hallucination Present
32 | P a g e
Attention was aroused and concentration was sustained as tested from serial substraction
test. He could perform the serial subtraction 100-7 test and 40-3 test correctly. He could tell
ORIENTATION
He had the good level of orientation.
MEMORY
Immediate, recent and remote memory was intact.
INTELLIGENCE
situation, he is assumed to be of average intelligence. When asked about a young girl
called their parents“.
JUDGEMENT
Social judgment: Good
Test judgment: In well-stamped envelope test, he said he will try to find out the concerned
ABSTRACTION
He was asked to find out the difference between apple and orange, but he continually said
the similarities between them as they were both juicy and fruits. Abstract is impaired
INSIGHT
Insight is rated on a point 6(Emotional insight). His understanding about his problem as a
33 | P a g e
DIAGNOSIS
F10-F19
MANAGEMENT PLAN
Family intervention
34 | P a g e
CASE-V

Name: MRG
Sex: Male
Age: 33 years
Address: Butwal
Education: Up to class l0
Occupation: Politician
Religion: Hindu
Ethnic group: Brahmin
Diagnosis: ADS (Alcohol Dependence Syndrome)
lNFORMANT’S INFORMATION
Name: MIG
Age: 28 years
Relation: Wife
Length of acquaintance: After marriage
35 | P a g e
According to the patients
 excessive alcohol intake since 1 and half week

 decreased sleep

Onset: Abrupt
Course: Continuous
Severity: started since intake of alcohol to remove the memory of incidence happened last 8
years.
Precipitating factor: Excessive intake of alcohol.
Previously discharged 2 months back from same hospital, patient was apparently well. 1 and
half weeks back, he started to take alcohol with his business partners. He was going in and
out with his partners which is why he was taking it regularly since then.
Patient was previously a Maoist cadre and involved on the war. He is traumatized by the
incidents happened on war such as:
 Killed a teacher in Gorkha

 While involving on war in Argakhanchi, he heard the news that he was searched by
policeman in his house locality. Such incident made him anxious more and on
returning back to home he developed the suspiciousness that the policeman was
hiding inside his house.
According to the patient after his previous discharge the phenomenon of hypervigilance of
his trauma stopped. He was able to cooperate was daily life and his work. Previously patient
used to take alcohol to forget his past memories.
Before l and half week patient started taking alcohol on his business meeting and after that
he took alcohol for 2nd and 3rd episodes. His sleeping pattern got disturbed being hunted by
the pregnant lady whom he had saved at the time of war.
His alcohol craving phenomenon gradually increased on attending the parties and other
ceremonies. In order to get out from his craving, he admitted to hospital himself.
36 | P a g e
Medical and surgical history: Patient has been under medication because of
hypertension since 3. There is no history of any medical problems, hospitalizations,
Psychiatric history: PTSD
FAMILY HISTORY
Type of family- nuclear family with wife and children.
Total no of family member- 4 members
Index
Patient
Male
Female
37 | P a g e
BIOLOGICAL SYMPTOMS
Sleep: Increased
Appetite: Normal
Weight: Significant loss in weight.
Bowel and Bladder: No bowel and bladder problem.
Libido: Unchanged.
Personal care: Maintained throughout the course if illness.
Work performance: His socio-occupational function has been significantly disturbed. He was
unable to carry out daily routine of his life since one month.
been withdrawn, isolated.
PERSONAL HISTORY
Perinatal history
Childhood history
Detail regarding childhood history was not available. As per the patient’s knowledge
childhood development was average and not any type of neurotic symptoms were present.
Educational history
average. He continued his schooling up to class 6. Due to family problems let his study.
Sexual history
NA
Work history
Previously the war fighter and later involved in business and politics.
Substance abuse
Chewing tobacco and alcohol intake.
38 | P a g e
Traits
The prominent trait were found to be extrovert. He used to avid arguments as far as
possible.
Interpersonal relationship: Good.
Use of leisure time: Enjoy with friends.
Pre-Dominant mood: Sociable and Happy
Attitude to self and others: Enjoy working.
Attitude to work and responsibilities: He was responsible and dedicated in his work but
after the incidence he developed the habit of drinking alcohol to overcome the stress that
leads to negative impact in his daily functioning and his work Religious beliefs and more
attitudes: Belief on God.
Habits: Habits of Alcohol intake.
Normal in all physical examination according to the report

Appearance: Age appropriate
Level of cleanliness: Adequate well maintained
Mode of entry: Self willing.
Behavior: Normal
Cooperativeness: Presence
39 | P a g e
Gesture, Posture and Other movement: Normal
SPEECH
Initiation: Spontaneous
Reaction time: Normal
Rate: Normal
Productivity: Adequate
Volume: Normal
Tone: Normal variation
Relevance: Fully relevant
Coherence: Fully coherent
MOOD AND AFFECT

Subjective: thikai chaa
THOUGHT
Stream: Absence of any thought blocked, flight ideas and unclear thinking
Form: Normal
Content of thought: Absence of delusion, obsession but presence of some sort of
preoccupation.
PERCEPTION
Illusion: Absence
Hallucination: Have auditory and visual hallucination
40 | P a g e
test. He could perform the serial subtraction 100-7 test and 40-3 test correctly. He could tell
ORIENTATION
Well oriented regarding time, place and his present situation.
MEMORY
Intact immediate, recent and remote memory.
INTELLIGENCE
situation. he is assumed to be of avenge intelligence. When asked about a young girl
called their parents".
JUDGEMENT
Social judgement: Appropriate according to his behavior during interview.
Test judgment: In well-stamped envelope test, he said he will try to find out the concerned
ABSTRACTION
He was asked to find out the difference between water and alcohol he frequently answered
both are liquid. Abstract is impaired.
INSIGHT
Insight is rated on a point 5(emotional insight). His understanding about his problem as a
41 | P a g e
DIAGNOSIS
F10-F19
MANAGEMENT PLAN
Family intervention
42 | P a g e

A Report Submitted For Partial Ful Llment of The Requirement

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A Report Submitted For Partial Ful Llment of The Requirement

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Rhythm Neuropsychiatry Hospital and Research Center

 To provide comprehensive, quality mental health services at a cost affordable to the

The Special Features of RHYTHM includes the following:

The services of the hospital are:

BIODATA OF THE PATIENT

HISTORY OF PRESENTING ILLNESS

MENTAL STATUS EXAMINATION

MOOD AND AFFECT

ATTENTION AND CONCENTRATON

BIODATA OF THE PATIENT

HISTORY OF PRESENTING ILLNESS

HISTORY OF PAST ILLNESS

MENTAL STATUS EXAMINATION

MOOD AND AFFECT

BIODATA OF THE PATIENT

 Physically abusive to second wife

HISTORY OF PRESENTING ILLNESS

HISTORY OF PAST ILLNESS

MENTAL STATUS EXAMINATION

MOOD AND AFFECT

BIODATA OF THE PATIENT

 Self- talking, self- laughing

HISTORY OF PRESENTING ILLNESS

HISTORY OF PAST ILLNESS

MENTAL STATUS EXAMINATION

MOOD AND AFFECT

BIODATA OF THE PATIENT

 excessive alcohol intake since 1 and half week

HISTORY OF PRESENTING ILLNESS

 Killed a teacher in Gorkha

MENTAL STATUS EXAMINATION

MOOD AND AFFECT

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