SOCIO-DEMOGRAPHIC DETAILS

The patient is 33 year old Muslim unmarried male undergraduate

student living in nuclear family from urban areas, belongs to middle
socio economic status. He was brought to IMHANS by his father.

CHIEF COMPLAINTS
 AGGRESSION
 SUSPICIOUSNESS
 WANDERING BEHAVIOUR
 POOR SELF CARE
 IRRITABLITY

TDI: 6years
EXCERBATION: 1 MONTH
NATURE OF ILLNESS
 ONSET : Insidious
 COURSE: Fluctuating
 PROGRESS: Improving
PREDISPOSING FACTOR
Family history of psychiatric maternal aunt.

PRECIPITATING FACTOR
Business problems
PERPETUATING FACTORS
Poor compliance to medication

HISTORY OF PRESENT ILLNESS

The patient was in his usual state 7 years back. When he dropout to
College in the middle graduation and he told his parents that he
didn't like to go to college anymore and wants to start his own
business. But his father refused his idea and wanted him to complete
his graduation. But he does not resume his studies by saying that he
forget everything whatever he read or learn. He continues to
motivate his father and finally his father was agreed to invest in his
business. He started a business in dealership but his plan doesn’t
work as he wanted. He again approach his father to invest another
business .This time his father doesn’t allow to invest again he
refused. He started to fight with his father and stopped talking with
his family, and he isolated himself from his family. He didn't let
anyone to enter his room. He turned off the lights in his room and
wants to stay on his bed. He used to think about his future. After
some time, his family noticed that he didn’t take bath from many
days. His family reported that he started to throw the house hold
utensils, and his family took him to private physician and he
prescribed some medication. But after some time his condition gets
worsened and he started to eat less (earlier he used to eat a plate of
rice), Even his mother cooks his favourite meals but he didn't eat. He
stayed away whole night from his home. They took him to another
doctor and he put him on medication where his condition improved
but after some time he discontinued his treatment on his own. After
that he became suspicious about his family that they are mixing
medicines in his food, he used to change his plate by serving his food
on his own. And sometimes he used to eat outside. Whenever he
saw his sisters in his house he started to abuse them, then again his
family took him to the same doctor, he prescribed some medicines,
but the patient doesn’t continue the medicine and starts to
complaint again. Due to discontinuing his medicines he never
touched the borderline and also his appetite and sleep decreases
during the period.
Since last one year, he doesn’t eat anything at his home and also he
used leave the house with scooty in the morning and used to roam
around and used to eat food outside every-day and used to come
home very late. He said in the morning that I want one thousand in
my pocket, after spending the money he doesn’t remember where
he spent the whole money. He started hearing voices from far away
and commands him to laugh and also he reported that he cannot
control his laugh and is laughing continuously along with the voice he
is hearing, he don’t have any control on his laugh and sometimes he
heard that two people are talking about him, the condition remains
same from the last three months. One day during winter, in the
morning his father told him not to go outside wearing summer
clothes, but he got angry due to his father and he started to beat his
mother, and then the family brought him to IMHANS for better
treatment.

NEGATIVE HISTORY
There were no significant negative history.

PRESENT TREATMENT HISTORY

Tab > Olanzapine 10 mg {BD}
Inj. > Lopez 1 amp I-M {BD}
Cap > PAN D 1 am {BBF}
Tab > Lorazepam 2mg T-D

PAST PSYCHIATRIC ILLNESS

Patient was in his usual state of mind 5 years back, when his business
partner broke the promise of dealership. He was taken to various
psychiatrists and faith healers but his condition doesn’t improve
because of poor compliance to medicines.

MEDICAL HISTORY
There was no significant medical history, the informant reports were
lost.

FAMILY HISTORY
GENOGRAM
 68 YEAR OLD
64 YEAR OLD

33 YEAR OLD
35 YEAR 29 YEAR
OLD patient OLD

The patient lives in a nuclear family with 5 members, comprising of

his father 68 years old, his mother 65 years old, his sister 35 years
old and his younger sister 29 years old. His father is the only bread
earner in family. The patient is 2nd in birth order and has good
relation with his mother. The attitude of family toward the patient
tends to be carrying and supportive. He enjoys good family support.
The family history is suggestive of psychiatric illness in his maternal
aunt.

PERSONAL AND SOCIAL HISTORY

Birth and development history:
Patient is born out non-consanguineous marriage, and born out of
full term normal delivery. There were no pre-natal and post natal
complications, patient achieved his normal development milestones
at appropriate time. There were no development delays reported,
birth cry was also present.

Childhood History:
The patient's primary caretakers were his parents. The financial
condition of the family was stable and patient was emotional
attached to his mother. But the home atmosphere was not good and
the patient was affected due to bad home atmosphere.

PLAY HISTORY
The patient liked to play outdoor games with his friends. He had so
many friends whom with he used to play cricket and his favourite
game was cycling.

EDUCATIONAL HISTORY
The patient was undergraduate student and was very interested in
studying but his dream was to become a good business man so he
left studies in between and starts do business but his business
doesn’t work as he planned and due to loss in business he got
psychiatric illness.

PREMORBID HISTORY
The patient was solace and spends most of his time being alone, he
rarely interact with people socially. He was attached to his mother
and was very poor in making friends.

USE OF LEISURE TIME:

The patient was spending most of his time in thinking about his
business and how to expand his business more.
PREDOMINANT MOOD:
He was aggressive towards his family.

ATTITUDE TOWARDS SELF:

The patient was self-conscious and he often compares himself to
others on a contrary, he considered himself as full of potential but
was unable to meet his potential. He had good relation with others
except his family members. He prefers company over solitude.

ATTITUDE TOWARDS WORK:

The patient was reported to be responsible towards any work, he
used to help his mother in home chores.

RELIGIOUS BELIEFS AND MORAL ATTITUDES:

The patient likes to be as neat and clean every time. He used to
offer his prayers on time, his religious belief was very strong and he
finds peace while visiting the shrines.

FANTASY LIFE:
He left his studies early because he wants to become a good
businessman.

ALCOHOL AND SUBSTANCE HISTORY:

No significant history of alcohol and substance use.

MENTAL STATUS EXAMINATION {MSE}

GENERAL APPEARANCE AND BEHAVIOUR:
Young male with average built, poorly groomed sitting comfortably
on bed, dressed as per weather and culture.

EYE CONTACT: Eye contact was initiated and maintained

ATTITUDE TOWARDS EXAMINER:
Co-operative

RAPPORT:
Easily established.

PSYCHOMOTOR ACTIVITY:
Psycho motor activity was decreased as the patient was sitting
comfortably on the bed during the whole interview.

SPEECH:
The speech was soft audible and low in intensity with low volume,
and the rate of speech was norms, pitch was norms, reaction was all
the time relevant and coherent.

MOOD AND AFFECT:

MOOD: The patient verbalised his mood as acha hai.
AFFECT: Congruent to mood,
REACTIVITY: Normal.

THOUGHT:
STREAM: Flight of ideas
FORM: Audible hallucination

CONTENT: Marriage ideations

POSSESSION: NIL
COGNITION: Oriented to t/p/p
CONSCIOUSNESS AND ORIENTATION:
The patient was fully aware and conscious, and was oriented to time,
place, and person.

ATTENTION AND CONCENTRATION:

Patient was asked to repeat 3 digits, he could repeat the forward
digits. But when asked to repeat the same digits backward. He wasn't
able to repeat, his concentration was checked by asking a question
when we subtract seven from ten he answered it correctly.

MEMORY:
 IMMEDIATE MEMORY: Intact
 RECENT MEMORY: Intact
 REMOTE MEMORY: Intact

INTELLIGENCE:
The patient was asked about the current leaders of the country and
general information like in which state do you live, he could
adequately answered.

JUDGEMENT:
SOCIAL JUDGEMENT: Intact
PERSONAL JUDGEMENT: Intact
TEST JUDGEMENT: Intact
IMPRESSION: Intact

PERCEPTION:
Patient denies any abnormal perception.

INSIGHT GRADE- 5
PROVISIONAL DIAGNOSIS:
With Schizophrenia, 33 years old Muslim unmarried male belongs to
nuclear family with middle socio-economic status present with the
duration of illness one month with insidious onset and deteriorating
with complaints suspiciousness, wandering behaviour, aggression,
irritability, and poor self-care with grade-5 insight.