SOCIO DEMOGRAPHIC DETAILS

The patient is 55 year old married Muslim male, currently socio-occupationally

dysfunctional since 3 years, studied till 6th class, living in an extended family,
belonging to middle socio-economic status accompanied by son presented in
the hospital.

CHIEF COMPLAINTS
 LOW MOOD
 CRYING SPELLS
 SUSPICIOUSNESS
 LOW SOCIAL INTERACTION
 SELF MUTTERING /SELF LAUGHING
 RESTLESSNESS

TDI: 3YEARS

EXCERABATION
2MONTHS

NATURE OF ILLNESS
 ONSET OF ILLNESS :
 INSIDIOUS

 COURSE OF ILLNESS:
EPISODIC

 PROGRESS OF ILLNESS:
DETERIORATING

PREDISPOSING FACTORS
 Conflicts with cousin brother about land
 PRECIPITATING FACTORS
 Property dispute , GI bleed
PERPETUATING FACTORS
 Getting angry after seeing his cousins , he feels down
 Poor compliances to medications

HISTORY OF PRESENT ILLNESS

The patient was in his usual state of health 3 years back, when he was involved in
an ongoing property dispute with his cousin and the matter was subjudice since
2009. After a long drawn court battle, he was hopeful that the case will go in his
way but unfortunately it went the other side. After that the family noticed some
changes in his behaviour evolving over a period of 2-3 weeks. He began interacting
less with family members and when he was asked about this, he did not provide
any reason for this. On some occasions, the family noticed that he used to get
restless, pacing around the house and need to go outside aimlessly and returned
within quick time .There were a few episodes of crying as well during night. He
started skipping prayers especially early morning ones which was not the case
earlier when he used to wake up early and then go to mosque for offering prayers.
He stopped taking part in family discussions and when he was asked to provide an
opinion about some financial matters of the family, he used to hesitate and
appeared to doubt himself while earlier he used to actively participate in family
discussions and was usually the go-to person whom every member of the family
sought advice from. Before he used to be very active nut now he has no interest in
anything .He became silent completely.
According to the attendant, the patient develops the complaint about being
restless, he used to suspect neighbours that they will take away his property, he
became suspicious about neighbours, he start laughing with himself and does not
interact with people. He start talking to himself. According to the informant, the
patient was overthinking and giving odd postures while walking outside. He used
to get angry when he sees his cousin and his sons he gets so irritated, but he could
not express his anger and cannot express his feelings. According to the attendant
the patient was looking very disturbed with his facial expressions, the patient used
to pray and changing his position while being in sajda, he goes backward in sajda.
He keep thinking and when asked about what he is thinking, he won’t respond and
will keep staring at the person continuously in the same posture. The attendant
also make complaint about the patient that he suddenly runs away while sitting in
family , they had family business of apple orchards ,he used to sit there and
suddenly feels irritated and runs away and returned within quick time. The patient
becomes suspicious about neighbours and even fought with one of them over the
issue. Though the family repeatedly tried to convince him that the neighbours
have not occupied the land, and it is there as it was since long, he didn’t budge
and was firm in his belief. After a few weeks had passed, the family now noticed a
weird thing about him. He became completely silent, did not respond to anything,
used to remain still, staring at the wall continuously for 10-20 minutes at a stretch.
This prompted the family to seek a psychiatric consultation [in Oct]. He was put on
medication and there was significant improvement in his symptoms. He started
talking and interacting with his family members, started praying regularly even
going to the mosque, actively participated in family discussions, started going to
the orchards again and worked there and even the suspiciousness was also gone.
He was doing well for three months on treatment.He stopped taking medications
due to some GI symptoms, which deteriorated over a period of some days and
suffered a GI bleed for which he was admitted in Baramulla hospital in 2021 for 10
days under the treatment of Dr. Mohammad Yousuf. According to the attendant
the first episode was seen on 26 November 2019 when he became completely
silent and when asked about anything he does not respond ton anything then
after that he was put on medication and there was significant improvement in his
symptoms. He started doing work in orchards and also started participated in
family function as well. He was doing well after putting him on medication.
Second episode was seen in Oct 2021, when he again start doing weird action,
again he had similar symptoms as previous episode with low social interaction,
easy suspicious, became silent again, un-responsiveness. This episode lasted for
around six months [May 2022] when the family again sought psychiatric help, he
was again put on treatment. The symptoms again resolved and he start doing well
while being on treatment. In Oct 2022 he had a fresh episode of being suspicious,
remains silent, stay still in one position, and low social interaction, self-smiling ,
talking to himself, staring continuously in the same posture for prolonged, even
being on treatment but after that he was advised to get admitted in psychiatric
hospital Rainawari.

PAST PSYCHIATRIC HISTORY

In 2019, when the patient complaint of being restless, low mood, low social
interaction, and remains silent, he was taken to Dr. G A Wani and continued his
treatment for 3 months and start doing well. After that in Oct 2021 according to
the attendant, the patient stops taking medicine again and complaints again about
being restless and stop talking then after that he was advised to take psychiatric
consultation.

MEDICAL HISTORY
In 2021 the patient was suffering from GI bleed and was under the treatment of
Dr. Mohammad Yusuf and admitted in Baramulla for 10 days but according to the
attendant, the patient was recovering from the medication and then the
medication was discontinued by the patient himself.

NEGATIVE HISTORY
No history of diabetes
No history of excessive talking
No history of reckless spending
No history of excessive hand-washing
No history of forget-fullness

PREVIOUS TREATMENT HISTORY

 TAB > LOPEZ 4mg 1/2 TID
 TAB > ADMENTA 10mg OD [M]
 TAB > PANTIOD 40mg OD
 TAB > AMANTADINE 50mg OD[BT]
 SYP > DIVALPROEX SODIUM [250/5] 5ml [BD]
 FAMILY HISTORY
GENOGRAM:

PATIENT

55YEAR OLD 53 year old wife

INFORMA SON SON DAUGHTER

NT SON
AGE 28 AGE 26 AGE 24 AGE 22

AGE 2

The patient lives in nuclear family of 5 members comprising of patients

wife 53 years elder son 28 year second son 26 year old third son 24 year
old and a daughter 22years old. The informant is first in birth order.
According to the informant, the patient had good relationship with every
member of the family. However the patient is emotionally attached with
his elder son whom he had spends most of his time. The attitude of family
towards patient tends to be caring and supportive. The family is worried
about patient’s health and wants him to get well soon. The patient’s
behaviour towards his family was good. There is no psychiatric illness in
the family.
PRESENT TREATMENT
 SYP > DIVALPROEX SODIUM [250/5] 5ml BD
 INJ > LOPEZ 1mg 1/M BD
 ECT

PERSONAL AND SOCIAL HISTORY

BIRTH AND DEVELOPMENTAL HISTORY
Patient is born out of non-consanguineous marriage and born out of full term
normal delivery. According to the attendant, patient is second in order, and
there were no prenatal and post-natal complications. Patient achieved his
normal developmental milestones at appropriate time. There were no
developmental delays reported

CHILDHOOD HISTORY:
The patient’s primary care-takers were parents. Patient was bought up by his
parents. The patient was very beloved and well-behaved child to his parents.

EDUCATIONAL HISTORY:
Patient studied till 5th class. Patient was very respectful to his teachers and in
good relationship with teachers and his classmates and friends.

PLAY HISTORY:
The patient had good interest in games like cricket in his childhood. He liked to
play outdoor games more than indoors. Even if he played, he used to play
indoor hide and seek with his siblings and cousins.

OCCUPATIONAL HISTORY:
Patient was doing a job in the year 1989 to 1993, and then he left that job
because of his father’s death in 1993. Then after that he worked as a contractor
eight years [2008-2016], and then he left that job because of his own will.

SEXUAL AND MARITAL HISTORY:

Patient was married as his parent’s choice, and he lived a happy married life. He
is very happy with his married life with duration of 30 years of marriage and is
also happy with his wife.

PREMOBID HISTORY:
 Interpersonal Relationship
The patient easily made friends and liked to interact with new people
and well adjusted.
 Use of leisure time
The patient spends most of his time in thinking and sleeping.
 Predominant mood:
The patient used to remain silent and starring at walls continuously.
 Attitude towards self:
The patient consider himself as he cannot do anything as he was not doing
well presently. The patient had good relationship with his family and with
others when he was well.
 Attitude towards work:
The patient has no interest in doing any work.
 Religious belief and moral activities:
The patient finds peace while visiting shrines, he likes to visit shrines. He
also likes to visit peer baba and also visited them so many times.
 Fantasy life:
The patient wants to get well soon and wants
to start work again in orchards.

MENTAL STATUS EXAMINATION [MSE]

 GENERAL APPEARANCE:
Middle-aged male, average built, moderately groomed and kempt, dresses as
per the weather and culture, sitting comfortably on chair. Behaviour is
constant with time.

 EYE CONTACT:
The patient initiates eye-contact, but doesn’t maintain it for an adequate
duration, but stares at the wall.

 ATTITUDE TOWARDS EXAMINEE:

Cooperative
 RAPPORT:
Partially established
 PSYCHO-MOTOR ACTIVITY:
The patient was sitting comfortably on the chair starring at the wall
continuously during the interview.
 SPEECH:
The speech intensity was low and was not audible, and rate of speech was
also low, quality of speech was soft, and ease of speech was effortless.
Speech was relevant and coherent all the time, self-muttering was also
present.
 MOOD AND AFFECT:
Mood: The patient verbalized his mood as theekh
Affect: Blunt, Incongruent to mood, range restricted and low reaction.
 THOUGHT:
Stream: FLIGHT OF IDEAS
Form: No formal thoughts disorder
Adequate sample couldn’t be taken. Patient is conscious and well oriented
about person, place and time.

 CONTENT:
Nothing abnormal detected
 COGNITION: ORIENTED TO T/P/P.
ATTENTION AND CONCENTRATION: The patient was asked to
repeat three digits. He repeat forward digits correctly, when asked to
repeat backward, he repeats backward three digits correctly.
Consciousness and orientation: Patient was fully aware and is conscious
and well oriented about person, place and time.
 CONSCIOUSESS AND ORIENTATION:
The patient was fully conscious and aware about the time, place, and
person.
 MEMORY:
IMMEDIATE: Intact
RECENT: Intact
REMOTE: Intact

 INTELLIGENCE:
The patient was asked about the current leader of the country and general
information, he gave right answers to the questions. Patient was also aware
of place, when asked about the current place, he answered correctly as I am
in hospital.

 JUDGEMENT:
Social judgement: Intact
Present judgement: Intact
Test judgement: Intact
Impression:
 PERCEPTION:
Denies any abnormal perception.

 INSIGHT:G-1
 PROVISIONAL DIAGNOSIS:
With recurrent depressive disorder psychotic symptoms, catatonia 55 year
old married male belongs to nuclear family with poor socio-economic status,
presents with the duration of illness 2 months with insidious onset and
deteriorating with complaints of low mood, crying spells, suspiciousness,
low social interaction, self-laughing, and restlessness with grade 1 insight.