CLINICAL CASE

FOLLOW UP
ANXIETY
(F-41)

BY AKSHAT JAIN
MBBS 2021
DD2114301011
 DETAILS OF THE
PATIENT
•NAME: MR. KASHMIR SINGH
•AGE/SEX: 54 YEARS/ MALE
•ADDRESS: VILLAGE FATUA,HARIDWAR, U.K
•OCCUPATION: FARMER
•MARITAL STATUS: MARRIED
•RELIGION: HINDU
•IPD/OPD: 3048697 (23/50714)
•DATE OF ADMISSION: 12/09/2023
•DEPARTMENT/WARD: PSYCHIATRY / WARD 107
•UNIT IN CHARGE: DR. RANJAN AVINASH PRIYA
•DATE OF DISCHARGE: 17/09/2023
•MOBILE NO. : 7088789400
 CHIEF COMPLAINTS

GHABRAHAT(NERVOUSNESS)
LAZINESS
DECREASED INTEREST IN INTERACTIONS X 2 MONTHS
DECREASED INTEREST IN WORK X 2 MONTHS
 HISTORY OF PRESENT ILLNESS

The patient was apparently well 3 years ago when he started having
Nervousness. At the time when he was taking alcohol daily(90 ml
approx.)
but when he stared having Nervousness he stoped alcohol after 1
month of symptoms . he started treatment from HIMS and after
improvement he started to take alcohol again.
Patient continued treatment for around 1 year after which he
stopped treatment and continued drinking. Around 1 year ago he
again developed complains of Nervousness along with feeling of
impeding doom.then he stopped alcohol once again and he started
treatment from HIMS
FAMILY HISTORY:
Alcohol use in father
PERSONAL HISTORY:
Substance abuse of alcohol , for 20 years , 90 ml/day
abstinence for 1 year then restarted
DRUG HISTORY:
In year 2020

Tab. venlafaxine(37.5 mg)

Tab. Buspirone (5mg)
PROVISIONAL DIAGNOSIS

ANXIETY
ALCOHOL ABUSE
DEPRESSION
 EXAMINATION AND
INVESTIGATIONS
PULSE: 80/MIN
BP: 124/78 MM OF HG
RR: 18/MIN
NO RELEVANT FINDINGS IN SYSTEMIC EXAMINATION
PATIENT WAS CONSCIOUS, AND WELL ORIENTED IN TIME, PLACE
AND PERSON.
HB: 13.7 G
TLC: 5.54 THOUSAND/CUMM
LFT : NORMAL FINDINGS
DEFINITIVE DIAGNOSIS

ANXIETY
(F-41)
 TREATMENT

THERAPEUTIC OBJECTIVE:
REDUCE OVERALL FREQUENCY, INTENSITY
AND DURATION OF THE ANXIETY SO THAT
DAILY FUNCTIONING IS NOT IMPAIRED
 DRUG OF CHOICE

Tab.VANILAFAXINE (SNRI)
* 150mg ( TWICE DAILY)

Tab. BUSPIRONE*10 mg (TWICE DAILY)

 TREATMENT AT THE TIME OF
DISCHARGE
1.Tab.VENLOR-XR (venlafaxine) 150mg BD (1--x--1)
2.Tab.OLEANZ (olanzapine) 2.5mg BD (1--x--1)
3.Tab.MIRTAZ (mirtazapine) 15mg HS (x--x--1)
4.Tab.ETILAAM-CR(etizolam) 1.5mg HS (x--x--1)
5.Tab. TOFICALM (tofisopam) 50mg BD (1--x--1)
6.Tab.WAKELERT(armodafinil) 50mg BD (1--x--x)
7.Tab.CIPLAR (propranolol)20mg BD (1--x--1)
8.Tab.ZAPIZ-MD(clonazepam) 0.5 mg SOS in case of ghabrahat
and restlessness
9.SYP. CREMAFFIN 2 tsf HS (x--x--1)
 MONITORING OF DRUG
THERAPY

OF HYPERSENSITIVITY REACTION-
RASHES AND ITCHING
OF OVERDOSE - DIZZINESS AND COMA
 MONITORING OF DRUG
ACTION

SELF REPORTING OF SYMPTOMS

(REDUCTION OR INCREASE)
PHYSIOLOGICAL MEASUREMENTS OF HEART
RATE AND BLOOD PRESSURE
 DRUG INTERACTION

SNRI-SEROTONIN SYNDROME CAN OCCUR

WHEN GIVEN WITH MAO INHIBITOR
BENZODIAZEPINE CAN CAUSE EXCESSIVE
SEDATION WHEN GIVEN WITH BARBITURATES
THANK YOU