CASE STUDY

Presented by Anjana Alina Varghese

Class: XIIB
Reg no:
Guide: Ms. Ancy Aniyan
 SOCIO-DEMOGRAPHIC DATA
• Name : Mrs AJ

• Age : 67 years

• Sex : Female

• Rural / Urban : Urban

• Marital Status : widowed

• Languages known : Malayalam, English,

• Education Level : Bsc Chemistry

• Occupation : currently unemployed (was a lab technician before)

• Religion : Christian

• Family Size :4

• Head of the Family : currently wife

• Type of family : Nuclear

• SES : High Socio-economic Status

• Informant : Daughter (eldest) and granddaughter

• Reliability / Adequacy : Reliable and adequate

 PRESENTING COMPLAINTS
• CLIENTS VERSION
What if I got increased diabetes? Or a heart ailment that can lead to a heart attack? Any of these
illnesses can kill me. I might get heart attack or Covid-19 and no one will even look at my direction
or help me. So I visit many doctors but they don’t find any problem with me. But I am not still
satisfied. I don’t want to die. I have lots to do than waiting for death.
• INFORMANTS VERSION (DAUGHTER ELDEST)
Extremely anxious over health, goes for daily checkups but even though doctors assure her and the
test results are normal she is not satisfied. Her condition worsened during the pandemic. Due to this
she never leaves the house, refused her daughter and granddaughter to enter the house, became
unavailable during the Pandemic
 CHIEF COMPLAINTS

• Over anxious about health

• Sometimes not going to required doctors
• Excessive washing of hands 7 to 8 times
• Suspicious of neighbors having illnesses that she can get if she gets close
• Duration : 4years
• Mode of onset : Gradual
• Course : Continuous
• Precipitating factor : Pandemic
• Perpetuating factor : not available
• Predisposing factor : Not available
 HISTORY OF PRESENTING ILLNESS

• Gradually started being anxious about her health more often gets anxious over neighbors
contracting illnesses. This fear started when one of her neighbors contracted chickenpox when
she was undergoing her first cataract operation. Afterwards a person living next to her got Covid-
19
• She refused to go for checkup for her heart and stomach and went to see other doctors which led
to a mild heart attack during mid August.
• During the pandemic her condition worsened in early 2020 she started suspecting the people
around her of having Covid-19. The fear of contracting Covid -19 was extreme so she refused to
let anyone in and was adamant in not letting herself out.
• When she goes out she wears a double mask, a face shield, gloves, full sleeved clothing and
shoes. When she returns she cleans the house until it reeked of disinfectant she washes herself
daily seven to eight times.
 NEGATIVE HISTORY

• No history of substance intake.

• No history suggestive of persistent repetitive behaviors, movements or actions.
 PAST HISTORY OF MENTAL ILLNESSES

• No history of mental illness/treatment

PAST HISTORY OF PHYSICAL ILLNESS

• Diabetic medicines
• Heart attack (mild)
• cataract
PEDIGREE CHART

CLIENT
FAMILY HISTORY

• Client was the third child of her parents. Both parents died normally.
• The clients relationship with most of her family members were cordial (slightly strained with
eldest daughter)
• Husbands death devastated her mentally emotionally and physically. Interpersonal relationship
was normal.
PERSONAL HISTORY

Birth and development:

• Birth was normal
• Further detail no available

Behavior during childhood & adolescence:

• Was friendly and extroverted engaged in normal plays and activities that other children did at her
age
EDUCATIONAL HISTORY
Client was academically smart
12th std : 92%
10th std: 80%

Menstrual History
Mrs. AJ age of Menarche was 16-17 and her reaction was confusion at first but she adjusted
quickly attained menopause at 50 years

SEXUAL HISTORY
She had good & normal sexual relationship with her husband. Masturbatory practices, homosexual
practices, extra marital affairs and anxiety or guilt associated with sexual fantasies were found to
be absent.
MARITAL HISTORY
She was married to her husband when she was 24 years old. He was an alcoholic and smoked
excessively had anger issues (lashes out at random intervals) They have two daughters aged 41 and
47 respectively. Her husband’s death was quick and violent. Vomited blood (excessive) on 18 th May
2010 diagnosed with stage four cancer died three days later on 21 st May 2010 due to complications.
He vomited right in front of his wife and daughter while eating lunch.
Death devastated the client mentally and emotionally

Interpersonal relationship
Relationship is fairly stable with relatives slightly strained with eldest daughter. Fairly good
relationship with siblings has a lot of friends and visits church every Sunday.
Premorbid personality
Extroverted, responsible and had a cheerful disposition. Loved talking with everyone she meets.
She was updated with the times and mixes well with both old and new generation.(She keeps up
with the times.)

Treatment history
AJ has neither been in therapy nor on any medication for mental ailments (undiagnosed).

Use of leisure time

She is interested to read and write and draw. She also loved watching Malayalam TV shows
(serials) loves travelling and meeting others.

Religious attitudes
She is a believer goes to church every Sunday believed that there is an omnipotent being above us
Habits
• Reading books
• writing stories and poetry (Malayalam)
• Drawing
• Travelling

Social Life
The patient was happy to participate in any social activities
MENTAL STATUS EXAMINATION
 CRITERIA FOR ILLNESS ANXIETY
DISORDER
• Preoccupation with having or acquiring a serious illness.
• Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is
present or there is a high risk for developing a medical condition (e.g., strong family history is present), the
preoccupation is clearly excessive or disproportionate.
• There is a high level of anxiety about health, and the individual is easily alarmed about personal health
status.
• The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for
signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
• Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may
change over that period of time.
• The illness-related preoccupation is not better explained by another mental disorder, such as somatic
symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-
compulsive disorder, or delusional disorder, somatic type. Source: Reprinted with permission from the
Diagnostic and Stat