Dr Hamed Borham Dr Nashwa Mousa

1. Case Presentation
Dr. Hamed Borham
Dr. Nashwa Osman

2. Personal Data:
• Said Fathy Mohammed AbdelAal is 32y old male
who is muslim , married and live in 1- Alameer
Ahmed Refaat St – Moharram-Beh – Gorbal. He
is recently non functioning but used to work
before as (nakkash mobilia) and as driver with
educational level of only read and write . and he
is admissioned involuntary to our hospital

3. ‫‪Complaint‬‬
‫:‪• from patient‬‬
‫أنا حاسس اني مش سعيد اللي انا عارفه .. واني‬
‫اتغيرت ... وبتجيلي نوبات غضب مش بعرف اتحكم فيها‬
‫ومعمول لي سحر بيني وبين مراتي يخليني اشوفها شطانة‬
‫شكلها وحش ومش طايقها‬

4. ‫‪Complaint‬‬
‫:‪• from relative‬‬
‫جبنا سعيد المستشفى تقريبا عريان .. كان راح عند حل ق‬
‫معرفة وهاج عنده وقلع هدومة كلها وقال له رجعني سعيد‬
‫بتاع زمان احلق لي جسمي كله .. والناس اللي انت عارفهم‬
‫بيحاولي يقلدوني اياك تحلق لهم زيي .. قبلها كان عاوز يقتل‬
‫صاحبه وقال انه كان مرافق مراته .. وفي رمضان اللي‬
‫فات ساب المشروع بالركاب اللي فيه ورجع البيت ونام من‬
‫غير ما يقولنا حاجة.‬

5. History of present illness:
•The condition started originally 3 years back with gradual
onset and progressive course.
• With apparent stressor of prison. As he was arrested and
investigated by the police man . he asked him about his wife
name , the pt. started to be convinced that his wife betrayed
him (for one year of imprison) . and as he was discharged
from the prison .he said that his evidence that his wife
changes her clothes much of the time in the toilet with other
behavioral changes , and also he was convinced that
children are not his children and reacted to this by hitting his
wife….. . . he also appear as if he hears a voice of a female
and he said that the voices ordered him to pray …… and he
obeys .

6. History of present illness:
•Then he was sad due to his conviction and tried to get rid of
his life twice …… by superficial cuts in front of his relatives .
he also neglect his work and became socially isolated with
disturbed sleep (interruption) his appetite decreased .. and
this was for one and half year. Then he divorced his wife,
after that he sought psychiatric advice at our out pt. clinic
and received medication …..on which he was compliant for
4 months and improved first regarding sad mood and
appetite and then to his convention and has his wife back
again . then he stopped the ttt as he said that it make him
sleep to much . after stoppage of ttt he has the same
convictions and behaviors again so he was admitted in our
hospital for one day as he escaped from the hospital and
didn’t received ttt or ECT.

7. History of present crisis:
•One month ago the original condition increased and
he heared voices of passengers saying that his wife
betrayed him , then he left the bus and didn’t work
again ……. the pt. attempts to kill his friend …..he
was convinced that (Amerat Albahr) changed him so
he went to hair dresser to make him back to normal
….. there is history of substance abuse all through
even during his improvement there is no history
manic symptoms or organicity

8. Family History:
•Consanguinity: No history of consanguinity
•Father:Fathy mohammed Abdek aal, Died at the
age of 82 due to cardiac cause, He had
harmonious relation with the pt. and he worked in
petroleum company
•Mother: died at the age of 61 due to DM, And she
was house life and also had harmon. Relation with
the pt.
•Siblings: 4 brothers and 3 sisters . with harmonius
relations

9. Family History:
•Housing & living atmosphere: quarrelsome
with his wife, Monthly income was above
average …… tell the illness
•No Family history of psychiatric illness
•Family history of medical illness : diabetes
and heart disease

10. Personal Hx:
•Prenatal , natal , post natal : passed uneventual
•Developmental history : passed uneventual
•Educational record : he left the primary school …..
•Work record : first he was ( nakkash mopeliah )
and he had above average income and left it
because of other people . then he was driver and
has average income and then he traveled to Libya
twice for better income …

11. Personal Hx:
•Military service : exempted due to non psychiatric
causes
•Psychosexual :He reached puberty at average age
. with male gender role and identity with
heterosexual orientation tell the illness he
experienced disturbed sexual relation ship with is
wife …..
•Marital history :Marital status married with poor
relation to his wife and children after illness …..

12. Personal Hx:
•Past history of drugs: Hash + tramadol
(occasionally) last hash 4 m. ago
•Past history of medical illness : query peptic
ulcer

13. Forensic history:
In the prison for one year……
Premorbid personality
•Extrovert with antisocial traits
•Reactive to stress by nervousness
•He is impulsive and believer
•His hobby is drawing and he is smoker

14. Observation in the ward :
•pt. is socially isolated spent most of time in
bed

15. Mental State Examination
•General appearance and behavior :
young adult male average body built , poor
grooming and fair self hygiene , co-operative
.
•Mood : dysphoric
•
•Affect : tense , reactive and appropriate
•Speech : in answer to questions average
amount volume and stream , coherent

16. Mental State Examination
•Thought process :
-stream : average
-Content: delusion of persecution ….
d. of influence ….. and
delusion of infidelity become
shakable.
delusional perception(??)
- control : +ve
- form: circumstantiality
- abstraction : fair

17. Mental State Examination
•perception :
no perceptual disorder at the time of interview ( …….)
•cognitive function:
the pt. is fully conscious , attentive ,
 concentrative , or. To ppt . with intact
 immediate recent and remote memory
 average intelligent and general
knowledge with poor judgment . and
 insightless to illness, and need for ttt

18. Physical Examination:
•physical examination :
•vital data : bl. Pr. : 120/80 , pulse : 82
,temper. : 36.5
•injury mark ……
risk assesment :
•risk of homicide and suicide

19. Formulation
32 y old male pt. with 3 y history of
delusions of infidelity , persecution ,
influence ,thought control disorder ,
delusional perception and auditory
hallucination , social isolation, neglect
work , with history of dysphoric mood
after it . and parasuicidal attempts , with
substance abuse all through

20. Differential diagnosis:
• paranoid schizophrenia with co morbid
substance abuse
• uni polar depression with psychotic
feature with co morbid substance abuse

21. Diagnosis:
- DSM4:
•Axis 1: paranoid schizophrenia, continuous type
•Axis 2: ………..
•Axis 3: ? peptic ulcer
•Axis 4: prison
•Axis 5: non functioning

22. Diagnosis:
- ICD10 :
• Axis 1: paranoid schizophrenia
continuous type
•Axis 2: non functioning
•Axis 3: prison

23. ‫جزاكم ال خيرا‬
‫‪Thank You‬‬