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Schizophrenia case history- prof. fareed minhas

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Schizophrenia case history- prof. fareed minhas

  1. 1. Case Discussion • A 22 year old medical student, single, comes from a middle socio-economic background • Brought by mother to psychiatric OPD • Incident at referral : She left the Forensic theory paper half-done and came home
  2. 2. Presenting Complaints According to Student According to mother (2 months) •Increasing difficulty in concentrating on studies •Disturbed for the last 1 year and behaving oddly •Poor memory •Aggravated condition for last two months •Failing in tests recently
  3. 3. Events of the last year… 1 YR BACK Didn’t receive title at class function. Cry easily, drink water excessively. Attention to physical appearance 10 MONTHS AGO Lost company of friends. Saw undergarments hanging on streets. Songs in taxi played for her. Fearful of boy next door trying to rape her Believed family is trying to poison her/her uncle is trying to rape her. Uses additional locks on her room and sleep + appetite has reduced 6 MONTHS AGO 2 MONTHS AGO Says brothers are making her movie
  4. 4. Past History • No past psychiatric or relevant medical history • Personal history : - Born full-term, no complications - Milestones achieved appropriately - Easy child, started school at 5 - Attachment to father. Father was a patient of brain tumor and died when she was 10 - A high achiever who was ambitious And chose the medical profession herself
  5. 5. Family Psychodynamics • Family history : 2 nd in sibship of 4 2 brothers and a sister Mother is bread-earner (gets rent from a house) • Living pattern : 3-storey house with 2 rooms on each floor Ground and middle floors used by grandmother and maternal uncle’s family
  6. 6. Premorbid Personality • An ambitious and optimistic individual • Very sensitive to criticism, short-tempered • Healthy interpersonal relations with family and friend circle active • Mother and friends – trusting relations • Confident and dominating • Takes responsibility around the house on will • Worrier • Poor control over expressions of anger/hurt • Likes reading books, listening to music • Fairly religiously oriented • Satisfied with self • Low tolerance to stress
  7. 7. On Physical Examination… • Underweight • Signs of Anemia • Rest of the Examination was unremarkable
  8. 8. On Mental State Examination… • • • • • • • • Restless and awkwardly confused Mood was variable (mostly euthymic; also low) Times when she grew blank Thought process : - Organized delusional system (next slide) - Suicidal ideation Perception : no abnormality Oriented but concentration impaired Thinking was concrete Lacked insight into her medical condition
  9. 9. Delusional System Delusion of reference… “The taxi songs are for me”;”Boys of the class follow me” AUDITORY HALLUCINATIONS Sexual Delusions… “Brothers make my video while I sleep”; “Undergarments hang by ropes where I go on streets” Delusions of persecution… ”Family wants to poison me”; ”Friends misguide me”; “Uncle wants to rape me” SOMATIC HALLUCINATION OF LOWER BODY
  10. 10. Diagnosis PROVISIONAL DIAGNOSIS Acute Psychotic Episode DIFFERENTIAL DIAGNOSIS - Affective Disorder - Schizophrenia MEDICAL DIAGNOSIS - Anemia
  11. 11. Investigations • PHYSICAL INVESTIGATIONS - Blood Complete Picture (Hb level) - Other baseline investigations (Urine R/E, ECG, Liver and Renal Functional Tests) • SOCIAL INVESTIGATIONS dynamics - Detailed account of history and family • PSYCHOLOGICAL INVESTIGATIONS - House/Tree/Person test (maternal dependence; immature; confused thinking; ideas of paranoia and sexual pre-occupations; fantasy-seeking; poor ego) - Beck’s Depressive Inventory (low score)
  12. 12. Management THREE LEVELS OF MANAGEMENT BIOLOGICAL Iron supplements Antipsychotics Anti-depressant PSYCHOLOGICAL Supportive Therapy Daily Activity Chart Study-plan Relaxation exercises SOCIAL Educating family Family Therapy