SOCIO-DEMOGRAPHIC DETAILS

The patient is 24 year old Muslim un-married female undergraduate

student from rural areas, lives in nuclear family, belonging to lower
socio economic status. She was brought to IMHANS by her family
members.

CHIEF COMPLAINTS
 Wandering behaviour
 Poor self-care
 Suspiciousness
 Hyper-religious

TDI: 7 Year
EXCERBATION: 20 Days

NATURE OF ILLNESS
 ONSET OF ILLNESS:
INSIDIOUS

 COURSE OF ILLNESS:
EPISODIC

 PROGRESS OF ILLNESS:
DETERIORATING

 PREDISPOSING FACTORS:
Parental negligence
Bad home atmosphere
  PRECIPITATING FACTORS:
Beaten by father on excessive use of makeup.
Breakup

 PERPETUATING FACTORS:
Poor insight into illness, poor compliance to medication, and
poor psycho-social support.

HISTORY OF PRESENT ILLNESS

The index patient was in her usual state of health as per the
informant the patient shows the behavioural symptoms of
aggressiveness, intolerance, unorganised since her childhood and she
stays with her paternal family, she had frequent out bursts and fights
with her cousins. In 2015, it was a normal day but at night same
incident with her cousins occurred after which the patient
complaints that she feels a very heavy thing on her heart,
restlessness and started to shout on everyone in the family. She
became unconscious for 3 to 5 minutes, secrete saliva and pass urine
at that time afterwards, she regains her consciousness. She was
taken to various faith healers as the patient says that evil eye has our
power her, but her condition did not improve. When she would get
ill she would attribute it to evil eye. She complaints of persistant
headache she step out of home happily but comes back home with a
bad mood and then picks fight with everyone over small things starts
to shout on everyone, she usually goes out with her friends and after
returning when she was asked about where she had been the whole
entire day she would get irritated and tell not to interfere In her life.
She talks to herself and gets happy and something would cry, she
was taken to psychiatrist on recommendation of a faith healer. She
was prescribed some medication the record of which were not
available. The patient wanders from one room to another, cannot
stay at one place stand up, sit down which had got worse to the
extent that she runs from home at night saying that some feminine
voice is calling her from outside. From last one year her sleep had
reduced to only three hours. Day gets up frequently when in sleep
and tries to wander away from home.
On one occasion she gets up in the middle of the night and went out
to the neighbours whom started to knock the door. She was brought
back into the house by her family members. On asking why she went
there she said that “mujhe koyi bhula raha tha suhaib ke ghar” on
one occasion in the evening she got up and went to the window side
and started shouting that her cousin brother is calling her and telling
her to follow him to “misr” but there were no one to be found
outside after few days she suddenly got up from sleep and would say
“misr ki ziyarat pe mujhe jana hai” and move outside of the house.
Her brother stopped her from going outside because of which she
got angry and started beating her brother weeping and yelling that
the family members don’t wish her good. Earlier she would wash
herself on frequent instances, groom herself was addicted to
makeup, self-medicate herself for weight gain. But now she had loss
all her interest now her mother forces her to take bath she stays
without washing her face, nails untrimmed dirty clothes for a weeks,
she was not able to wash herself her mother would bath her which
was contrary to her earlier behaviour. She is not responsible towards
any of her duties earlier she would help her mother in household
chores but now she don’t even care. She would suspect that her
family members are against her, they are planning something which
is not in her favour. At times when family members were talking she
becomes suspicious and starts abusing. Since last one year, her
symptoms have increased in severity her suspiciousness has
increased she thinks that her family members are casting black magic
on her whenever her father advise her for something she engaged in
a violent fight with him and accused him of having evil intentions
against her. She avoids interaction with her family saying that she is
alone and everyone in the family is against her she would not eat
anything provided by her family members saying that they have
mixed something in it. On some occasions she would go in the
kitchen tries to prepare food for herself but would not be able to do.
So, as she don’t know the proper procedure when hungry she go and
takeout food by herself and sit separate and eat and mutter to
herself. She treats her family members of suicide if they interfere in
her life. Patient was in a relationship for three years. During which
she would go and visit him in parks. Her relationship ended because
her partner doubt that she will cheat him as he saw such things in
her, she had lots of male friends and loved making friends in social
media. But now, she even don’t like the starring of a man towards
her before as per attendant. She loves to attract man towards her.
Whenever a man comes near her she tries to cover her face, would
ran away and starts muttering, and she was brought to IMHANS by
her family members.

PAST PSYCHIATRIC HISTORY

In 2015, when the patient complaint of restlessness, frequent
headache, body-ache. She was taken to DR. ASLAM {Psychiatrist}.

MEDICAL HISTORY
According to the attendant, the patient was recovering from the
medication and then the medicine was discontinued by the patient
herself.
The patient has ovarian cyst, the treatment of which was going at
Govt. hospital Budgam.

PREVIOUS TREATMENT HISTORY:

Previous records are not available {as per the attendant.
FAMILY HISTORY
GENOGRAM

44 year old
46 year old father mother

24 year 22 year
old old
patient

The patient lives in a nuclear family of 4 members comprising of her

46 year old father, 44 year old mother, and younger brother 22 year
old. The patient is first in birth order and had not good relationship
with every member of her family. However she is emotionally
attached to her grandmother with whom she had spent most of her
time. The attitude of family towards the patient is to be caring and
supportive despite of her bring irritable over small matters due to
the current illness. There is no psychiatric illness in the family.
PRESENT TREATMENT HISTORY
Tab > OLANZAPINE 15 mg {BT}
Tab > PANTANM 2 mg {OD}
Tab > CLONEZPAM 1 mg
INJ > LOPEZ
TAB > PROVANOL 20 mg

PERSONAL AND SOCIAL HISTORY

 BIRTH AND DEVELOPMENTAL HISTORY:
Patient was born out of non- consanguineous marriage and
born out of full term normal delivery. Patient is first order.
There were no prenatal and post natal complication. Patient
achieved his normal developmental milestones at appropriate
time. There were no developmental delays reported. She cried
immediately after birth.
 CHILDHOOD HISTORY:
The patient’s primary caretakers were parents. However, her
mother left her with her father and parental family when she
was 7. The patient was deprived of parental love and affection,
that’s why the patient found solace in her grandmother. There
is a history of exercise up-to 12 years. She was verbally abused
by her aunt and cousin.
 EDUCATIONAL HISTORY:
The patient is presently persuing graduation. She is good at
studies. When she was in 12th standard, a teacher named Ishfaq
sir was strict towards her home, she was afraid she had lots of
friends at school with whom she had very good bonding.
  PLAY HISTORY
The patient had good interest in games but barely played in her
childhood as her father don’t allow her play outside even if she
plays she used to play indoor with her cousins with marbels.
 MENSTRUAL HISTORY
The patient period started when she was in 9th standard. She is
having regular periods her last period was on 9th December
duration 4to 5 days.
 PREMORBID HISTORY
 INTERPERSONAL RELATIONSHIP
The patient made easily friends and liked to interact with new
people.
 USE OF LEISURE TIME:
She spend most of her time sleeping and using phone.
 PREDOMINANT MOOD
She was aggressive with her family members.
 ATTITUIDE TOWARDS SELF
The patient was self-conscious she often compares herself to
others on the contrary she considered herself as full of potential
but who has been unable to meet her potential. She had good
relation with others, except her family members. She prefers
company over solitude.
 ATTITUDE TOWARDS WORK
Patient was reported to be responsible she used to help her
mother in home chores she was good at her studies too and
finishes her home-work on time.
 RELIGIOUS BELIEF AND MORAL ATTITUDE
She would be neat and clean the patient also used to offer her
prayers. Her religious belief was strong.
 FANTASY LIFE
She had a dream of going to Saudi Arabia for Umrah.
 ALCOHOL AND SUBSTANCE HISTORY
Use of tobacco for a short period of time.

MENTAL STATUS EXAMINATION

GENERAL APPEARANCE AND BEHAVIOUR:
The patient was ill-kempt and un-tidy poorly groomed and
looked appropriate to the stated age. She was dressed
appropriately as per weather and culture. Her nails were unclean and
untrimmed, the patient looked drowsy.

EYE-CONTACT:
Eye contact was initiated and maintained

ATTITUDE TOWARDS EXAMINER

Co-operative

RAPPORT
Easily established

PSYCHOMOTOR ACTIVITY
Psycho-motor activity was increased moreover, she was getting up
again and again during interview.

SPEECH
The speech was audible and spontaneous rate of speech was normal
also pitch was normal fluctuation were found speech was not all the
time relevant and coherent.
MOOD AND AFFECT
MOOD: The patient verbalised her “mood bohat acha hai”
AFFECT: Congruent to mood, full range, reaction was normal.

THOUGHT
STREAM: Flight of ideas
FORM: No formal thoughts disorders
The thought process were not relevant to the questions asked
showing evidence of losing of associations and tangentiality
apparent.
POSSESSION: Nil

COGNITION
CONCIOUSNESS AND ORIENTATION:
The patient was aware and conscious and was oriented to time, day,
person but not aware of place.

ATTENTION AND CONCENTRATION:

Patient was asked to repeat three digits, she could repeat the digits.
Furthermore, when asked to repeat three digits backward, she
couldn’t repeat the digits recited to her.

MEMORY
 IMMEDIATE: Intact
 RECENT: Impaired
 REMOTE: Impaired
INTELLIGENCE
The patient was asked about the current leaders of the country and
general information as she could answer adequately.

JUDGEMENT
 SOCIAL JUDGEMENT: Intact
 PERSONAL JUDGEMENT: Impaired
 TEST JUDGEMENT: Intact
 IMPRESSION: Intact

PERCEPTION
The patient complaints of auditory and visual hallucinations.

INSIGHT GRADE-1
PROVISIONAL DIAGNOSIS
With BPAD, 24 year old Muslim unmarried female belongs to nuclear
family with poor socio-economic status presented with the duration
of illness 20 days with insidious onset and deteriorating with
complaint of wandering behaviour, poor self-care, suspiciousness
and hyper religious with insight grade-1