Case I

Identification information

Name S.S

Age 55

Gender Male

Education Primary

Occupation Hotel worker

Number of siblings 3

Birth order Eldest

Marital status Married

Socio economic status Middle Class

Religion Islam

Informant Brother

Reason for Referral

The client was referred by his brother and Dr. Nazair for treatment of his

psychiatric problems.

PRESENTING COMPLAINTS: ( nature of problem, precipitating event, patient feeling and

thought about

Problems)

 Mjy nenend ni atti bth ziada khailaat atty h ar bth ziada sochta ho aisa lagta soch soch ky

mere sar phat jaye ga mere bagir is duniya ka kya ho gal akin mjy Allah py yakeen h
  Mn bth azeem ho aur Mere pass bth ziada alim h jo mjy Allah ny dea h agr mn chaho

tu tmhy jannat mn ly ky ja sakhta ho

 Ar mjy cheezy dekhai detti h ar farishty mj sy batty karty h

Symptoms of the Case according to DSM criterion

Following symptoms have been present from last 7 months;

 Negative thinking

 Hallucinations

 Delusion

HISTORY OF PRESENT ILLNESS: (duration of present problem, change in nature intensity

or frequency of problem over time, prodromal manifestations, other past problem of

psychological nature, no of attack)

I am 55 year old male, its started about 7 months ago. I was working in hotel and

suddenly I started hearing some voices and my breathed stopped. I was fainted on the

spot .Then my coworkers took me to mayo hospital Where I received treatment for

asthma problem. After sometime I recovered and returned to my home in Rawalpindi.

However, after a few days, I started hearing voices again and also see angels who visit

me, share knowledge with me. then my father admitted me in Christian hospital of

Rawalpindi but I could like that place then the doctor referred me there and I am good and

doctor give me permission to returned home.

PRIOR TREATMENT

He was admit in mayo hospital for a week and then in Christian hospital and then
 doctor referred to mental hospital for the treatment of psychiatric problems.

PSYCHATRIC/ MEDICAL HISTORY

After her mother death he was suffered by asthma and kidneys related problem

after with passage of time he developed himself in psychiatric problems.

FAMILY HISTORY OF ILLNESS

Client’s family included 11 members, he had one wife, five childrens four sons and

one daughter, father and siblings with no psychiatric problem. His mother died because of

asthma and kidney failure. Client had a very good relation with his mother he said that

after his mother death he would feel very lonely and he blamed himself for his mother

death.

FAMILY HISTORY : (migration, birth, marriage, serious illness, job of earning member ,

relationships with family members)

After his marriage he come to Lahore for doing job in restaurant the client was born on

October 20, 1970. He got married in the age of 25. He was suffered by asthma problem. He is the

eldest, he and his father was earning member of his family. He had a very good relationship with

mother but not with other. And he thought that his neighbors would killed him.

Birth: (normal, caesarian, instrumental etc)

Normal

HISTORY OF PRENATAL DEVELOPMENT &MILESTONES

According to her father the client was born on October 20, 1970. His early

development was normal as he started walking in his first year and speaking shorter
phrases

after his first year. His physical health was good. No physical health issues reported in

childhood. His period of adolescence was fine. And got married when he was 25 year

old. After started to work on the farm and later in adulthood he come to Lahore and doing

job in different restaurant. Moreover, he was the eldest child and after her his mother

death he was suffered by asthma and his condition worse with Passage of time and then

Christian hospital doctors referred to mental hospital.

WORK HISTIOY:(nature and duration of job, reason for job change, relationship with

colleagues)

When he was 18 year old he doing work in farm and after her marriage he going to

Lahore and doing job as worker in rang mahil hotel at the age 45 he changed hotel

because the first hotel was sealed. The client had a good relationship with colleagues.

HISTORY OF RELATIONSHIPS: (family, peers friend, colleagues, bosses, marital)

He has a good relationships with family, peer, friend, marital, colleagues and bosses

but not good relationship with neighbors. He thought that they killed him.

SCHOOL HISTORY

The client had completed their education from fifth standard.

General Mental State Examination: (orientation, attention, memory etc)

His orientation was good because he know that he was in mental hospital but

attention was impairment and memory was also good.

PERCEPTION:(illusion, hallucinations-auditory, visual, tactile, somatic, olfactory)

No issues related tactile and olfactory but in fallowing;

Illusion
 He said that he had the knowledge of unseen things

Hallucination-auditory

He thought that he talked with angel and angel gave him the unseen knowledge.

And his neighbors killed him because of his knowledge.

Visual

See angels

Somatic

Severe headache

THOUGHT

I would not good thought about world and peoples that what they do but I have a lot

of trust on Allah.

AFFECT:(cry spell, depression, guilt feeling, suicidal, excited, hostile, grandiosity,

blunted effect).

Grandiosity: feel that I am a great personality

Guilt feeling: He blamed himself for his mother death

SLEEP:(insomnia, sleep walking, night mares)

Insomnia issues

BEHAVIOR: (Speech, mute, talkative, abusive, restless etc)

More talkative than unusual

Speech personality

MENARISM AND POSTURING: (usual gestures, preservative movements)

He used to speak loudly to make his point, repeat words excessively, and gesticulate
excessively with his hand.

ANXIETY:(tension, nervousness, obsession / compulsion)

No sign related this shown during interview.

SOMATOFORM: (conversion, hypochondria’s, other somatic complaints)

Headache and have little worry about kidneys and breathing problem.

PSYCHOSEXUAL: (gender identity, paraphilia’s psychosexual dysfunction )

No issues related to psychosexual.

PSYCHOSOMATIC: (obesity, headache, painful menstruation, skin disorders, asthma,

ulcer, nausea and vomiting)

Problem related asthma

ADDICTION

Nasvar

PERSONALITY TRAITS: (paranoid, schizoid, schizotypal, antisocial, borderline,

histrionic, narcissistic, avoidant, dependent obsessive compulsive, passive aggressive)

Narcissistic: he was very self obsessed.

INTERVIEW BEHAVIOR: (open, anxious, relaxed, withdrawn, cooperative,

aggressive,

Compliant, oppositior)

He was very open to speaks and seen as a relaxed and cooperative throughout the

interview.

STRENGHT: (degree of insight, motivation, intellectual level, other telents)

He had a good degree of insight, and motivated throughout the interview and good

intellectual level, and the talent to known of unseen things.

I have a lot of knowledge about thing