case presentation

Case PresentationCase Presentation

Dr. Hamed BorhamDr. Hamed Borham

Dr. Nashwa Osman Dr. Nashwa Osman

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

Complaint • from patient:

عارفه انا اللي حاسسانيمشسعيد أناغضب.. ... نوبات وبتجيلي اتغيرت واني

لي ومعمول فيها اتحكم مشبعرفاشوفها يخليني مراتي وبين بيني سحر

وحشومشطايقها شكلها شطانة

Complaint • from relative:

راح .. كان عريان تقريبا المستشفى سعيد جبناكلها هدومة وقلع عنده وهاج معرفة حالق عند

لي احلق زمان بتاع سعيد رجعني له وقالعارفهم .. انت اللي والناس كله جسمي

قبلها .. زيي لهم تحلق اياك يقلدوني بيحاوليمرافق كان انه وقال صاحبه يقتل عاوز كان

المشروع .. ساب فات اللي رمضان وفي مراتهما غير من ونام البيت ورجع فيه اللي بالركاب

. حاجة يقولنا

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 .

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.

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

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

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

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 …

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 …..

Personal Hx: •Past history of drugs: Hash + tramadol (occasionally) last hash 4 m. ago

•Past history of medical illness : query peptic ulcer

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

Observation in the ward :

•pt. is socially isolated spent most of time in bed

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

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

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

Physical Examination: •physical examination :

•vital data : bl. Pr. : 120/80 , pulse : 82 ,temper. : 36.5

•injury mark ……

risk assesment :

•risk of homicide and suicide

Formulation32 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

Differential diagnosis:

• paranoid schizophrenia with co morbid substance abuse

• uni polar depression with psychotic feature with co morbid substance abuse

Diagnosis: - DSM4:•Axis 1: paranoid schizophrenia, continuous type

•Axis 2: ………..

•Axis 3: ? peptic ulcer

•Axis 4: prison

•Axis 5: non functioning

Diagnosis: - ICD10 :

• Axis 1: paranoid schizophrenia continuous type

•Axis 2: non functioning

•Axis 3: prison

خيرا الله جزاكمThank You