SOCIO-DEMOGRAPHIC DETAILS

The patient is 25 year old unmarried Muslim male formally educated

and is undergraduate student living with his family from rural area
living in a nuclear family, belongs to the upper-middle socio-
economic status, accompanied by his father and his elder brother
presented in the hospital. He was bought to IMHANS forcefully by his
family.

CHIEF COMPLAINTS
 CRYNG SPELLS
 LOW SOCIAL INTERACTON
 FEARFULNESS
 SELF muttering
 LOW APPETITE
 DEMADING PARENTS FOR HAJJ

TDI: 5 Year

EXCERBATION: 12 Days
NATURE OF ILLNESS:
 ONSET OF ILLNESS:
EPISODIC
 COURSE OF ILLNESS:
CONTINUOUS
 PROGRESS OF ILLNESS:
DETERIORATING
PREDISPOSING FACTORS:
Patient is having inferiority complex disorder, where patient is
thinking that he is not able to compete with his friends in studies , he
cannot do anything, he is not able to do further studies.

PRECIPITATING FACTORS:
The patient is overthinking about his studies. He keep thinking that
his friends move forward for further studies. According to the
informant, the patient said his teacher scolded him and asked him to
change his getup and cut his beard and change his institution, and his
classmates also bully him.

PERPETUATING FACTORS:
The patient is not taking his medicine on time, and left them in
between. According to the informant, the patient is thinking that no
one is taking care of him, no one is thinking about his health and his
condition. He also said that he is not able to complete his further
studies.
HISTORY OF PRESENT ILLNESS
The patient was in his usual state of health 5 years back, when he
was the student of 11th standard. According to the informant , one-
day while coming back from school the patient start crying and make
complaint of being bullied by his teacher, that his asked him to
change his religious look and his school, because he was brought up
with full religious environment by his family. He was following his
father. After that the patient start making complaints of fearfulness,
and crying spells, staying aloof, low social interaction, he start
talking with himself, laughing with himself and was not eating well,
he also start getting angry and hitting family members. According to
the informant, In the beginning the patient was demanding for three
things, he asked his family to make him get married and send him to
Hajj and also wanted to complete his graduation. The patient was
insisting for getting married and performing Hajj.

According to Informant, The patient start feeling depressed when his

teacher bullied him and insulted him in classroom in-front of his
classmates. He felt so down and insulted and came back home and
start crying loudly. His family asked him what happened, he replied
while crying that his teacher asked him to change his look and cut his
beard and change his school he insulted him in-front of his
classmates. Day by day he start thinking too much and was staying
alone. He isolated himself from his family and staying in his room
without talking to his family members. His classmates start bullied
him and he left school, his condition gets more worsened day by day.
His family came to know that he needs to get Psychiatric
consultation. In 2019 they took him to Dr. Majid and he declared him
as schizophrenic patient. But the informant said that we were not
fully sure about that and we took him to another doctor Dr. Majid
from Srinagar and he put him on medication and asked him to
continue medicines for 2 weeks, he continued his medicines for 2
weeks and he felt better and start doing well for 10 days. After 10
days he start doing weird actions and start getting worse again. He
start crying again and staying alone. He used to go out in the
morning along with his bag and returns back when his father is back
from work. The patient is very close to his father and wants him stay
with him all the time. In 2019 only he got second episode and again
they took him to the same doctor, he gave medicines and asked him
to continue his medicines for 6 weeks, where the patient took that
medicine for some time and left in between and start hitting his
family members, who so ever asked him to eat anything he slaps
them, he also slaps his uncle and aunt. According to the informant,
the patient was getting more worsened day by day. One day he
asked the patient to come back early but the patient didn’t come for
two three days, his family gets worried about the patient and start
looking for him, the patient was sleeping at the tea stalls and was
paying money .One day the informant told his family that, they
should took him to the psychiatric hospital for better treatment, and
they took him forcibly to the IMHANS for treatment. In 2022 he got
second episode and that was more-worse and serious than before
and is admitted in IMHANS on 13/12/2022 for better treatment.
According to the informant, there is no improvement in patient’s
health, appetite, sleep and patients mood. The patient is in same
condition as he was in before that, the informant reported that the
patient is not responding or eating well.

PAST PSYCHIATRIC HISTORY

In 2018, the patient was in his usual state of health, when he got
scolded by his teacher in 11th standard, the patient start getting
depressed and disturbed, start crying loudly in-front of his family.
The patient in 2019 the patient was declared as schizophrenia
patient by DR. Majid and was admitted for 10 days. In 2019, the
patient was detained for 3 days in Delhi hospital. According to the
informant, the patient’s sister is also mentally challenged.

MEDICAL HISTORY
The patient got fatty liver due to complete sitting. There is no further
medical history.

SUBSTANCE HISTORY
No history of substance use
 PREVIOUS TREATMENT HISTORY
No record available

PRESENT TREATMENT HISTORY

 TAB > OLAZAPINE 15mg OD(BT)
 INJ > LOPEZ 4mg 1/m (bt)
 INJ > NUM FORTE
 TAB > EVIOM 600mg 10 D
 TAB > BILYPRA 4mg 10 D
 ECT

FAMILY HISTORY

Year old50 50 year old

teacher teacher

PATIENT
M.CHAL
LENGED MARRIED
The patient lives in nuclear family comprising of 5 members,
patient’s parent, elder sister [she is mentally challenged] and brother
and his wife. The patient is third in order. According to the
informant, the patient is very close to his father. The patient had a
good relation and emotionally attached with his father whom he had
spent most of his time. The patient’s relation towards his family was
very good before his illness and also the patient is very beloved child
to his family. According to the informant, the patient in his childhood
was getting disturbed because of small fights between parents. The
informant and the family of the patient is very worried about the
patient’s health and wants him to get well soon. Patient’s elder sister
is mentally challenged from birth, but there is no other psychiatric
illness in the family.

PERSONAL AND SOCIAL HISTORY

BIRTH AND DEVELOPMENTAL HISTORY:
Patient is born out of non-consanguineous marriage and born out of
full term normal delivery. According to the informant, he is third
child in birth order and there were no prenatal and post natal
complication. Patient achieved his normal developmental milestones
at appropriate time. There were no developmental delays reported.

CHILDHOOD HISTORY:
The patient’s primary care takers were his parents. Patient was
bought up by his parents. The patient was very beloved and also a
well behaved child to his parents.
EDUCATIONAL HISTORY:
The patient is undergraduate student, and the patient was very
respectful towards his teachers and his behaviour towards his
teachers and friends was good

PLAY HISTORY:
The patient had a good interest in outdoor games more than indoor
games. The patient liked to play cricket in his childhood. His relation
with his friends was good and was waiting for his turn to play. No
aggressive behaviour were seen in his childhood.

PREMORBID HISTORY SOCIAL HISTORY:

 INTERPERSONAL RELATIONSHIP: The patient was not socially
active. The patient’s social interaction is very low, and was not
talking that much to his family members.
 USE OF LEISURE TIME:
The patient spends his most of the time in sleeping and writing
diaries.

 PREDOMINANT MOOD:
The patient used to remain silent and with closed eyes and
always in bad mood.

 ATTITUDE TOWARDS SELF:

The patient considers himself as he cannot do anything and is
not a good human being as he is not doing well presently more
over the patient is having inferiority complex.
 ATTITUDE TOWARDS WORK:
The patient has no interest in work and is not doing any work
currently.
 RELIGIOUS BELIEF AND MORAL ACTIVITIES:
The patient has good attitude towards shrines but he is not
visiting the shrines. But according to the patient said by himself
that he likes them and calling them a beautiful places and is
being very respectful to them.

 FANTASY LIFE:
The patient wants to get well soon and wants to go home and
start writing poetry again, as he is a creative poet who likes to
write poetry by himself.

 ALCOHOL AND SUBSTANCE HISTORY:

No history of substance use

MENTAL STATUS EXAMINATION {MSE}

 GENERAL APPEARANCE BEHAVIOUR:
23 years old young adult male, average built, moderately groomed
and kempt, dresses as per the weather and culture, sitting
comfortably on the chair. Behaviour is constant with time.

 EYE-CONTACT:
The patient initiates eye-contact, but doesn’t maintain it for an
adequate duration, and stares at his father continuously.
 ATTITDE TOWARDS EXAMINEE:
Suspicious and hostile

 RAPPORT:
Partially established
 PSYCHO-MOTOR ACTIVITY:
Psycho-motor activity was increased, moreover the patient was
getting up again and again during the whole interview.
 SPEECH:
The speech was not audible in intensity and the rate of speech
was low, speech was not all time relevant and coherent .
 MOOD AND AFFECT:
Mood: The patient verbalised his mood as “MOOD KHARAB HAI”.
Affect: Incongruent mood, and reactivity was not normal.
 THOUGHT:
Stream: Flight of ideas
Form: No formal thought disorder
 CONTENT: Depressive rumination
 POSSESSION: Nothing abnormal detected
 COGNITION:
 ATTENTION AND CONCENTRATION: The patient was
asked to repeat three digits, and he repeated forward digits
correctly. When asked to repeat them backward, he
repeated only two digits.

 CONSCIOUSNESS AND ORIENTATION:

Patient was not fully aware and was not conscious and
well oriented about the person, place and time.
 MEMORY:
 IMMEDIATE:
Impaired

 RECENT:
Impaired

 REMOTE:
Intact

 INTELLIGENCE:
The patient was asked about the current leader of the country and
general information, but he didn’t and remained silent. Patient
was not aware of place when asked about the current place.
 JUDGEMENT:
SOCIAL JUDGEMENT:

Impaired

PRESENT JUDGEMENT:

Intact

TEST JUDGEMENT:

Intact

IMPRESSION: INTACT

 PERCEPTION:
The patient denies any abnormal perception
 INSGHT G-: 1

 PROVISIONAL DIAGNOSIS:
With BPAD, 25 year old Muslim unmarried male belongs to
nuclear family with upper-middle socio economic status,
presented in the hospital with duration of illness 12 days episodic
onset and no improvement with complaints of crying spells, low
appetite, low social interaction, self-laughing, anger issues with
insight grade-1.