Patient’s Name : Payel Das Age: 47 Sex: F
Informant’s Name:
Relation with Informant: Mother
Mobile No: 8697538056
Date of Admission: 07.02.2025 Date of Discharge: 03.03.2025
Treating Consultant: Dr. Goutam Bandyopadhyay
Diagnosis: Schizophrenia (F20)
Presenting Complaints:
1.Hearing voices and seeing three different spirits since 24 years
2. Muttering to self, severe anger outburst, irrelevant talks since 15 days
3. Decreased sleep and appetite since 15 days
Summary : A 47 years old unmarried female, educated up to class 8, hailing from a nuclear
family with lower socio economic status, residing in urban area, with easy premorbid
temperament without any significant past medical, surgical or psychiatric illness and family
history of suicide of father was brought to psychiatry OPD of Medical College Kolkata around 2
months ago with complaints of easy irritability and anger dyscontrol for the last 29 years,
seeing people not seen by others and hearing voices unheard by others for the previous 24
years, severe anger outburst, aggressiveness and violent behaviour with irrelevant talks
associated with reduced sleep and apetite for the previous 15 days before admission. Her
symptoms she was in eighth grade, following her father's unexpected death by suicide and her
subsequent poor performance in the final exam of eighth grade. Symptoms started with severe
anger outbursts with violent, aggressive behaviour uncontrolled by family members. After initial
stabilization with psychotropic medications, the first five years were marked by easy irritability
and anger outbursts, although anger issues gradually increased. The patient used to see the
spirits of three unknown individuals alongside her father. Gradually, their presence increased
over time, and they began to disturb her during meals, sleep, and even while she was taking a
bath. The patient had to spit on them, throw water on them, and even fight with them to get
away. For the past year, they have been lying on her chest during sleep and sometimes try to
harm her by pressing on her neck. In June 2023 and again in October 2024, she was admitted to
the psychiatry ward at Medical College Kolkata due to severe and unmanageable violent and
aggressive behavior. During this admission, she experienced a similar exacerbation of her
aggressive symptoms.
MSE on admission: The patient is of average built, appropriate to age, kempt, dressing appropriate to
weather and surroundings, maintained eye contact, with speech being audible, increased productivity,
normal reaction time, relevant, coherent and goal directed. Affect being irritable, full range, normal
reactivity, mobility and communicability, with delusion of persecution, Auditory and Visual
Hallucinations present , judgement intact with grade 2 insight.
Treatment Received:
Patient was started on Tab Aripiprazole( 30 mg) and Tab Clonazepam (1mg) on the first day of
admission. He was later started on Tab Amisulpiride (400) as anger dyscontrol was prevailing even after
20 days. Later, she was having hand tremors and Sialorrhea probably due to extra pyramindal
symptoms, so Tab Trihexyphenidyl ( 2) was added. Tab Diazepam (5) was added due to persistent sleep
disturbances during 1 month of stay. Later patient's blood reports showed dyslipidema, as per advice
from Medicine OPD, patient was put on T. Atorvastation(10). Patient's Anger outbursts & violent
behaviour was not responding to the medications, so later Tab Clozapine(50) was added which was
gradually titrated upto 100mg. Since Patient is K/C/O DM-2, as per advice from Endocrinology, patient
was started on Injection Glargine(6) which was later tapered & shifted to Oral Antihyperglycemic Tab
Metformin (1gm) BD. Later, Tab Aripiprazole (30) was gradually tapered down & omitted. Patient is
currently maintaining on Tab Clozapine (100), Tab Amisulpiride (600), Tab Trihexyphenidyl (2), Tab
Diazepam (5).
Investigations: Hb:10.9g/dl , RBC: 4.5 million/cu mm , TLC: 5150, Platelets: 2.37 lakh
N/L/M/E/B: 51/34/04/10/00 ,
LFT :WNL
Urea: 3.3, Creatinine:0.9 , Na+: 140 , K+: 3.8 ,
TSH: 2.56 fT4: 1.43
(29.3.25) FBS: 88mg/dl , PPBS:147 mg/dl,
S. Chol- 256mg/dl S.TG: 210mg/dl
Serology: Non reactive
Treatment Advice: Supervised medications:
1. T. Clozapine (25) x-2-2
2. T. THP (2) 1-x-x
3. T. Amisulpiride(100) 3-x-3
4. T. Metformin1g) 1-x-1
5. T. Diazepam(5) x-x-1
6. T. Pantoprazole (40) 1-x-x
7. T. Atorvastatin (10) x-x-1
8. T Vit B complex x-1-x
B/F : CBC with ANC , LFT , FBS, PPBS, LIPID PROFILE
Follow up:To attend Psychiatry OPD after 14 days/ER SOS.
Refer to Endocrinology OPD and Medicine OPD for management of T2DM and dyslipidemia.
