Appendices
Appendix A : Case history samples (Anonymized)
Case 1: Ms.K
Age/Gender: 18 years, Female
Religion: Hindu
Residence: Bullandshahr
Socioeconomic Status: Lower class
Education: 10th pass
Occupation: Homemaker
Marital Status: Married (3 months)
Informant: Mother
Referral: GIMS Hospital
Date of Admission: 05/05/25
Total Duration of Illness (TDI): 9 days
Presenting Complaints:
• Odd behavior
• Incontinence
• Self-talk
• Sleep disturbance
Onset: Acute
Course: Continuous
Progress: Deteriorating
1.History of Presenting Illness (HOPI):
The patient was reportedly maintaining well until 01.05.25, when she began exhibiting odd
behaviors such as picking garbage from the bin, clenching her teeth and fists, incontinence,
self-talk, and refusal to respond to family members. The informant (mother) also reported
disturbances in sleep and appetite. These symptoms escalated over the next few days and led
to hospital admission on 05.05.25 for further management.
2.Past Psychiatric and Medical History:
No known history of prior psychiatric illness or significant medical/surgical history.
3.Family History:
No significant psychiatric or neurological history.
4.Family Dynamics:
The patient has a cordial relationship with her maternal family. However, she reports a
strained relationship with her in-laws.
5.Personal History:
• Birth history: Inadequate, as the patient was adopted.
• Developmental history: Not mentioned in the report.
• Education: Completed 10th class; average in academics.
• Occupation: Homemaker
6.Pre-morbid Personality:
The patient was described as well-adjusted in social and occupational areas prior to the onset
of illness.
7.Provincial Diagnosis:
Acute and Transient Psychotic Disorder (F23, ICD-10)
8.Treatment Plan:
• Initiated antipsychotic medication to manage acute psychotic symptoms.
• Provided supportive psychotherapy and psychoeducation for patient and family.
• Considered short-term benzodiazepines for agitation and sleep disturbance.
• Conducted family counseling to address marital stress and improve support.
• Planned regular follow-up for monitoring and relapse prevention.
Case 2 :Mr. A
Age/Gender: 32 yrs/M
Education: 10th class pass
Occupation: Works in blinkit store
Residence: Greater Noida
Socioeconomic Status: Lower class
Date of Visit: 16/5/25
TDI : 2 years
Informants: Wife and brother (married for 2 years)
Reliability of Information: Reliable
Chief Complaints:
• Irritability
• Fear of contamination
• Suspiciousness
• Difficulty in sexual intercourse
Onset: Insidious
Course: Continuous
Duration : 2 years
1.History of Presenting Illness (HOPI):
The patient was asymptomatic until 2008.The complaints gradually began, including
repetitive washing, checking, fear of contamination.Exhibited aggressive outbursts, fear of
being touched, compulsive checking of gas, fan, and water tap.The patient also reported
difficulty in sexual performance.
2.Precipitating Factor: Exam stress (10th class)
3.Predisposing Factor: Head injury in 2008
4.Past Psychiatric and Medical History:
Head injury in 2008
No prior formal psychiatric treatment reported
5.Family History:
No psychiatric illness reported in the family
6.Family Dynamics:
Patient shares a cordial relationship with his wife and brother.
Family is supportive and cooperative.
7.Personal History:
Sexual & marital history indicates lack of interest in sex and difficulty performing.
Less inclined towards intimacy.
8. Provincial Diagnosis:
OCD ( F42 - ICD )
9.Treatment plan:
• Start SSRI medication (e.g., Fluoxetine or Sertraline) for symptom reduction.
• Begin CBT with ERP to target obsessions and compulsions.
• Psychoeducation for patient and family about OCD and its management.
• Teach anxiety-reduction techniques like deep breathing and relaxation.
• Involve family in therapy to reduce enabling behaviors and increase support.
Case 3: MR.I
Age/Sex: 52/M
Education: 10th pass
Occupation: Carpenter (20+ years)
Marital Status: Married
Date: 28/5/25
Informant: Wife
Informant Reliability: Reliable and complete
Chief Complaints :
• Persistent low mood for the last 1 year
• Decreased sleep and appetite
• Generalized weakness
• Social withdrawal and isolation
• Suicidal ideation (active suicidal)
• Irritability
1.History of Present Illness (HOPI):
The patient started experiencing persistent sadness, fatigue, and hopelessness around one year
ago following financial stress. He reported a loss of interest in daily activities, decreased
energy, and feelings of worthlessness. He had suicidal ideation 2–3 times but no attempts. He
became withdrawn and irritable. No psychotic symptoms were reported.
2.Precipitating Factor:
Financial strain related to inconsistent work and household pressures
3.Personal History:
Substance Use: Smoked beedis for 10+ years (1–2 every 3–4 days); not currently using
Sleep/Appetite: Decreased in current episode
Social: Currently withdrawn; previously socially functional
4.Childhood History
Had a comfortable childhood
Close bond with his mother
No reported trauma or major conflict
5.Educational History:
Average academic performance
Studied up to 10th grade
6.Occupational History:
Works as a carpenter for over 20 years
Maintains a cordial relationship with colleagues and clients
7.Sexual and Marital History:
Married
No issues reported in sexual functioning or marital relationship
8.Family History
No significant family history of psychiatric illness
9.Premorbid Personality (PMP):
Patient had a reserved, introverted personality. Preferred solitude and was emotionally less
expressive
10.Provisional Diagnosis :
Major Depressive Disorder (Moderate to Severe without psychotic features) – ICD-10
Code: F32.1/F32.2
11.Treatment Plan:
• Pharmacotherapy: Initiation/continuation of SSRIs (e.g., Escitalopram or Sertraline)
• Psychotherapy: Cognitive Behavioral Therapy (CBT) to address negative thoughts
and behavioral activation
• Psychoeducation: For patient and family regarding illness, coping, and medication
compliance
• Monitoring: Regular suicide risk assessment and follow-up sessions
• Lifestyle modification: Encouraging daily structure, healthy sleep, and social re-
engagement
Case 4: Mrs. K
Age/Sex: 48 years / Female
Marital Status: Married
Occupation: Homemaker
Socioeconomic Status: Lower
Residence: Dadri
Referral: Department of Medicine (10-Medicine)
Date : 11/6/25
Informant: Husband
Informant Reliability: Reliable and complete
Chief Complaints:
• Headache (hammering/throbbing in nature)
• Fainting spells (lasting 4–5 minutes)
• Low mood
• Irritability
• Weakness
Onset – Abrupt
Course – Continuous
Duration- 4 years
1.History of Present Illness (HOPI):
The patient was apparently maintaining well until 4 years ago when she began experiencing
episodes of headache, described as a hammering and throbbing sensation starting at the top of
her head and spreading throughout. These episodes were frequently accompanied by
dizziness and fainting spells lasting for about 4–5 minutes. Over time, she also started
reporting low mood, persistent irritability, and generalized weakness, which affected her
daily functioning.
2.Past Psychiatric History:
No prior history of psychiatric illness was reported.
3.Past Medical History:
The patient has a history of thyroid disorder for the past 8 years and has been on regular
medication for the same.
She was once admitted for 2 days in her native village (Silakwa) due to headache and fever.
4.Family History:
The patient currently lives with her husband and three sons. She shares a cordial relationship
with her family members. No history of psychiatric or major medical illness was reported in
the family.
5.Personal History:
Diet: Vegetarian
Sleep: sleep disturbances
Menstrual and sexual history: Menstrual cycle (2 days) with severe cramps
6.Pre-morbid Personality:
Kusum was described as a friendly and socially active individual. She maintained cordial
relations with her neighbors and extended family. She has been an emotionally expressive
person with a tendency to seek support from close ones during stress.
7.Provisional Diagnosis:
F44.4 Dissociative Convulsions (according to ICD-10)
8.Treatment plan:
• Psychoeducation to the patient and family about dissociative disorder and stress-
related symptoms.
• Supportive psychotherapy to explore emotional conflicts and provide reassurance.
• Stress management techniques like deep breathing and relaxation exercises.
• Family counseling to strengthen support and reduce reinforcement of symptoms.
Case 5: Ms. S
Age/Sex: 24/F
Education: 10th pass
Marital Status: Unmarried
Religion: Hindu
Informant: Brother
Informant Reliability: Reliable and complete
Chief Complaints
• Nervousness ( Ghabrahat )
• Decreased need for sleep
• Wandering from home (2 episodes)
• Irritability and aggression
• Poor self-care (Duration: 2 months)
Onset: Sudden
Course: Continuous
Duration: 2 months
1.History of Present Illness (HOPI):
The patient was apparently maintaining well until 2 months ago, when her family began
observing behavioral changes. She started speaking excessively, sleeping very little, and
engaging in increased and aimless physical activity. There were two incidents of wandering
from home. She also showed irritability, became aggressive at times, and neglected her
personal hygiene. No history of substance use. No prior psychiatric illness reported.
2.Family History:
No significant family history of psychiatric illness reported
3.Personal History:
Substance Use: None
Sleep and Appetite: Decreased during the episode
Menstrual/Sexual History: Within normal limits
No significant psychosocial stressor identified
4.Pre-morbid Personality:
Reserved and quiet, emotionally responsive, maintained good relationships with family
5.Provisional Diagnosis:
Bipolar Affective Disorder – Currently Manic Episode Without Psychotic Symptoms
ICD-10 Code: F31.1
6.Treatment Plan :
• Mood stabilizers (e.g., Lithium or Sodium Valproate) to manage manic symptoms
• Antipsychotics (e.g., Risperidone or Olanzapine) if agitation or impulsivity is present
• Psychoeducation for patient and family about BPAD, episode patterns, and
medication adherence
• Regular follow-up to monitor mood, functioning, and medication side effects
Appendices B : Assessment tools used
1. MoCA (Montreal cognitive assessment)
2. ACE-3 (Addenbrooke's cognitive examination)
3. Rorschach Inkblot Test
4. WSCT (Wisconsin cards rating scale)
5. HAM-D ( Hamilton depression rating scale)
6. YMRS (young mania rating scale)
7. BPRS (Brief psychiatric rating scale)
8. BKT (Binet Kamat Intelligence) IQ
9. PANSS ( Positive and negative syndrome scale )
10. VSMS ( Vineland Soxial Maturity Scale )
