CASE HISTORY REPORT

CASE STUDY 1: BIPOLAR AFFECTIVE DISORDER

CASE STUDY 2: NEAD WITH BORDERLINE INTELLIGENCE

CASE STUDY 3: LATE ONSET OF PSYCHOSIS

CASE STUDY 4: ALCOHOL ADDICTION

CASE STUDY 5: UNSPECIFIED NON-ORGANIC PSYCHOSIS

CASE HISTORY- I

SOCIODEMOGRAPHIC DETAILS:

NAME : Singaravel. M

AGE : 43 yrs

GENDER : Male

MARITAL STATUS : Married

EDUCATION : 12th standard

RELIGION : Hindu

FAMILY TYPE : Nuclear

SOCIO-ECONOMIC STATUS : Upper middle class

OCCUPATION : Real estate business

INFORMANT : Wife

DOMICILE : Rural

REFERRED BY : Others
RELIABILITY : Reliable

PATIENT’S REPORT:

IDENTIFICATION: The patient has a scar on his

left hand in mid finger and he has a mole on his left
eye corner.

CHIEF COMPLAINTS AS NOTICED:

Abnormally upbeat
 Increased activity,
energy or agitation.
 Exaggerated sense of
well-being and self-
confidence (euphoria)
 Decreased need for
sleep.
 Unusual talkativeness.
 Delusion of
grandiosity
 Depression
 Ulcer complaints
 Racing thoughts
 Distracability

COMPLAINTS BY INFORMANT:

 Agitation
 Anger
 Sleeplessness
 Aggressive behavior

PERSONAL HISTORY AND PREMORBID HISTORY:

The patient was born as 3 rd child in his family and
has 2 elders and 1 younger with him. His milestone development was not
normal; his father used to be strict and will beat him often after alcohol
consumption and his mother had a genetic mental illness of BPAD, that makes
him so worried his academic performance was not much good but he involve
in some sports and engage in talking like speech competition.

MARITAL AND SEXUAL HISTORY:

The patient got married in the year of 2004 and have
got 3 children’s, considering his relationship with his wife he would get angry
often without reasons and consume alcohol and beat her occasionally, their
sexual life was normal and they were both satisfied with their sexual practice
and both involved with interest is that without any denial.

CRIMINAL HISTORY:
The patient had met with an accident a year ago, he was under
toxication and made this accident unknowingly so he was filed with the case
of drink and drive and then with his speed limit he had been filed up with a
case.

MEDICAL HISTORY:
The patient had a problem of stomach and mouth ulcer and
he was under treatment for it and was taking medications. He was also having
a metal plate placed in his left leg due to the accident he met with, so
constantly he has a problem of leg and knee pain.

INTRODUCTION:
Mania occurs for a period of 1 week or more where the affected
individual may experience a change in normal behavior that drastically affects
their normal functioning. The defining characteristics of mania are alteration
in mood (elation and ecstasy), increased talkativeness, and rapid speech, sleep
disturbance, racing thoughts, increase in their goal-directed activity, increased
psychomotor activity, and poor insight.

CASE DESCRIPTION:
A 43-year-old male got admitted with the complaints of
decreased sleep, irritable and excessively happy, irrelevant and increased
speech, use of abusing words to His family, and had a grandiose idea that he is
having a close relationship with actor rajini for past days. His onset of
symptoms is sudden with 6 months of duration. He had a predisposing factor
as family history of the bipolar affective disorder for his mother and now she
is under the treatment. He was an introvert person, he isolated himself, and he
did not maintain a good relationship with her family members and friends. He
had a fear of getting Low income due to covid reasons. During assessment his
vitals were stable, and he had a previous history of catatonia for which he
received treatment in concerned clinical setting in March 2019 and was
advised to have a regular follow-up. He was not under regular treatment and
follow-up, and then he developed the symptoms of feeling sad, not interacting
with his family members, and not able to maintain his activities of daily living
(ADL). There he was under the treatment for 2 weeks, and the physician
advised to continue treatment for at least 3–4 months. But he took medicines
only for 2 weeks and as he felt normal he stopped taking drugs; due to
noncompliance, then he developed the above symptoms. Then he was brought
to concerned clinical setting for the further management; there he underwent
investigations such as history collection, mental status examination, etc., and
based on the ICD 10 criteria he was diagnosed as having the bipolar affective
disorder. He was under pharmacotherapy and psychotherapy, which improved
his condition and he was discharged.

ASSESSMENT:

He underwent special investigation such as psychometric

assessment— mania rating scale (MRS), and the findings had been recorded
as score 37 and was identified as the manic episode.

DIAGNOSIS:

Based on ICD 10 classification the patient was diagnosed as the F 30

manic episode. Other classification of mania may include: F31 bipolar
affective disorder; F31.0 bipolar affective disorder, current episode hypo
manic; F31.1 bipolar affective disorder, current episode manic without
psychotic symptoms; F31.2 bipolar affective disorder, current episode manic
with psychotic symptoms; F31.3 bipolar affective disorder, current episode
mild or moderate depression; F31.4 bipolar affective disorder, current episode
severe depression without psychotic symptoms; F31.5 bipolar affective
disorder, current episode severe depression with psychotic symptoms; F31.6
bipolar affective disorder, current episode mixed; F31.7 bipolar affective
disorder, currently in remission; F31.8 other bipolar affective disorders; F31.9
bipolar affective disorder, unspecified.

TREATMENT AND FOLLOW-UP:

The client underwent treatment such as psycho

pharmacotherapy, electroconvulsive therapy (ECT), and other
psychotherapies. Psychopharmacological therapy may include T.
chlorpromazine 100 mg PO 0-0-2, T. lithium 300 mg PO 1-0-1, Syp.
Divalproex sodium 250 mg/mL PO 10 mL-0-10 mL, Cap. Pantop D1 cap PO
(BF) 1-0-1, Syp. Sucralfate 10 mL PO 1-1-1 and Cap. Bifilac 1 cap PO 1-1-1.
He underwent two sessions of ECT and there were no complications during
the session; several other psychotherapies had been given such as individual
and family counseling therapy, supportive therapy such as yoga and music
therapy, and deep breathing techniques also had been taught to the patient. He
got discharged after third session of ECT. He got improvement in his physical
and psychological health, and then he got discharged and the family members
were educated about drug noncompliance, availability of rehabilitation
services, and follow-up services. He insisted for follow-up after 10 days.

RATE OF BREATHING: It is about the counting of inhale and exhale of a

person in a minute. In this process the patient is aware of each and every part
of his body and mind and he was able to control it on his own will. This
enables the client to control his stress factor and able to manage his depression
caused by stress.

MIRROR GAZING: Looking at the mirror increases liking the person and
develops positive attitude.

LAUGHTER THERAPY: The patient was asked to laugh for 15-30 mins.
This releases neuro-chemicals in the brain which makes him feel happy and
relaxed.

ELECTRO CONVULSIVE THERAPY: The patient was given a modified

ECT to activate the brain chemicals and balance the brain chemicals and
involve with preventing further illness severity.

PHYSICAL AND MENTAL STATUS EXAMINATION:

In physical examination, vitals were stable. He

had associated disturbances such as sleeping disturbance and loss of appetite.
In mental status examination, the following findings were noted: increased
psychomotor activity, delusion of grandiose (he said that he is having a close
relationship with actor rajini), excessive talkativeness, mood elevation
(shifting his thoughts from one topic to another), more strong in his speech,
too difficult to interrupt, poor judgment, not able to concentrate in his daily
routines, and poor insight.
DISCUSSION:

The prognosis of manic patients is favorable. Here the patient

presented with many symptoms and after several therapies became normal
because adhered to medications and all the therapies. Some factors associated
with a poorer outcome are a history of abuse, psychosis, low socioeconomic
status, co morbid illness, or a young age of the first onset.

CASE STUDY-II

SOCIODEMOGRAPHIC DETAILS:

NAME : Parasuraman

AGE : 12 yrs

GENDER : Male

MARITAL STATUS : Unmarried

EDUCATION : 7th standard

RELIGION : Hindu

FAMILY TYPE : Nuclear

SOCIO-ECONOMIC STATUS : Middle class

OCCUPATION : Driver

INFORMANT : Mother

DOMICILE : Urban

REFERRED BY : Child specialist doctor

RELIABILITY : Reliable
PATIENT’S REPORT:

IDENTIFICATION: The patient has a scar on

his right knee and on his left eyebrow. The
patient has mole on his right palm and on left
leg toe.

CHIEF COMPLAINTS AS DIAGNOSED:

Memory lapse
 Confusion
 Fainting spells
 Body tremors
 Temporary loss of attention
 Low motivated behavior
 Disturbed sleep

COMPLAINTS BY INFORMANT:

Poor academic results

 Attempts only 1 mark questions in exam
 Lack of attention and concentration
 Stare at particular things
 Addiction to games

PERSONAL & PREMORDID HISTORY:

The patient was the only child for his parents and
he is currently studying in his 7th grade, there is no trace of any genetic
factors for his illness and the patient had a delayed speech and jaundice
during his period of infancy. His milestone development was not much
normal.

EDUCATIONAL HISTORY:

The patient is studying currently in his 7 th grade

when we undergo his educational history he was mentioned to be a slow
learner from his 1st grade and then when he continues to other further
grades he had a difficulty in understanding concepts and also had
difficulty in attempting examination. He only attempts with 1 mark
questions and leaves all other questions in exam when he was questioned
he answered that he feel much difficulty in learning big answers even
with 2 mark questions. Then he was consulted by a child specialist and
they asked his parents to take an assessment on intelligent scale.

MEDICAL HISTORY:

The patient has a complaint of NEAD- Non Epileptic

Attack Disorder for past 5 years and he was not aware of what is
happening to him he just feels a body pain and stressed because of
studies. He had a normal ECG and MRI but he had an abnormal EEG.

INTRODUCTION:

Non-epileptic attack disorder (NEAD) is characterized by

episodic disturbances of normal function and control that superficially
resemble epileptic attacks but are not caused by epileptic activity in the
brain and are thought to have a psychological basis. Diagnosing NEAD
can be difficult even for specialists but it can reliably be distinguished
from epilepsy using video-EEG which shows normal electrical activity in
the brain during attacks. Most patients with NEAD currently receive an
initial diagnosis of epilepsy and there is often a delay of several years
between the initial seizure manifestations and eventual diagnosis of
NEAD. Misdiagnosis leads to emotional distress, confusion, inappropriate
use of antiepileptic medication, repeated attendance at emergency
departments (EDs) and prevents access to psychological treatments.
Prolonged seizures are often misdiagnosed in EDs as status epileptics
leading to inappropriate treatment with intravenous benzodiazepines,
anesthesia and admission to ITU, putting patients at risk of the adverse
consequences of these treatments that include death. Patients often
experience negative attitudes from health care professionals, many of
whom misunderstand NEAD, and believe that patients are consciously
faking epileptic seizures during their attacks.

CASE DESCRIPTION:

A twelve year old patient was taken to hospital by

emergency ambulance during his first seizure. He was admitted to
hospital, treated with IV diazepam, diagnosed with epilepsy and started
on anti-epileptic drug (AED) therapy. This was ineffective so he was
referred to a tertiary centre where he underwent video EEG and was
diagnosed with non-epileptic attack disorder. His experience of the
diagnosis was positive; it didn’t allow him to understand what was
happening to him and to understand the link between his seizures, adverse
childhood experiences and the death of his grandfather who has been
taking care of him so closely. He stopped taking AEDs and he was
referred to a psychologist who led to a significant improvement in his
functioning and quality of life. The patient was taking treatment for his
NEAD for past 5 years even though he doesn’t have an insight on what is
happening to him, this episode of seizure of once happened to him in his
school and then his teachers reported to his parents that this might be a
reason for his intelligence level and then again they went on with taking
ECG, MRI & EEG they got abnormal in EEG and then in order to make
him understand about his problems and in order to check his intelligence
his doctor recommended his parents to take to a psychologist but they
never thought of it that their son would have this problem of intelligence
and after 1 year again he got out with the above mentioned symptoms
relating to his academics and then his parents visited psychologist and
found that he had a borderline intelligence. The patient was getting
distracted much and he was not able to do his assessment with
concentration and attention.

DIAGNOSIS:

The patient was diagnosed as having NEAD- Non Epileptic

Attack Disorder with Borderline Intelligence. The differential diagnosis
made was suspected seizures is long but over 90% of self-limiting
episodes of unprovoked transient loss of consciousness (TLOC) are
caused by epileptic seizures, vasovagal syncope and NEAD.
Cardiovascular conditions which cause TLOC are often associated with
brief myoclonic jerks that can be mistaken for epileptic seizures.
Vasovagal syncope is the most common cardiovascular cause of TLOC
but other potentially serious conditions such as cardiac dysrhythmias can
cause TLOC.

TREATMENT & FOLLOW-UP:

Various treatments have been tried with variable success for

NEAD. Treatment regimes for NEAD include non-psychological (eg, anti-
anxiety and antidepressant medication) and psychological therapies
(including cognitive behavioral therapy, hypnotherapy and paradoxical
injunction therapy). With paradoxical injunction therapy, the therapist
imposes a directive that places the client in a therapeutic double bind that
promotes change regardless of the client's compliance with the directive.

RATE OF BREATHING: It is about the counting of inhale

and exhale of a person in a minute. In this process the patient is aware of
each and every part of his body and mind and he was able to control it on
his own will. This enables the client to control his stress factor during his
study session and able to manage his stress caused by studying.
 CANDLE GAZING: This technique help to the patient to
increase his concentration level and allow him to focus on the task that he
is performing and it increases the assertiveness.

SKIPPING: It brings co-ordination between mind and body.

It increases the concentration and sense of achievement.

WALL PUSHING: It helps the patient to realize that effort on

certain things does not bring any change so we need to make utilize of the
energy in other fruitful ways and this also makes the person physically
active.

PHYSICAL AND MENTAL STATUS EXAMINATION:

In physical examination, vitals were stable. He had associated

disturbances such as sleeping disturbance and loss of appetite. In mental status
examination, the following findings were noted: increased psychomotor
activity, stressed due to studies, excessive talkativeness, mood elevation
(shifting his thoughts from one topic to another), more strong in his speech,
too difficult to interrupt, poor judgment, not able to concentrate in his daily
routines, and poor insight.

DISCUSSION:

There is increasing understanding of NEAD but many remains

unknown. As yet there is no consensus on terminology, with non-epileptic
attack disorder, psychogenic non-epileptic seizures, functional seizures,
dissociative seizures all in current usage. The term pseudo-seizures is still
sometimes used but is now regarded as out-dated and pejorative. The lack of a
simple label and a mechanistic account of the pathogenesis of the disorder as
well as the stigma associated with seizures and mental health disorders make
the explanation of the diagnosis problematic. A common misunderstanding is
that these episodes are consciously staged or faked, that non-epileptic attacks
are voluntary and under conscious control, and that they can be initiated or
terminated at will. These misunderstandings are commonly held by healthcare
professionals and are likely to give rise too overtly or poorly concealed hostile
communication and behaviour and low quality care. Better understanding,
better communication, good quality information provision and education are
essential to improve care for patients with NEAD.
 CASE STUDY-III
SOCIODEMOGRAPHIC DETAILS:

NAME : Phelominal

AGE : 72 yrs

GENDER : Female

MARITAL STATUS : Married

EDUCATION : B.ed

RELIGION : Christian

FAMILY TYPE : Nuclear

SOCIO-ECONOMIC STATUS : Middle class

OCCUPATION : Retired teacher

INFORMANT : Husband

DOMICILE : Urban

REFERRED BY : Others

RELIABILITY : Reliable

PATIENT’S REPORT:

IDENTIFICATION: The patient had a scar on her

left hand elbow and had a mole on her right side
forehead.

CHIEF COMPLAINTS AS DIAGNOSED:

 Crying spells
 Delusion of black magic
 Insomnia
 Agitation
  Loss of appetite
 Oneirophobia

COMPLAINTS BY INFORMANTS:

Complaint of arthritis
 Crying spells
 Improper sleep
 Loss of interest
 Hopelessness

PERSONAL & PREMORBID HISTORY:

The patient was born as 4 th child in her family and

has 3 elder brother and 1 younger brother, her milestone development was
normal and she was grown as a only girl child in her family so she was
given all sorts comfort zone and she got married at the age of 21 and she
had a normal life with her husband and have got 2 children’s and they
also got married and settled with their life. She had a lonely life after her
children have got married and also she was retired and husband was still
working in some company.

MARITAL & SEXUAL HISTORY:

The patient had a satisfied married life is that she was

not forced to get married and their sexual relationship was normal and
there were no complications with them regarding their sexual activities.

MEDICAL HISTORY:

The patient had a complaint of co-morbidity that is diabetes

mellitus and hyper tension and a known case of thyroid condition under
which she in treatment for past years.

INTRODUCTION:

Several risk factors make older adults more prone to

psychosis. The persistent growth in the elderly population makes
important the necessity of accurate diagnosis of psychosis, since this
population has special features especially regarding to the
pharmacotherapy and side effects.  Late onset psychosis includes not
only late-onset schizophrenia but also the other psychotic disorders-
affective psychoses (manic or depressive), paranoid psychoses without
hallucinations (delusional dis- orders) and those psychotic affective and
paranoid syndromes that may arise in association.

CASE DESCRIPTION:

The patient was 72 yrs old and she was started with crying
spells and then gradually she had a medical complaint of known case of
thyroid and diabetes mellitus which made her more prone to her disorder
of late onset of psychosis as this was the underlying co-morbidity factor.
She was working as a 2nd grade teacher and got retired years before and
she was all day alone and then she started with hobbies such as collecting
paper cuttings, drawing, hearing to songs. After some days she started
with the complaints of delusion of black magic, crying spells, loss of
appetite and lack of sleep and reported with poor self care. She was not
having any history of past mental illness, she was a stable person but she
started with auditory hallucination and fear of dream and started with
agitation and delusion of grandiose ( god calls me often) and then she was
recommended by her physician to a psychiatrist and then she was under
treatment for her late onset of psychosis.

DIAGNOSIS:

The patient was diagnosed with late onset of psychosis at her age
of 72 yrs. The patient presented at the concerned clinical setting with
psychotic symptoms. Her initial symptom presentation was atypical, in
that at age 70, she had no history of psychiatric illness, no known history
of substance abuse. A number of evaluations, including history, physical
examination, and laboratory tests, were conducted to rule out specific
diagnoses. The differential diagnosis included psychotic disorder due to a
general medical condition (metabolic or other medical encephalopathy),
delirium, psychosis secondary to substance abuse/dependence, dementia
with delusions and hallucinations, mood disorder with psychotic features,
delusional disorder, psychosis not otherwise specified or
schizophreniform disorder, brief reactive psychosis, and schizophrenia
with onset before versus after age 45. But finally she came out with late
onset of psychosis.

TREATMENT & FOLLOW-UP:

The patient started a regimen of haloperidol, 6 mg/day. Her

hallucinations and delusions improved. The patient decided on her own to
completely stop taking her medications. She reportedly did well without
her medications for about 6 months. At that time, she again developed
psychotic symptoms, with a significant disturbance in her functioning in
social relations and self-care. By the time she came to the clinic, she had
been experiencing a full-blown recurrence of her hallucinations and
delusions for at least several weeks. She began thinking that her brother
and neighbors were plotting against her and were out to take her money
and lock her up. The patient medications at this time included haloperidol,
2 mg at bedtime, for psychotic symptoms, trazodone, 25 mg at bedtime,
for insomnia, and levobunolol, 0.5% ophthalmic solution, for glaucoma.
The patient asserted that she was taking his medications regularly.
Although she had been informed several times about the benefits of
switching to a newer atypical antipsychotic medication, she continued to
refuse this medication because she feared that it would not be helpful for
him and that his auditory hallucinations would return if she switched to a
different medication. She also refused to participate in individual or group
psychotherapy and dropped out of research but attended the medication
clinic regularly.

RATE OF BREATHING: It is about the counting of inhale and exhale of

a person in a minute. In this process the patient is aware of each and every
part of his body and mind and he was able to control it on his own will.
This enables the client to control his stress factor during his study session
and able to manage his stress caused by studying.

PSYCHODYNAMIC THERAPY: It focuses more on emotional problems

and relies on the Therapeutic Relationship to bring about change.

GENERAL COUNSELING: It is less structured but still provides a safe and

non-judgmental environment to discuss issues which is therapeutic in its own
right.

HYPOTHERAPY: It is an alternative form of therapy that can be applied to a

very wide range of problems.

LIGHT THERAPY: Light therapy is a common treatment for sleep disorders

and mood disorders that affect sleep. Also called phototherapy or bright light
therapy, it involves using a special light box at home, or sometimes simply
getting sun exposure at the right time of day.

PHYSICAL & MENTAL STATUS EXAMINATION:

 In physical examination, vitals were stable.
She had associated disturbances such as sleeping disturbance and loss of
appetite. In mental status examination, the following findings were noted:
increased psychomotor activity, stressed due to worrying about her son’s life,
excessive crying spells, mood elevation (shifting her thoughts from one topic
to another), more strong in her speech, too difficult to interrupt, poor
judgment, not able to concentrate in her daily routines, and poor insight.

DISCUSSION:
As mentioned above, late-onset psychosis has become the center of
concern of geriatric psychiatrists, and it is important for those who treat the
elderly patients with psychosis to be concerned about late-onset psychosis and
to have a thorough knowledge of this disorder. In a broad sense, late-onset
psychosis includes not only late-onset schizophrenia but also the other
psychotic disorders-affective psychoses (manic or depressive), paranoid
psychoses without hallucinations (delusional disorders) and those psychotic
affective and paranoid syndromes that may arise in association with
demonstrable or suspected cerebral disease in the absence of a diagnosable
dementia syndrome in elderly patients. The diagnosis and treatment of
psychotic symptoms in elderly patients requires more than just extrapolation
from that of young patients. It is important to have a thorough knowledge of
the characteristics of late onset psychosis for the appropriate management of
elderly patients with psychotic symptoms.

CASE STUDY-IV

SOCIODEMOGRAPHIC DETAILS:

NAME : Raghupathy

AGE : 39 yrs

GENDER : Male

MARITAL STATUS : Married

EDUCATION : 8th grade

RELIGION : Hindu

FAMILY TYPE : Nuclear

SOCIO-ECONOMIC STATUS : Middle class

OCCUPATION : Farmer

INFORMANT : Brother

DOMICILE : Rural

REFERRED BY : Brother

RELIABILITY : Reliable

PATIENT’S REPORT:

IDENTIFICATION: The patient had a scar on

his left leg and he had a mole on his right hand
index finger and in his right collar bone.

CHIEF COMPLAINTS AS DIAGNOSED:

 Hallucination (visual & auditory)

 Trembling of hands
 Insomnia
 Loss appetite
 Anger
 Aggressive behavior
 Guilt and anxiety
 Agitation

COMPLAINTS BY INFORMANT:

Aggressive behavior
 Lack of sleep
 Dizziness
  Anger
 Craving
 Shakiness

PERSONAL & PREMORBID HISTORY:

The Patient is the 3rd among 5 siblings with 2 elder
brothers and 1 younger brother and 1 younger sister. The development
milestones were age appropriate and achieved normally. Patient started going
to school at the age of 3 years. The highest educational qualification the
patient completed is his 8th grade because he was not interested to continue his
studies further and involved himself in doing farming. He used to participate
in the co-curricular activities in school and had no disciplinary complains in
school.

MARITAL & SEXUAL HISTORY:

Marital adjustment of the patient is not satisfactory.
Intake of alcohol was present in the patient before his marriage. He was on
abstinence for 2 years. But it was not disclosed to the spouse family. Marriage
took place within 15 days after both the family came to know each other. One
year of the marriage life went on smoothly. Marital adjustment was cordial at
the initial years. But the patients relapse on the day of his son hair cutting
ceremony. He had consumed alcohol on that occasion. After that he started
showing abusive and auscultative behavior towards his family members and
his alcohol intake behavior was increased. This incident has affected their
marital life. Knowing that wife went back to home. She was at home for 45
days. Family members from the patient’s home went to bring her back from
home for 17 times. At last when the patient promise to quit alcohol she came
back. But the patient could not maintain it and relapse. Wife went to home
again. And after giving many chances to the patient to quit alcohol and
maintain a stable life she has lost all her hope.

INTRODUCTION:
A chronic disease in which a person craves drinks that contain
alcohol and is unable to control his or her drinking. A person with this disease
also needs to drink greater amounts to get the same effect and has withdrawal
symptoms after stopping alcohol use. Alcoholism affects physical and mental
health, and can cause problems with family, friends, and work. The disorder
characterized by a pathological pattern of alcohol use that causes a serious
impairment in social or occupational functioning. Primary, chronic disease
with genetic, psychosocial, and environmental factors influencing its
development and manifestations. The disease is often progressive and fatal. It
is characterized by impaired control over drinking, preoccupation with the
drug alcohol, use of alcohol despite adverse consequences, and distortions in
thinking, most notably denial.

CASE DESCRIPTION:
The patient in the present case has been denied supportive,
intimate and long lasting relationships. Patient’s wife left the patient several
times not able to withstand his alcohol intake behavior, which affected his
major source of support and social acceptance. He has been neglected by his
sibling; there was lack of support from their side. In the present case alcohol
abuse has affected the couples’ relationships in a variety of negative ways,
including communication problems, increased conflict, nagging, poor sexual
relations, and domestic violence. Patients was not able to perform a role as a
father because of his drinking behavior, he was inconsistent, unpredictable,
and lacking in clear rules and limits. As it has found in the research that
children of alcoholic parents commonly experience poor parenting and poor
home environments, conflict, interpersonal problems during significant
developmental periods and its effect their physical mental and cognitive health
. In the case study the wife of the patients, is especially affected in this way,
often becoming emotionally inaccessible not only to the husband alcoholic
behaviour but to her children as well, due to the need to try to block out the
overwhelming emotional climate. Children notice this when they see
behavioral changes, crying, and physical or affective distancing by mother.
while emotional distancing is evidenced by such things as mothers talking to
their children less, answering only basic questions and being more inclined to
silence .In the case we found that staying alone and working out of his home
town without any supervision of medication as the patient’s own lack of
insight into his symptoms and contributes into the treatment non-compliance
as the patient does not feel the need to take any medications and refuses to do
so.

DIAGNOSIS:
The patient was diagnosed with ADS- Alcohol Dependency
Syndrome ( F10) according to ICD-10 and he was in the stage of daily pattern
is that eye opener drinker drinking alcohol sudden after their sleep and wake
up in morning.

TREATMENT & FOLLOW-UP:

The treatment included with enhancing the motivation
of the patients, to reduce the distress in patient and family members, to
strengthen the support system, to psycho educate the patient and family
members, to reduce the expectations in family members and enhance support.
Admission counseling, Family intervention, Psycho-education,
Supportive therapy, Motivational Enhancement Therapy, Brief intervention,
Family intervention.

COGNITIVE BEHAVIORAL THERAPY:

Cognitive Behavioral Therapy (CBT) is a
proven method for alleviating the burdens of alcoholism. The basic premise of
CBT is the importance of identifying negative thoughts and behaviors and
replacing them with positive thoughts and behaviors. A CBT session will be a
conversation between a patient and a psychologist. CBT is a solutions-
oriented approach to treatment which focuses less on diagnosis and more on
constructive action, such as challenging harmful beliefs, confronting fears,
role playing to improve social interactions, and crafting strategies to stop
drinking alcohol or using drugs. This makes the patient to have a positive
thought and neglect about the fear of social withdrawal.

DIALETICAL BEHAVIORALTHERAPY:
Dialectical Behavioral Therapy (DBT) is
another type of evidence-based talk therapy. The DBT method operates from
the assumptions that everything is connected, the world constantly changes,
and opposite elements (thesis and antithesis) may synthesize into a better
element or a greater truth. These assumptions comprise the basis of the
philosophical system of dialectics. In practice, an individual or group DBT
session will involve learning to live in the present instead of dwelling on the
past, managing emotions and distress, and practicing honest communication.
Ultimately, DBT is designed to help patients find emotional balance and
embrace positive change. This help the patient feel emotionally strong and
find a social approval of their concern after their de-addiction.

YOGA AND MEDIATION:

This helps the patient to stop his craving and also help
him to control himself. Yoga and meditation can be beneficial techniques for
managing cravings and staying focused during recovery. Some rehab centers
even offer yoga and meditation courses. Broadly speaking, yoga is a
collection of physical and mental exercises. A yoga practice does not
necessarily have to involve a spiritual or religious dimension. Meditation is
any method of relaxation which helps a person maintains calm, emotional
peace, and clarity. Studies have indicated that yoga and meditation can
function as therapy for people with substance use disorders, especially if the
sessions are led by a mental health professional and supplement other
treatment.

ART AND MUSIC THERAPY:

Art and music therapy are thought to help patients tap
into emotions and needs that may be difficult to express through more
traditional forms of communication. Music therapy also provides clients with
increased motivation for treatment. Physically, artistic expression connects us
to our emotions. It is a tangible way to reconcile emotional conflicts. This
connection can help fill the void that drugs and alcohol leave in a substance
abuser. It also helps build new insights.

The follow up involved with the following: After the discharge of the patient
they came for follow up. A brief investigation about maintaining the
medicines and other related problems has been inquired and assured that the
patient is maintaining well. Suggestions had been provided to the family
member to continue the follow up. Follow-up plan: Follow up to ensure
medication compliance and maintaining abstinence, to motivate the patient to
engage in productive work without getting relapse.

PHYSICAL & MENTAL STATUS EXAMINATION:

In physical examination, vitals were stable. He had
associated disturbances such as sleeping disturbance and loss of appetite. In
mental status examination, the following findings were noted: increased
psychomotor activity, stressed that how to stop drinking, excessive crying
spells, mood elevation (shifting his thoughts from one topic to another), more
strong in his speech, too difficult to interrupt, poor judgment, not able to
concentrate in his daily routines, and poor insight.

DISCUSSION:
The patient had gained insight regarding his illness. Patient’s
motivation has been enhanced. Family members have better understanding
about patient’s illness. Thus it can be said that Psycho-social interventions
play an important role in determination of treatment outcomes. It has been
shown to improve patient compliance to medication and the retention of
patients in treatment. It has also been shown to increase alcohol abstinence
rates and quality of life in persons with alcohol dependence. Psychiatric social
work can play a key role in working with person with alcohol dependence
syndrome, educating, enhancing motivation and teaching skill for recovery
and also working with the family. So we can conclude that treatment and
rehabilitation of patients with alcohol dependence has been an important area
of psychiatric social work. Psychosocial intervention can enhance
pharmacological treatment efficacy by increasing medication compliance,
maintenance in treatment, and attainment of skills.

CASE STUDY-V
SOCIODEMOGRAPHIC DETAILS:

NAME : Simon Paethru

AGE : 31 yrs

GENDER : Male

MARITAL STATUS : Unmarried

EDUCATION : 8th grade

RELIGION : Christian

FAMILY TYPE : Nuclear

SOCIO-ECONOMIC STATUS : Middle class

OCCUPATION : Daily wage

INFORMANT : Friends

DOMICILE : Rural

REFERRED BY : Others

RELIABILITY : Reliable

PATIENT’S REPORT:
IDENTIFICATION: The patient had a scar on his
right leg and in his right elbow he had a mole on his
left collar bone and on his right foot.

CHIEF COMPLAINTS AS DIAGNOSED:

 depressed mood
 sleeping too much or not enough
 anxiety
  suspiciousness
 withdrawal from family and friends
 delusions
 hallucinations
 disorganized speech, such as switching topics erratically
 depression
 suicidal thoughts or actions
 difficulty in concentration
 childhood sexual abuse

COMPLAINTS BY INFORMANT:

 disorganized speech, such as switching topics

erratically
 depression
 suicidal thoughts or actions
 difficulty in concentration
 childhood sexual abuse

PERSONAL & PREMORDID HISTORY:

The patient was born as 2 nd child in his family and he

has 1 elder sister and 1 younger brother. The milestone development of the
patient was not normal because he had a history of childhood abuse by his
sister and that he got disturbed with that and in his recent past he had a
premarital affair with a girl of 18 yrs old and then got break with that
relationship. This may be the cause for his mental illness his mother died at
his early age and his father got re married to other person that he got separated
from his biological family and was living with his relative family later on he
was addicted to alcohol and so he was rejected by his family.
SEXUAL HISTORY:

The patient had a sexual abuse by his sister in his younger age
and then he involved in abusing an 18 yr old girl by seducing her and then
broke with that relationship. He didn’t have any sexual disorders or sexual
dysfunction.

INTRODUCTION:
Unspecified Non Organic Psychosis - a common diagnosis for
a first episode of psychosis. Non-organic psychosis is a physical as well as
psychological state, as any mental experiences assumable are, but not an
objective medical problem. The cause of one’s experiences cannot be
determined by evaluating whether or not they could be labeled a “psychosis”,
so we rely on context and also a search for physical problems to exclude
various explanations.

In a non-organic psychosis your brain is fine but you may not be feeling fine
or having experiences considered usual, comfortable, or even bearable. As
mentioned, being non-organic does not mean there is no physical grounding to
the experiences, it is just drawing a line between something working
‘incorrectly’ and something working as designed.

CASE DESCRIPTION:

In the present case the patient has been involved with

mental illness regarding unspecified non-organic psychosis and he was forced
to seek help of psychologists. He refused to seek help with mental health
professionals and so he was injected with sedative and taken to the concerned
clinical setting. Once he got admitted he had complaints of family withdrawal,
social withdrawal, rejection from his family, hallucination and delusion,
aggressive behavior etc. Then he was under treatment for days and he got
somewhat recovered from his symptoms of hallucination and thought
insertion. He refused to take medicines at the beginning and thought that he
was being arrested by someone. Then with sessions of ECT he got his
recovery with the medications too, he was not able to seek with attention and
concentration towards the counselor or with other people. He was not able to
focus on his daily activities and had a poor self care.

DIAGNOSIS:

The patient has been diagnosed with F29 for Unspecified psychosis
not due to a substance or known physiological condition is a medical
classification as listed by WHO under the range - Mental, Behavioral and
Neuro developmental disorders.

TREATMENT & FOLLOW-UP:

 The main type of drug that doctors prescribe to treat

psychotic disorders are “antipsychotics.” Although these medicines aren't
a cure, they are effective in managing the most troubling symptoms
of psychotic disorders, such as delusions, hallucinations, and thinking
problems. Therapies for psychosis include different types of
psychotherapy, antipsychotic medications, mood stabilizers, substance abuse
counseling, family therapy, and support from a group or therapist.

COGNITIVE BEHAVIORAL THERAPY: Cognitive Behavioral

Therapy (CBT) is a proven method for alleviating the burdens of alcoholism.
The basic premise of CBT is the importance of identifying negative thoughts
and behaviors and replacing them with positive thoughts and behaviors. A
CBT session will be a conversation between a patient and a psychologist.
CBT is a solutions-oriented approach to treatment which focuses less on
diagnosis and more on constructive action, such as challenging harmful
beliefs, confronting fears, role playing to improve social interactions, and
crafting strategies to stop drinking alcohol or using drugs. This makes the
patient to have a positive thought and neglect about the fear of social
withdrawal.

RATE OF BREATHING: It is about the counting of inhale

and exhale of a person in a minute. In this process the patient is aware of
each and every part of his body and mind and he was able to control it on
his own will. This enables the client to control his stress factor during his
study session and able to manage his stress caused by studying.

CANDLE GAZING: This technique help to the patient to

increase his concentration level and allow him to focus on the task that he
is performing and it increases the assertiveness.

MIRROR GAZING: Looking at the mirror increases liking the

person and develops positive attitude.
 LAUGHTER THERAPY: The patient was asked to laugh for 15-
30 mins. This releases neuro-chemicals in the brain which makes him feel
happy and relaxed.

ELECTRO CONVULSIVE THERAPY: The patient was given a

modified ECT to activate the brain chemicals and balance the brain chemicals
and involve with preventing further illness severity.

PHYSICAL & MENTAL STATUS EXAMINATION:

In physical examination, vitals were stable. He had

associated disturbances such as sleeping disturbance and loss of appetite. In
mental status examination, the following findings were noted: increased
psychomotor activity, stressed out because of his childhood abuse by his
sister, excessive sadness and all of sudden to excessive sadness, excessive
anger, mood elevation (shifting his thoughts from one topic to another), has a
poverty of speech, if he speaks out it is too difficult to interrupt, poor
judgment, not able to concentrate in his daily routines, and poor insight.

DISCUSSION:
Non-organic psychosis is a physical as well as psychological state, as
any mental experiences assumably are, but not an objective medical problem.
The cause of one’s experiences cannot be determined by evaluating whether
or not they could be labeled a “psychosis”, so we rely on context and also a
search for physical problems to exclude various explanations. In a non-
organic psychosis your brain is fine but you may not be feeling fine or having
experiences considered usual, comfortable, or even bearable. As mentioned,
being non-organic does not mean there is no physical grounding to the
experiences it is just drawing a line between something working ‘incorrectly’
and something working as designed. Neither organic nor non-organic
psychoses will necessarily have an established or scrutable cause. Sometimes
we just don’t know why something is happening, whether generally or on a
mechanical level. What is more important is excluding known possibilities
and addressing the concerns of the person having the experiences to their own
preferences and satisfaction.