Bobby Thomas Kokkatt, (2007) Psychological Case Record. Diploma thesis, Christian Medical College,Vellore.
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Abstract
DIAGNOSTIC CLARIFICATION: The patient was apparently all right till four years back. During the second year of PUC patient complained to his parents that he had been sexually abused by an elderly male person while he was in a park. He was severely distressed and was taken to a psychologist where he underwent therapy. Following this he was apparently all right and had joined a catering course. He was staying in a hostel in his second year. During this time he was reportedly sexually abused by his hostelmates and when he had tried to resist, had been threatened that he would be killed. Since then, has been expressing that he had frequent repetitive thoughts that semen was continuously passing out of him. He felt that the anal region had some sticky sensation on standing, making him have the urge to pass stools. He also felt that there was a snake inside his abdomen and whenever he touched a metal piece he had the thought that it may become a sickle and cut his body into pieces. Hence he deliberately avoided touching any metal. He says that these thoughts were recurrent, recognizing that it is partly true, struggling to dismiss these thoughts because of its disturbing nature but unable to do so. He had less control over the obsessions and upto fifty percent of time was successful in diverting the attention by imagining that these problems were transferred to another person. CONCLUSIONS: Thought processes lacked clarity. Obsessive nature of thinking was predominant. There was fear of being harmed. Interpersonal relations were poor and group conformity also was poor. His mentation was slow. Inability and inferiority were evident. There was low ego strength and under productivity. Anxiety and depressive features were also evident. Findings revealed that his reality orientation was not very strong; however he did not have responses that were suggestive of a psychosis. There were indicators of a severe level of emotional disturbance. Patient would improve significantly with psychotherapy and medication. NEUROPSYCHOLOGICAL ASSESSMENT: The patient is a known diabetic and hypertensive since fifteen years. In 1998 in his office he was found unconscious and probably not attended for about an hour. In the hospital his blood pressure was found to be high. The CT scan revealed gross intraventricular hemorrhage with large hypo dense area in right tempro-occipital region, small intra cerebral hematoma in left Para ventricular region with few lacunar infarcts on both sides. He regained consciousness in 3 to 4 hours time. The details of his physical status were not known as he was admitted in intensive care unit. The relatives did not notice any features suggestive of any neurological deficits during his stay in the hospital and was discharged in the eighth day. Following the discharge he was found to have problems in memory. He was not able to identify close relatives and used to let strangers into the house. He was not able to remember his address, not aware of the current events, misplace things and forget what he had for the breakfast. He was unable to understand what is spoken and had difficulty in finding correct word. He also had difficulty in using familiar objects like tooth brush and had difficulty in performing simple tasks at home. He was almost fully dependent in ADL like feeding, toileting, bathing, dressing and grooming. He also had difficulty in relating to news paper or TV. He also had difficulty in managing finance or give advice to people regarding the insurance. He also was unable to engage in social activities and behave in socially appropriate way. He improved gradually after a period of 3 to 4 months and has improved up to fifty percent in one year period. He did not show much improvement after these. CONCLUSION: Deficit was evident across lobe functions. DIAGNOSTIC CLARIFICATION: Ten yeas back when patient presented with depressive symptoms like anhedonia, easy fatigability, low mood decreased concentration and memory feeling of worthlessness and hopelessness he was treated with antidepressants but discontinued the medication in less than a month due to the side effects. Details of his clinical status were not known but he had consultations with multiple medical practitioners and underwent numerous investigations over the next five to six years. During this period he completed his PUC, B.Sc. and had joined for MIT in Chennai. In 2004 he was treated with antidepressants and antipsychotics when he presented with depressive symptoms with psychotic features. He seemed to have been on regular antidepressants till date when he presented. While on medication he presented with three to four months history of suspiciousness towards family members, talkative, had spoken proud of himself, and was hyperactive. He had engaged in odd behaviors like sending telegrams that his family members were dead etc. He presented with high irritability, assaultiveness and occasionally threatened to kill himself or other family members. He claimed that he had lodged a complaint with the supreme court and CBI regarding his threat and they were on their way to catch the relatives .The symptoms were worse when he claimed that he heard strange noises that people were coming to kill him .Patient claimed that God had given him information with which he had escaped from several attempts in his life. There were no history of head injury, high grade fever, loss of consciousness, seizure, or vomiting preceding this episode. There was no history of any substance abuse. PERSONALITY ASSESSMENT: Patient had the first episode of abnormal movements of the body three months back. It occurred at school and was characterized by hyperextension of both upper limbs, with flexion of the neck with eyeball moving upwards followed by a loud cry. Patient was fully conscious but could not speak. Each episode lasted for ten to fifteen minutes. This was not associated with any incontinence or generalized tonic clonic movements. Such episodes had occurred multiple numbers of times at school. At times this used to occur three to four times in succession in a short span of time with full recovery in between the episodes. Such episodes were very infrequent at home. There were no such episodes during sleep. Last episode was ten days back. There were no history of headache or vomiting or any features suggestive of neurological deficits. There were no histories of head injury or substance abuse. There were no histories suggestive of depressive, manic or psychotic or obsessive compulsive or anxiety symptoms. The onset of symptoms had a temporal correlation with few stressors following a warning by the headmistress and parents, for the love affair with a boy of the same school And in the same week some unknown person make some sexual advances towards her. Other stressors elicited were, difficulty in studies, the problem in relationship with younger sibling and the critical attitude of the parents. CONCLUSIONS Tests revealed feelings of decreased self-esteem, anxiety, uncertainty, insecurity and apprehensiveness about issues in life. High affection and dependency needs were present and this had lead to helplessness and suffering. Her low average intelligence and poor coping skills and the high expectation of the relatives contributed to her problem. Test findings were suggestive of cluster C personality traits. INTELLIGENCE ASSESSMENT: He was sent to school at three years of age and was average in the studies in the initial few classes .However he gradually started having difficulty in reading complex sentences and in calculation .He was then shifted to a different curriculum in a low functioning school. In class six he had failed once and was currently in class seven during his visit to the hospital. He had been regular to school and but for the past six months prior to the visit had discontinued. Previous consultations – at one and a half years of age he was not able to close the left eye lid with pupils rotated medially. He underwent surgery the following year, the details of which are not known. Two years later he had a sudden deviation of angle of mouth to right side with sixth and seventh cranial nerve palsy. CT scan showed the left lateral ventricle mildly dilated with hemi atrophy features. No specific treatment was advised Five years later he developed mild weakness of the upper limb and was advised physiotherapy. In 2003 the repeat CT scan showed parenchymal volume loss in left hemisphere. There was no history suggestive of seizures, psychosis, depression, obsessive compulsive disorder, tics or other pervasive developmental disorder.
| Item Type: | Thesis (Diploma) |
|---|---|
| Uncontrolled Keywords: | Diagnostic Clarification, Neuropsychological Assessment, Diagnostic Clarification, Personality Assessment, Intelligence Assessment. |
| Subjects: | MEDICAL > Psychiatry |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Jan 2020 00:57 |
| Last Modified: | 04 Dec 2020 02:00 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11864 |
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