Cattamichi Vinila, (2010) Psychological Case Record. Diploma thesis, Christian Medical College,Vellore.
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Abstract
NEUROPSYCHOLOGICAL ASSESSMENT: The episodes started when Mr. MS was eight years of age. Episode starts with lip smacking, rubbing his hands together clinching with vacant stare look. He would be found unresponsive on call. After twenty to thirty seconds, he became responsive. There was no major confused state after the episode. When tried to clarify by others nearby what was happening, he could not recollect whether any such episode has happened. There was a history of post ictal state with left lower and upper limb weakness associated with fever. By 3 days fever subsided and his weakness improved to normal by one month. There was no aura or hallucination. There was no a tonicclonic movement or incontinence or frothing or loss of consciousness with postural fall suggestive of generalized tonic-clonic seizure. Four years later he had second episode of similar semiology except no history of limb weakness or association with fever. Since then starting the frequency of episodes used to be 1-2 times per month but past three years frequency increased to 5-6 times per week. Patient had poor scholastic performance due to seizures so dropped of school after 10th standard. Patient had few episodes occur at work place. Patient had injury during the episodes and sometimes while working as he develops seizures. Frequent episodes which started affecting his daily activities and also increased in frequency of episodes, and uncontrollable on medication he was brought to CMC for expert opinion. In view of mostly daily episode of seizures and poor control with antiepileptic and side effects of medicine option of surgery was considered. There was a one year history of recent memory impairment and increased anger outburst. There was no history of apathy or emotional labiality or sexual disinhibition. There was no history of forgetfulness or difficulty in speech. There was no history of apraxia or difficulty in calculation. There was no history suggestive of psychosis or syndromal depression or mania. There was no history of deviant personality traits or obsessions or compulsions. There was no history of phobia or panic attacks. There was no history of head injury. His biological function was reportedly normal. He still continued to his basic and instrumental activities of daily living independently. DIAGNOSTIC CLARIFICATION: From early childhood onwards, Ms. G was reported to be adamant and demanding in nature. She had poor frustration tolerance that even for trivial incidents at school or at home she would be angry and sometimes agitated. She was brought with history of episodic illness currently being the 3rd episode with inter morbidly reaching premorbid level of functioning. Initial episode was in November 2005 being different from other two episodes. Initial episode was at age of 15 years characterized by one week history of irritability, crying spells, low mood, body aches, nihilistic ideas that intestine and uterus was absent. She had decreased concentration in studies and decreased memory. She reported decreased sleep and appetite. She also reported hearing non existing voices. Stressor was the death of her grandfather just six months before the episode whom she loved the most. There was gross impairment of instrumental activities of daily living. She gradually improved on medication but was irregular on medication. Mother reports hearing of nonexistent voices continued during reviews which patient always denied. She completed her 10th standard during that period. The last two episodes she had was similar characterized by wandering, irritability, crying most of time, more adamant and demanding than premorbid condition. She also had hearing of non existing voices and smiling to self with decreased sleep and appetite. Previous episode she presented with one month history in August 2006 and reached premorbid functioning within one month and finished her 12th standard. She was on antipsychotic only. Lost follow up for 3 years and now presented with one month history of similar symptoms as previous episode except that she can hear Gods voices who was demanding her for things like pumpkin, lemon and asking her to pray. She keeps changing clothes more than three times per day, and saying she can achieve anything in life like she can earn lot of money, buy jewels and take care of herself. She keeps fighting with her parents most of the time and blaming them as she cannot fulfill her dreams because of them not letting her to study further. She breaks things at homes when her demands are not meet immediately. Her grandmother and relative give whatever she wanted like money or get things she wanted when she becomes irritable or breaks things. There was also history of weight gain on medication and amenorrhea. There was no history suggestive of first rank symptoms. There was no history of expressing false belief with conviction. There was no history of any abnormal perception. There was no history of phobia or panic attacks. There was no history suggestive of organicity or seizures or head injury or loss of consciousness. DIAGNOSTIC CLARIFICATION: Patient was apparently well till February 2008, except for anxiety during her exams manifested as tremors and palpitations. In February 2008 during her 10std final exam preparation she had been skipping meals and studying the whole night. She had loss of interest in pleasurable activities and had gradual decrease in appetite along with vomiting. She consulted a Gastroenterologist who diagnosed probable gastro paresis and functional vomiting and started her on Itopride and setraline. Her appetite improved on medication but she continued to have vomiting and was referred to Psychiatry for further management. She was diagnosed to have Somatoform autonomic dysfunction upper GIT and asked to come for inpatient admission for detailed evaluation. Currently she presented with history of increased vomiting immediately after food, bloating following food intake, and loss of weight of nearly 20 kgs in the last one year, constipation and generalized weakness. She also had history of amenorrhea since past 6 months. There was no body image distortion. Her sleep was normal with no pervasive mood symptoms reported. Her symptoms had led to significant impairment in her daily routine and academic performance following which she eventually dropped out of school. There was no history suggestive of first rank symptoms. There was no history of expressing false belief with conviction. There was no history of any abnormal perception. There was no history of mania or hypomania or phobia or panic attacks. There was no history suggestive of organicity or seizures. PERSONALITY ASSESSMENT: Patient reported that since childhood she had been having difficulty in adjusting with her mother whom she regarded as being uninvolved and uncaring. She reported that both her father and brother had similar problems with her mother. Frequent parental conflicts had been present and reportedly father and patient had been verbally and physically abused by the mother. She described her mother as career – minded, constantly preoccupied about money at the cost of neglecting the children’s needs for love and affection. She had often spent less time at home in an attempt to avoid conflicts with her mother. The last six months her mother had been increasingly assaultive and abusive towards her after the loss of her job. She had apparently been doing fairly well in her academics despite the problems at home till about 4 months back when she was noticed to be more withdrawn and dull. Crying spells was present. She expressed feeling sad and dull. Although she attended school she was not able to concentrate in studies or complete homework. She lacked confidence in self, felt tired and did not enjoy reading or browsing internet like before. She reported having disturbed sleep and difficulty in initiating sleep. She felt very dull in the morning but slightly better by evening. She had decreased appetite. She expressed suicidal ideas saying that she wanted to die as she had feelings of helplessness and hopelessness. She had guilt feelings of being a burden for her father and brother who was taking care of her. For the past two months, she was irregular to school and started expressing fear of class tests and eventually stopped going to school. The past one year it was observed that patient was easily angered, unable to forgive insults, and having a low frustration tolerance. She had become very sensitive, very doubtful and cautious. She was always preoccupied with details, rules and order. She expected things to be done in perfect way which interfered with her daily task like studies. There was no history suggestive of first rank symptoms. There was no history of expressing false belief with conviction. There was no history of any abnormal perception. There was no history of grandiosity, hyperactivity or elation of mood any time. There was no history of phobia or panic attacks. There was no history suggestive of head injury, fever, seizures, and loss of consciousness or substance abuse. INTELLIGENCE QUOTIENT ASSESSMENT: Since childhood, she had been noticed to be deficient in various skills compared to other children of her age. She had difficulty in understanding and learning new skills. She lacked the ability to take up minor responsibilities. She preferred the company of younger children but did not have the appropriate skills to play with them. Solitary play was more predominant. Her communication skill was not adequate and she had difficulty in expressing her thoughts. She required assistance in performing certain self care activities and her daily routine needed supervision. Her biological function was normal. There was no history to suggest psychotic symptoms, persistent mood changes, unconsciousness, seizures or other features of organcity. There was no specific periodicity to these complaints. Her delay had been noticed since 3 years of age.
| Item Type: | Thesis (Diploma) |
|---|---|
| Uncontrolled Keywords: | Neuropsychological Assessment, Diagnostic Clarification, Diagnostic Clarification, Personality Assessment, Intelligence Quotient Assessment. |
| Subjects: | MEDICAL > Psychiatry |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Jan 2020 06:52 |
| Last Modified: | 04 Dec 2020 03:04 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11884 |
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