Psychology Case Record

DIMENTIA IN ALZHEIMER'S DISEASE: According to the informants the patient was reported to be normal till 6 months back. Then, his elder daughter noticed that the patient repeatedly searched for certain common things in the house. He would forget simple things in the house like the way for going to toilet. At times he also found it difficult to return to his house after going for a walk Gradually, he was unable to identify his close relatives and called his daughter as his sister. And also he was not able to remember whether he had taken his food or not. His self care decreased gradually for 6 months. Now for 3 months, he did not take bath and did not change the dress. At times, he would pass urine inside the house. He was found to have disturbed sleep. He slept for very little time, and would wake up in the middle of the night and keep pacing inside the house. No H/o persistent depressed or elated mood. No H/o. sucidal ideas or attempts. No H/o repetitive thoughts/acts. ALCOHOL DEPENDENCE SYNDROME: The patient was reported to be normal 10 years back. Started to consume alcohol 10 yrs back along with his friends for pleasure, he gradually increases frequency as well as quantity over the time. For the past 5 yrs he used to have almost daily and start to have early in the morning, as he spent most of the money for alcohol and frequent absent in work caused decreased productivity. Because of that he had frequent interpersonal problem with his wife. For last 5 days for the concern of the family and concern with his physical condition he stopped consuming alcohol. He had sleeplessness since then. No H/o symptoms suggestive of psychotic features. No H/o inflated self esteem / elated mood. No H/o withdrawal seizures / suicide attempt. No H/o head injury / fever. No H/o hemetemesis / melena / abdominal pain. PARANOID SCHIZOPHRENIA: Mr. M. got married 4 years ago, was normal upto 1 year after marriage. Working as a carpenter and interacting well with others. Gradually he became dull and was found irregular in his work. He became less communicative and was pre occupied. He did not give any proper reply for his behavioural changes, when questioned by his wife. Gradually he started suspecting that his neighbours are talking ill about him and monitoring his daily activities secretly and also they are trying to do harm against him by doing black magic. He picked up quarrel with his neighbours for the same. He would also abuse and at times even assault his neighbours. He started refusing food at his relative's house suspecting it to have been mixed with poison. Stopped going for job. His self care gradually decreased. He took bath and brushed his teeth only on compulsion by his wife. Gradually, he began to talk alone for one year. He started having sleep disturbance for 6 months, had difficulty in initiation as well as maintenance of sleep. His appetite decreased and did not take food in adequate amount. Initially, he was taken for magico-religious treatment and since there was no improvement, he was taken to a private psychiatrist at Madurai and prescribed drugs. He was on irregular treatment since then. The symptoms improved to some extent. His sleep and self case improved. Suspicious ideas decreased. For the past 2 months the symptoms aggravated, his suspiciousness increased. He also started suspecting that his wife killed his son and daughter. He slept hardly for 2-3 hours per day. He was showing hostility towards his wife and once tried to slab her wife a scissors. No H/o persistent depressed or elated mood. No H/o repetitive thoughts and acts. No H/o suicidal ideas or attempts. No H/o head injury / LOC /Seizure / Fever. No H/o substance abuse. OBSESSIVE COMPULSIVE DISORDER: Mrs. N was reported to be normal 6 years back, working as a tailor and taking care of her family. Gradually, she started to think that her hands were contaminated and she started washing her hands very frequently. She started to worry about her routines and started to wash repeatedly all her households like utensils, clothes, floor, household items and used to take bath for long hours to keep herself clean. The thoughts of cleanliness occurred repeatedly as intrusive ones in her mind and got partial satisfaction only after performing these acts. The patient recognised the thoughts were her own, initially the thoughts were minimal and gradually, it started increasing. She tried to cut down the thoughts but she cannot. So she became anxious. This also resulted in disturbances in her work time, resulting in absenteeism and she was left feeling helpless over this issue. She kept doubting about matters like whether she had locked the door, switched off the lights and would keep checking repeatedly even though she felt it was excessive. The symptoms were increased for the past 6 months, and she started getting such thoughts most of the time. This made her very much distressed and her work performance decreased. She started feeling sad. She had sleep disturbance. She had difficulty in initiation of the sleep. At times, she had suicidal thoughts, but no attempts was made. No H/o. other repetitive thoughts / images / impulses. No H/o. suspiciousness (or) hearing voices. No H/o. seizure / head injury. PHOBIC ANXIETY DISORDER: Mrs. B was reported to be normal 3 years back, working in a Tasmac Shop. One day, he was travelling with his friend in a car; and his friend got out of the car in order to take cash out of the ATM and locked him in the car. About 5 minutes later, the patient experienced palpitation, sweating and trembling of hands, breathlessness and fear that something untoward may happen to him and wanted to get out of the car at once. He felt better after 5-10 minutes, when he came out of the car. Two months later, when he was travelling with the same friend, he experienced similar episode. After this incident he avoided travelling by cars. After that, he started feeling uncomfortable in other closed spaces, and also he was unable to travel in lifts, in government buses with automatic doors. Whenever he faces this situations, he experienced fear, and this fear would last for 5-10 minutes. He also experienced similar fear for heights and speaking in the public places. He also been persistantly worried, whenever he sees any unpleasant events or hear or watch bad news in TV, he began to think about atrocities occurring in the country like crime, rape, murder, kindnapping, bribery, poverty, famine and draught. He spent most of his time thinking about this. He keeps contemplating about his existence about who is he, what his role in the world. He has not been going for work for 3 years and he is not having confident of doing his job well and that fear and tremors disabled him from doing a job, and he also feels afraid of his superiors at work. When his mother asked him to get married he wished to have a guarantee that his mind and body is healthy and that of his wife must be certified as healthy. He has also been experiencing difficulties in going off to sleep, as he worries if some harm may befall on him, when he is asleep like earthquakes. He gets sleep after 2-3 hours and sleeps upto 7-8 am a day. All of these complaints have been present most of the time for the past 3 years. Since he had not seen going for work and refusing marriage his mother brought him to IMH for consultation. No H/o. talking / laughing to self. No H/o. abusive / assaultive behaviour. No H/o. inflated self esteem. No H/o. suspiciousness / hearing voices. No H/o. elated mood / sad mood. No H/o. repetitive thoughts / intrusive images. No H/o. seizuer / LOC / fever