Its classic case of depression in young adult.

1. CASE PRESENTATION
Presenter: Dr. Nilesh Basarkar
Moderator: Dr. C. Pinto, Dr. J. P. Rawat
Dept. Of Psychiatry
JRH BCT.

2. History
• A 19 yrs old
Right handed
Hindi speaking
Unmarried, Hindu male
Student of 12th std
Resident of Dahisar
• Complaints-
Self- Headache
Sadness of mood

3. • Objective data- Mother (Adequate & reliable)
• H/o – Socially withdrawn behavior
Lethargy
Loss of interest in surrounding
• Total Duration- 6 months.

4. ODP
• Patient was apparently alright 1 yr back.
• When he started symptoms without stressor
in the form of
Overfriendliness
Excess talk
Decreased sleep
Hyper religious behavior
• These symptoms mild in nature & lasted for 6
months. But they went unnoticed & he was
doing well in socio- occupational areas.

5. • But since last 6 months as the symptoms
changed following failure in 12th in the form of
Lethargy
Lack of interest in surrounding
Socially with drawn behavior
• Family members worried & got him to hospital
for psychiatric consultation.

6. Negative history
• No h/o hearing of voices, muttering to self,
laughing alone.
• No h/o suspiciousness, bizarre behavior.
• No h/o Repeated hand washing, checking or
cleaning behavior.
• No h/o seizure or neurological disorder.
• No h/o any substance abuse.

7. Past & Family history
• No similar complaints in past were noted.
• No family h/o Mental illness, Substance abuse,
MR, or Suicide.

8. Personal History
• Birth history- Full tem normal home delivery
• Milestones- Normal
• Education- Average in studies
Educated up to 11th
Failed in 12th
• Pre morbid personality- Minimal friends
-Poor social
involvement
-Hobby- watching TV

9. Physical Examination
• GENERAL EXAMINATION-
• Conscious, cooperative & well oriented
• General condition fair
• Pulse- 72 /min
• BP- 130/70 mmHg
• RR- 18/min

10. • NEUROLOGICAL EXAMINATION-
Higher functions
Sensory system
Motor system
All examination findings within normal limit.
• SYSTEMIC EXAMINATION-
CVS, RS, PA findings within normal limits.

11. Mental Status Examination
• General Appearance-
Conscious , Cooperative , Kept quite most of the
time during interview.
Well dressed
• Eye to Eye Contact-
Initiated & Maintained
• Rapport-
Established & Maintained
• Attention –
Arousable & sustained

12. • Mood- Sad
• Affect- Appropriate
• Speech- Continous , Coherent, Relevant
Decreased in amount
• Thoughts – Ideas of helplessness, hopelessness &
worthlessness present.
Denies delusions
Concept- Simple- Intact
Abstract- Intact

13. • Perception- No perceptual abnormility present.
• Memory- Registration- 3/3
Recall-3/3
• Intelligence- General Fund Of Information &
Calculation- Both average.
• Judgment- Social-Intact
Test-Intact
• Insight- 3/6 (claims illness as physical disease)

14. DIFFRENTIAL DIAGNOSIS
• Depressive phase in case of Bipolar Disorder.
• Schizoaffective Disorder.

15. INVESTIGATIONS
• Routine Blood & Urine Examination- Normal
• X-Ray Chest-Normal
• ECG-Normal
• Fundus Exam- Normal
• EEG- Normal
• MRI Brain- Normal

16. • PSYCHOMETRIC ASSESSMENT-
• BPRS- 24 (mild to moderate psychopathology)
• HDRS- 19 (significant depression)
• YMRS- 3 (No significant manic symptoms)

17. DIAGNOSIS
• DSM IV TR-
Axis I- Depression in case of Bipolar Mood D/o
Axis II- Cluster A personality traits
Axis III- No diagnosis
Axis IV- Failure in 12th examination
Axis V- GAF 61-70 at present & 71-80 before 1
year.

18. TREATMENT
• Patient was treated on OPD basis.
• PHARMACOTHERAPY-
Tab. Escitalopram 10 mg (1-0-0)
Tab. Na- Valproate 250 mg (1-0-1)
Tab. Lorazepam 2 mg (0-0-1)

19. • PSYCHOTHERAPY-
• Individual Psychotherapy- Patient was
explained about nature of illness &
importance of compliance.
• Family psycho education-
Family members were explained attitude
towards patient & way of dealing with him.
• Supportive psychotherapy was also given.

20. COURSE & TREATMENT RESPONSE
• Patient had depressive features since last 6
months.
• Previous history shows features of hypomania
which went unnoticed.
• He was never treated
• After starting medication patient improved
40% in 2 weeks.

21. • He showed 70% improvement after 1 month.
• Patient is on regular follow up for medication.

22. Depression: A global crisis