Case Presentation Dr. Hamed Borham Dr. Nashwa Osman
Personal Data:• Said Fathy Mohammed AbdelAal is 32y old male who is muslim , married and live in 1- Alameer Ahmed Refaat St – Moharram-Beh – Gorbal. He is recently non functioning but used to work before as (nakkash mobilia) and as driver with educational level of only read and write . and he is admissioned involuntary to our hospital
Complaint:• from patient أنا حاسس اني مش سعيد اللي انا عارفه .. واني اتغيرت ... وبتجيلي نوبات غضب مش بعرف اتحكم فيها ومعمول لي سحر بيني وبين مراتي يخليني اشوفها شطانة شكلها وحش ومش طايقها
Complaint:• from relative جبنا سعيد المستشفى تقريبا عريان .. كان راح عند حل ق معرفة وهاج عنده وقلع هدومة كلها وقال له رجعني سعيد بتاع زمان احلق لي جسمي كله .. والناس اللي انت عارفهم بيحاولي يقلدوني اياك تحلق لهم زيي .. قبلها كان عاوز يقتل صاحبه وقال انه كان مرافق مراته .. وفي رمضان اللي فات ساب المشروع بالركاب اللي فيه ورجع البيت ونام من غير ما يقولنا حاجة.
History of present illness:•The condition started originally 3 years back with gradualonset and progressive course.• With apparent stressor of prison. As he was arrested andinvestigated by the police man . he asked him about his wifename , the pt. started to be convinced that his wife betrayedhim (for one year of imprison) . and as he was dischargedfrom the prison .he said that his evidence that his wifechanges her clothes much of the time in the toilet with otherbehavioral changes , and also he was convinced thatchildren are not his children and reacted to this by hitting hiswife….. . . he also appear as if he hears a voice of a femaleand he said that the voices ordered him to pray …… and heobeys .
History of present illness:•Then he was sad due to his conviction and tried to get rid ofhis life twice …… by superficial cuts in front of his relatives .he also neglect his work and became socially isolated withdisturbed sleep (interruption) his appetite decreased .. andthis was for one and half year. Then he divorced his wife,after that he sought psychiatric advice at our out pt. clinicand received medication …..on which he was compliant for4 months and improved first regarding sad mood andappetite and then to his convention and has his wife backagain . then he stopped the ttt as he said that it make himsleep to much . after stoppage of ttt he has the sameconvictions and behaviors again so he was admitted in ourhospital for one day as he escaped from the hospital anddidn’t received ttt or ECT.
History of present crisis:•One month ago the original condition increased andhe heared voices of passengers saying that his wifebetrayed him , then he left the bus and didn’t workagain ……. the pt. attempts to kill his friend …..hewas convinced that (Amerat Albahr) changed him sohe went to hair dresser to make him back to normal….. there is history of substance abuse all througheven during his improvement there is no historymanic symptoms or organicity
Family History:•Consanguinity: No history of consanguinity•Father:Fathy mohammed Abdek aal, Died at theage of 82 due to cardiac cause, He hadharmonious relation with the pt. and he worked inpetroleum company•Mother: died at the age of 61 due to DM, And shewas house life and also had harmon. Relation withthe pt.•Siblings: 4 brothers and 3 sisters . with harmoniusrelations
Family History:•Housing & living atmosphere: quarrelsomewith his wife, Monthly income was aboveaverage …… tell the illness•No Family history of psychiatric illness•Family history of medical illness : diabetesand heart disease
Personal Hx:•Prenatal , natal , post natal : passed uneventual•Developmental history : passed uneventual•Educational record : he left the primary school …..•Work record : first he was ( nakkash mopeliah )and he had above average income and left itbecause of other people . then he was driver andhas average income and then he traveled to Libyatwice for better income …
Personal Hx:•Military service : exempted due to non psychiatriccauses•Psychosexual :He reached puberty at average age . with male gender role and identity withheterosexual orientation tell the illness heexperienced disturbed sexual relation ship with iswife …..•Marital history :Marital status married with poorrelation to his wife and children after illness …..
Personal Hx:•Past history of drugs: Hash + tramadol(occasionally) last hash 4 m. ago•Past history of medical illness : query pepticulcer
Forensic history:In the prison for one year……Premorbid personality•Extrovert with antisocial traits•Reactive to stress by nervousness•He is impulsive and believer•His hobby is drawing and he is smoker
Observation in the ward :•pt. is socially isolated spent most of time inbed
Mental State Examination•General appearance and behavior :young adult male average body built , poorgrooming and fair self hygiene , co-operative.•Mood : dysphoric••Affect : tense , reactive and appropriate•Speech : in answer to questions averageamount volume and stream , coherent
Mental State Examination•Thought process :-stream : average-Content: delusion of persecution …. d. of influence ….. and delusion of infidelity become shakable. delusional perception(??)- control : +ve- form: circumstantiality- abstraction : fair
Mental State Examination•perception :no perceptual disorder at the time of interview ( …….)•cognitive function:the pt. is fully conscious , attentive , concentrative , or. To ppt . with intact immediate recent and remote memory average intelligent and generalknowledge with poor judgment . and insightless to illness, and need for ttt
Physical Examination:•physical examination :•vital data : bl. Pr. : 120/80 , pulse : 82,temper. : 36.5•injury mark …… risk assesment :•risk of homicide and suicide
Formulation32 y old male pt. with 3 y history ofdelusions of infidelity , persecution ,influence ,thought control disorder ,delusional perception and auditoryhallucination , social isolation, neglectwork , with history of dysphoric moodafter it . and parasuicidal attempts , withsubstance abuse all through
Differential diagnosis:• paranoid schizophrenia with co morbid substance abuse• uni polar depression with psychotic feature with co morbid substance abuse