Case Presentation 20-11-2012


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Case Presentation 20-11-2012

  1. 1. Case Presentation Dr. Rehab Shafik Dr. Reham Abd-Elmohsen
  2. 2. Personal Data:• 48 years old, female patient, she has divorced since 17 years, has one son, she’s house-wife.• Admitted on 30/10/2012, involuntary admission.(several admission)
  3. 3. ‫‪Complaint‬‬‫:‪• from patient‬‬‫أخويا عمل لى عمل – بيحضر الشياطين عليا – بيخلى عينى تتشعلق‬ ‫فوق.‬ ‫دول مش أهلى أنا اتخطفت من وانا صغيرة – ممكن تكون الناس‬ ‫بتتكلم عليا.‬‫الناس اللى معايا عارفين أنا بافكر فى إيه إنما الناس اللى معاكم انتوا‬‫مش عارفين – الناس اللى معايا دول ناس أنا الوحيدة اللى باشوفهم‬ ‫واسمعهم وأحيانا بيتكلموا مع بعض عليا وأحيانا بيعلقوا على‬ ‫تصرفاتى.جوزي طلقني ورجعني تاني هم بيقولوا انه مات بس انا‬ ‫متأكدة انه عايش شوفته قريب.انا اهلي بيسيطروا على تصرفاتي‬ ‫بعمل حاجات من غير ارادتي‬
  4. 4. ‫‪Complaint‬‬‫)‪• from relative: (her sister‬‬ ‫بتشك فينا وبتكرهنا – بتقول علينا مش أهلها – بتكلم نفسها‬ ‫كأن حد بيكلمها – بتقول باشوف خيال ت – بتكلم نفسها كل م‬ ‫مش مفهو م – رافضة العل ج – مش بتعمل أى حاجه فى‬ ‫البيت – مش بتقو م من على السرير.‬
  5. 5. History of present illness:The condition started by insidious onset, progressivecourse of lack of sleep since one week, believes thather father will harm her, and that her relatives areforeign and she didn’t know them since 1 month, ideasthat others may talk about her since 1 month, sayingthat she sees persons who aren’t real and hears voicestalking with her & comment on her behaviorssometimes, and sometimes argue about her since 1month, refuse medication, lack of activity & self neglectsince 2 months. She says that her husband is still alivebut he’s died.
  6. 6. Past History:•Psychiatric:- Condition started since 16 years, by delusions ofpersecution, reference, ideas of grandeur, bouts of agitation,visual & auditory hallucinations since 10 years, bouts ofhyperactivity and talkativeness since 10 years in whichsymptoms continue in-between attack, the ptient receivedPrianil 600 mg/day – clozapex 600 mg/day, since 14 years- Since 2 years she said that her parents kidnaped her butthey treated her will, delusion of influnce and diagnosed asschizophrenia, received treatment and improved.
  7. 7. Past History:•Drug Abuse: heavy cigarette smoker•Medical: No HTN, No D.M, No other specificmedical condition.•Surgical: No previous surgical operations.
  8. 8. Family History:No similar cases in her familyFamily setting & Appearance:•Father:seller, has renal failure, good relationship with her.•Mother:intact personality, good personality, has good relationshipwith her. (‫)مامتى كانت مغنية مشهورة اسمها شوشو عبده‬•Consanguinity: positive.•Relation in between: good•Siblings: 2 sisters, 3 brothers.•Housing & living atmosphere: medium.
  9. 9. Personal Hx:•Pregnancy: normal,•Delivery: normal.•Early Development: Normal.•Neurotic trait: didn’t present.•Child abuse: no child abuse.
  10. 10. Personal Hx:•Scholastic history: good, ‫دبلو م تجارة‬•Occupational history: never has work.•Sexual history: good.•Marital History & offspring: good, widow, one son,denies that her husband is died.
  11. 11. Premorbid personality•Social relationship : has limited social relationship.• Mood: stable.•Energy: in reality.•Habits & hobbies: cooking.•Religiosity: was religious, praying regularly.•Personality trait: introvert.
  12. 12. Mental State Examination•General appearance & Behavior: suspicious withwandering eyes, average PMA,•Consciousness: fully conscious•Attention & Concentration: attentive, averageconcentration.•Orientation: oriented TPP.•Memory: intact recent, short, and long term memory.
  13. 13. Mental State Examination•Speech: induced coherent speech, relevant answers.•Thinking:- Form & stream: no Formal Thought Disorder-Content: Delusions of persecution, ideas ofreference ?? Delusions that her husband is alive,delusions that her parents kidnapped her?, and her sonisn’t her son. Thought broadcasting,-Possession: possessed by her brother.•Abstraction: abstract
  14. 14. Mental State Examination•Perception: auditory & visual hallucinations.•Mood & Affect: suspicious mood, constricted affect.•General information: average.•Assessment Of intelligence: average.•Judgment: impaired•Insight: partial.
  15. 15. Mental State Examination•Risk:-self: no suicidal ideas, no previous attempts-Others: no homicidal acts.-Neglection: mild•Mental capacity:
  16. 16. Physical Examination:-B.P: 110/70 - pulse: 80 temp 37-Appearance: NO abnormalities-Clinical examination free.Investigations: routine are normal
  17. 17. ‫جزاكم ال خيرا‬‫‪Thank You‬‬