2. Prof.Dr: Reda Roshdy
Head of the psychiatry department
&
Dr: Gafer Mohamed
Assistant lecturer of psychiatry
3. Male patient, Mohamed Ahmed Abdelhamid
43 years old, Works as a furniture painter
6th primary school certificate, Divorced 5
years ago and has a child 6 years old
Egyptian, Muslim, from Imbaba, Cairo
Cigarette smoking 20 cig/day
No other special habits of medical importance
4. Of the patient:
معنديش
حاجه
Of the informant (brother), reliable:
بيقول
كالم
غريب
وعمال
رايح
جاي
ومبيقعدش
By his family
For appropriate management
5. Known psyciatric patient, well functioning and
controlled on his medications in the last 5 years
(Depakine 500mg 1×2 – psychodal 3mg 1×2 –
Cogintol 2mg 1×2 – Haloperidol 50mg amp /2 wks)
The condition started 4 months ago in gradual
onset, progressive course In the absence of
apparent stressor Except for doctor modified his
medications”
The patient started to wake up earlier than the
expected time, go to his work but became intrusive,
neglecting his work
6. The patient became overly ambitious, Involved in
a deal with his neighbors to use their shops to
open a gallery of furniture which is more than his
finantial capacity
Also told the people to attend the opening day
without any previous plan
The previous symptoms continued for one week
His family sought medical advice at Al-Abassia
outpatient clinic and recieved unremembered
medications
7. Then his family reported that the patient was
seen happy most of the time, started to become
talkative than usual, speaking about multiple
topics at the same time, changing from topic to
another quickly
Decreased need for sleep, being refreshed
after few hours of sleep
increased in non goal directed activities to the
extent that the patient was pacing around the
room for hoars without any purpose
8. At that time the patient increased cigarette
smoking up to 60 cig/day
The previous symptoms was continued for
about one month
So, his family sought for admission at Al-
Abassia mental hospital
9. The patient admitted at Al-Abassia mental
hospital For 2 months received medication
without improvement, So the doctors
decided that the patient is indicated for ECT
But it isn’t available there at that time, So
discharged for recieving ECT at another
place, prescribing the following medications
(Depakine 500 2×2 – psychodal 3 1×2 –
neurazine 100 1×2 - achtinon 2 1×1 –
haloperidol 50 amp/2 wks)
10. His family reported that the patient was more
deterioraed after discharge as the patient
started to report that he is the prophet
Muhammad Also, claimed that he is the GOD
Also convinced that his divorced wife want to
poison him and another people do a magic to
harm him and if he dead the day of resurrection
would take place
Also, hit the ground by his foot saying “I will
make an earthquake”
11. Kissing the women in the wedding day of his
nephew, moving around a slipper claiming it’s
kaaba
The patient convinced that his father and
another dead people are alive and he had seen
them
His family reported that the patient was
frequently seen getting bouts of crying without
any apparent cause which lasted for few
seconds and return to his previous state as if
nothing occured
12. His family sought medical advice from Al-
Hussien hospital for recieving ECT sessions
The patient recieved ECT sessions without
admittion
After the 2nd session his family asked for
admission for more controlling him So the
patient was admitted in our hospital one
week ago , recieved “olapex 10mg 1×2 –
Depakine 500mg 1×3”
And planned for continue ECT sessions
13. Risk assessment on admission:
Risk on himself: there was no self harm, no
suicidal intent, thoughts or plans. (SAD-
PERSONS scale= 2 , low risk )
Risk on others: there was no intent to harm
any one, no homicidal thoughts or plans.
From others: no risk detected.
14. Recently After receiving 5 ECT sessions the
patient became less talkative, less
hyperactive, increased sleeping time,
decreased frequency of bouts of crying to the
extent that not happened in the last 2 days
The patient reported he didn’t hear the voice
who told him “don’t fear” in the last 5 days
Also told that ECT sessions withdraw his
capacity to do an earthquake
15. The patient still more familiar than usual
convinced that his divorced wife want to
poison him and another people do a magic to
harm him.
Believed that he is a good man with a special
relationship with GOD
16. History of substance use
The patient smoked cannabis since 2008
irregularly especially in occasions
The last time was 8 months ago
The patient started cigarette smoking when he
was 14 years old irregularly then increased
gradually throughout the following few years
till became 20cig/day.
17. No history of depression
No history of suicide
No history of obsessions
18. History of 2 similar episods Presented by the
previous symptoms
The First episode was On 3/2010 for which the
patient admitted in Abo –Elazaim hospital ,
recieved medical treatment and ECT sessions,
discharged after 1.5 month of admission, the
patient return to his baseline state And
complaint on his medication till 2015, After
modifying his medications The patient
developed lack need for sleep, talkativity,
hyperactivity for about 3 days So his doctor
adjust his medications, The patient return to
his normal state again
19. The Second one was On 3/2018 for which the
patient was admitted in Al_Abassia mental
hospital received medical treatment and ECT
sessions , discharged after 1 month of
admission
His family reported that the patient return to
his baseline state, recieved (Depakine 500mg
1×2 – psychodal 3mg 1×2 – Cogintol 2mg
1×2 – Haloperidol 50mg amp /2 wks)
20. No other psychiatric history
No history of epilepsy
No history or DM or HTN
No history of blood transfusion or drug
allergy
21. The pt is the 4th of 5 siblings of a
consangenous marriage
His father is a paternal cousin of his mother
The patient married 13 years ago and
divorced 5 years ago due to family problem
The patient has a male child 6 yeasrs old who
lives with his mother
22. The pt lives with his mother after divorcing
his wife 5 years ago
Crowding index is 1/room
The pt and his elder brother are the source
of income with average socioeconomic
standard
23. Name Age Work
Health &
Psychiatric
Relation to pt.
Father Ahmed Dead 40 yrs ago due to health problem
Mother Lwahez 70
House
wife
DM
HTN
Harmonious
24. Name Age Work
Health &
Psychiatric Hx
Relation to
pt.
Siblings Tarek Dead 20 yrs ago d.t substance intoxication
Adel 45
Owner of
furniture
gallery
-ve Harmonious
Soaody 40
Furniture
painter
Substance
user
Harmonious
Mohamed The patient
Imam 38
Furniture
painter
Substance
user
Harmonious
25. A cousin of his mother has unknown
psychiatric disorder
No family history of similar condition
No other family medical or psychiatric
history
27. The patient joined Public school at age of 6
with below average academic performance with
harmonious relation with his peers and
teachers.
Educated till 6th primary school and left school
due to finantial issue.
28. Patient reached puberty at the age of 14
Male gender identity
+ve role
Heterosexual orientation
29. He married 13 years ago (since 2010) from
mi Ez House wife (his paternal cousin)
They had 1 offspring
Adel 6 years old, 2nd year nursery
There were family problems and multiple
conflicts with his wife since marriage, so they
divorced 5 years ago (since 2018)
Their child lives with his mother.
No premarietal or extramarietal relationships
31. He started to work when he was 15 years
old as a furniture painter with his older
brother in his gallery till his illness 4
months ago
He was committed to his work ,had good
relation with his colleagues except during
his illness periods
33. Personality traits: introverted, having few
friends sharing little activities with them,
Reacion to stressor:poor tolerance and
Isolation
Religion: practicing.
Prevailing mood: euthymic
Affect stability: stable
Impulsivity: no impulsivity reported
Hobbies: listening to music
Habits: Cigarette smoking
34. No pallor, jaundice nor cyanosis
BP: 110/70
Pulse: 74
RR: 16
Temp.: 36.5
36. I met the patient at Sunday 5th of February
at 6 pm in Al_Hussein university hospital
4th floor at head of psychiatric department
office, the patient entered the office
accompanied by his brother, Average body
built, Appeared his stated age, Wearing
appropriate clothes to age, sex and culture,
Scare in his left wrist, no tattoos
37. No special gait or posture, No special
appearance of medica importnce, Fair eye
contact , over familiar attitudes, Partially co-
operative, Attentive, Partially concentrated,
oriented to time, place and person
38. ◦ Mood: patient reported euphoric mood
◦ Afect: appropriate ,congruent to mood
◦ Thinking:
Content: delusion of grandiosity and
persecution
No obsessions or suicidal idea
Control: himself
Streem :Average
Form: circumstantially, tangentiality
Abstraction: good for similars but can’t
understand proverb.
39. Perception: pt denies any hallucinations or
illusions
Memory: Impaired recent, Intact short and
long term memory.
Speech: spontaneous coherent speech,
average volume, tone and amount
Activity: : Increased psychomotor activity
Judgment: impaired
Insight: Not insighted
40. Another recent MSE had be done Yesterday
As before, in addition The patient became
less hyperactive
still more familiar
Preoccupied by discharge
Delusion of grandiosity and persecution are
still present
41. CBC: HGB:13.3 WBCs:9.1 Neut: 5.5 PLT:330
Liver & kidney functions: normal
Random Blood sugar: 88
Lipid profile TG:141 CHOL: 138
Thyroid function: normal TSH:1.5
Drug urine toxoscreen: -ve
ECG: normal
Hormonal prfile: normal except PRL: 27.6
Brain MRI: normal
Brain EEG: normal
42. Male patient 43 years old, presented 4
months ago by gradual onset and
progressive course of inflated self-esteem,
lack need for sleep, involvement in activities
that have a high potential for painful
consequences, habitual changes, over
familiarity, emotional lability, delusion of
grandiosity and persecution, social and
occupational dysfunction, can’t understand
proverb, not insighted and Impaired
judgement
43. History of similar condition 2 times in
2010 and 2018 for which the patient
was admittted in hosital and recieved
ECT sessions, the patient returned to
the baseline state.
44. Bipolar 1 disorder currently manic episode.
Schizophreniform.
