6. History of Presenting Illness
• Repetitive thoughts of uncleanness after urination
• Had to take bath and wash his clothes
• Repetitive thoughts & compulsive acts of rearranging books &
other things
• Repetitive clicking of pen
• Unable to study , frustration
7. • Approached psychiatrist 1 year ago
• Diagnosed with Obsessive compulsive disorder
• Prescribed FLUVOXAMINE 200mg O.D
• Discontinued medication after 2½ months
• Reasons for non compliance not known
8. • Symptoms intensified this year during exams
• Problems during studying
• Frustration
• Depression
“ There is nothing left for me in the world”
• Thought & planned suicide
9. • 5 attempts of suicide
1. Tried to cut his wrist
2. Copper sulphate: pinch
3. Paracetamol: 15+15 tablets
4. Mercury: small amount
5. Cyanide: ¼ bottle
• None successful
10. Suicidal Risk Assessment
• Sex (M>F)
• Age
• Depression
• Previous attempts
• Ethanol/ drug abuse
• Rational thinking
• Social support
• Organized plan
• No spouse
• Sickness
9/10
(very High)
11. Past History
• No past history of psychiatric disorder
• Substance abuse:
• Cigarette smoking: 2010; 1 pack/ day ; quitted in 2011
• Vodka: 2010; 3 units of alcohol/day; 2-3 months
• Marijuana: 2011; occasional
• Medical & surgical illness
• Typhoid; 2005
• Dehydration; 2006
• Asthma; 2005 onwards
13. Personal History
• Normal birth & developmental history
• Schooling:
• Started at age of 4
• Above average student & respectable relation with teacher
• Studies affected by OCD
14. Pre-morbid Personality
• Attitude towards:
• Self; over concerned with bodily functions
• Others; friendly
• Religion; compliant, hafiz e Quran
• Mood: optimistic, lively
• Reaction pattern to stress: frustration
16. • Appearance:
• Young boy of athletic built
• Dressed appropriately
• Well kempt
• Oriented in time place and person
• Behavior:
• Normal psychomotor activity & gait
• Adequate eye contact
• Rapport
• Attentive
• Irritable towards fellow patients
• Respectful and friendly towards physician
29. Management
• Treated indoor due to high risk situation
• High risk safety plan
• Situation was explained in detail to the parents
• Supportive counselling
• Psychoeducation
• Pharmacotherapy
• Fluvoxamine 300mg
• ECT under G.A after written informed consent
30. • After 4th ECT, achieved considerable improvement
• After 1 month of treatment, there was decrease in suicidal
ideation & OCD symptoms
• Improvement in sleep & appetite
• Discharged with weekly follow-up visits in psychiatry OPD
