2. SOCIO DEMOGRAPHIC DETAILS:
Name: MR. UJ
Age: 21 years old ( 29th April, 2001)
Gender: Male
Religion: Hindu
Marital Status: Single
Education Qualification: Msc Computer science (incomplete)
Socio-economic Status: Middle Class
Address: Sanga-Reddy, Hyderabad
Informant: Parent
Information: Reliable and adequate
Source of Referral: Parent
2
3. Chief Complaints:
Patient’s version:
I have no problem, to others what I am experiencing can be unbelievable and they might
think I am mad.
Informants version:
-Eats only once a day (around feb, 2020)
-Neglects personal hygiene (brushing teeth, march)(bath, may)
-Stops studying (January)
-Do not socialized with anyone (January)
-Sits in one position for a long period of time (May)
Duration: From around 3 years
3
(2021)
4. Nature of Illness:
Insidious Onset; Continuous Course; Deteriorating Progress.
Predisposing factors: stubbornness, above intellectual level, extroversion tendency
Precipitating factors: breakup with girlfriend, isolation in USA, watching videos of Sadh
Guru
Perpetuating factors: Watching videos of Sadh Guru
4
5. History of present illness:
The patient was well till 2018, the first incident with his girlfriend whom he had known from class
7 who he was very close with and gradually ended in a relationship during their 11 grade but
unfortunately broke up ( due to controlling behavior) (around may, 2018) right before going to
USA. They try to rebuild their relationship but failed. But they were still helping each other in their
studies before covid lockdown and hasn't spoke to each other till today. Apparently after this
incident the client was managing himself well.
In sept 2018 , after doing his homework, he came across Sadh guru’s video in YouTube and
meditate (20mins) following the instruction from the video. After this incident, he started to
meditate (20 mins) every day and eventually started to chant.
In February 2020, for a day he felt sudden coldness in his body and a pressure on his head.
In March 2020, he stops chanting (due to his work/studies) here, he felt anger and frustration all the
time and felt pressure on his head like a pile of books is kept on his head then he started feeling a
collection of energy in which he could feel the energy flaring up around his body (about 3-4 inch).
5
6. 6
Then, he watched sadh guru’s live stream (Satsang) about a poem called ‘the mad flower’ and
the patient strongly believed that the poem was made for him and from this day, he watched
sadh guru’s live stream which was held every month in the full moon night and every time he
watch it, he relates those words with the things that he experiences. Around this month, he
stopped brushing his teeth too as he feels that the energy in him is cleansing his mouth.
In April 2020, he shifted from his hostel to rent an apartment (because it was cheaper). In
June 2020, he shaved his head to see if the pressure would be gone.
In October 2020, this is when he notices that there is a left and right energy in his body. On
20th December 2020, he went to Isha foundation which was held in USA where he attended
only for half day.
On the same month (25th December 2020) he came home to India (due to covid).
In January 2021, he stopped all physical and social interactions. In April 2021, he went to Isha
foundation in India (Coimbatore, Tamil Nadu) for 3 days to stabilize his energy flow within
his body by meditating and the pressure on his head slowly flows in his left side of the body
(Sadh guru energy).
7. 7
In May 2021, he stops talking bath with soap due to the rash (dry skin). Here the energy is
gathered in his chest, from he hardly moves or do any physical work because if he uses or
do any physical movement his energy will be low and his joints would hurt, and this
troubles him a lot as he could start to feel angry, sad and frustrated because all this is
stopping him from doing his daily activities.
Around the month of March,2022, he had a sudden feeling of happiness, bliss, peace and
calmness which he had never ever felt before.
“I cannot be angry or sad because I have internal happiness in me, I am always happy and
smiling but people will think that I am weird so I hide it.”
8. 8
In June 2022, his energy shifted from his chest to his neck and on the 19th July 2022, he
was admitted against his will but was cooperative when seeing a Marshal taking him. After
his admission he was told to write a novel, so here he started feeling a ball of energy above
his right head who is helping him give energy to write or to do other activities.
9. 9
Treatment History for the present illness:
Nil significant
Disability and dysfunction due to present illness and how they are
being managed:
Neglecting personal hygiene, eating once a day, stopped his education and social
interactions and sits in one position for a long period of time and hardly leaves his room.
The patient is under a supervision for the above issues.
10. 10
Present problems and concerns:
-Informants version:
-No personal hygiene
-Eating once a day
-No interaction with family
-Not studying and any physical activities
-Staying inside room
Negative history:
No history suggestive of Psychosis, Substance Abuse, Seizures, intellectual Disability, Head
Injury.
11. 11
Past History of Illness:
Systemic:
-7 days after birth, the patient’s mother notice that the patient had no movement in the left hand.
She consulted the doctor who informed her that it was normal and no hospitalization and medicine
were required. The patient would move his hand in a couple of days eventually.
-At the age of 6 years, the patient had a Hydrocelectomy surgery at Apollo Hospital in Banjara
hill and was released the next day.
Brain/Neurological: Nil Significant
Psychiatric: Nil Significant
13. 13
Physical Illness:
Nil significant
Psychiatric Illness:
Nil significant
Type of Family:
Nuclear family
Status of Family:
Intact
Details about family members:
Father is currently working in a Sugar Factory in Sanga-Reddy and his mother is a home maker.
The patient has an older brother who is 13 years older than him is currently living in Canada with
his wife and two son.
14. 14
Family Relationship:
Parents would have a heated arguments about each other’s side family (in-laws) since the patient was a
child till the present day.
The patients is close with his mother but more closer to his father and brother.
Attitude of the family members towards patient’s illness:
The family are worried to see such a huge change in the patient’s life and his education. They are very
supportive in helping him to recover and trying to accept his illness.
Present Living condition:
The patient is currently living with his father and mother where his father is working.
The father is the sole earner in the family.
Overall, Patient’s interpersonal relationship with family:
The patient has a good relationship with his family.
15. 15
Personal History:
Birth and development:
-Normal birth -Birth cry was present -Birth weight- 3.5kg
-Walks at 9 months
-Starts to talk around 13 months
Overall, the patient had an early developmental milestones.
Scholastic:
-Started schooling at the age of 2 years.
-Was always the topper through out his schooling and had won several awards when presenting for
his school (project, debate and quiz).
-Always ahead of his class-mates and studies on his own style/method.
-His favorite subjects were science especially physics and mathematics but was weak in language.
-His teachers could often comment to his parents that “ Mr. U knows everything”.
-At the age of 17 years, he went to USA for BSc Computer Sc (5 years course) which he almost
completed in 3 years but due to covid he came back home leaving 20 credits for him to graduate.
16. 16
Occupational history:
No work history present.
Marital & Sexual History:
The patient had his first sex education during their 7 class with his friends. He masturbates twice a
week but stopped from around the year 2021.
No intimate relationship is present with her girlfriend.
Habits:
Till class 7, the patient was active and used to play (outdoor games) all the time but at class 8 he
started playing computer games ( sometimes 7-8 hrs.) till his time in USA.
Since childhood he loves to do different Sc project on his own and would often modified his
electronic gadgets and at the same time he loves to read novel, comics book and watch movies (
animation).
17. 17
Social:
The patient had a lot of friends during his childhood and but now has around 3 friends out of which
he is still in contact with one till today.
Personality/Adjustment prior to illness:
The patient said, “ I can do things and other stuff, so, I am just getting along with the
treatments”.
Premorbid Personality:
The patient was very active and popular during his childhood but was very stubborn. Once he
concentrated on one thing he would fully concentrated on that until it is done.
When he was around 11 years old, he began to distance himself with others and began to spend
more time indoor and was starting to be rebellious.
18. 18
Attitude about self:
“I have to keep doing what I have been doing but also at the same time try to learn a way or a
method to provide other people to go through a piece of my experience.
I am different and do not value human relation in the same way as them. They value the memory of
someone or something while I value them as a piece of life.”
Attitude towards Family:
The patient thinks that his mother is like a pole which can never be moved, once she wants
something she gets it.
He defines her as crafty ,manipulative woman.
The patient thinks that his father always fulfil his wants and further describes him as a strong
headed, string believer, emotional and sometimes behaves like a child.
Whereas with his brother, the patient thinks his brother is also emotional and he likes to spend time
with him.
19. 19
Attitude toward others:
The patient thinks that everyone is missing such an opportunity to fully experience life.
Fantasies:
He wants to reach the highest level of energy and continue with his novels and game programming.
20. 20
Mental Status Examination:
General Appearance and Behaviour:
The patient, was slightly lean and tall in height. The client was appropriately dressed, unkempt
and untidy, disheveled hair, finger nails were negligent and dirty but maintained good eye
contact and was in touch with the surroundings.
Rapport: It was easily established.
Attitude towards Examiner: The Patient was Cooperative and attentive
Motor Behavior: Appropriate
21. 21
Voice and Speech:
-Coherence: Coherent
-Productivity: Normal
-Goal Direction: Goal Directed
-Intensity: Audible
-Pitch: Normal
-Reaction Time: Normal
-Speed: Normal
-Ease of Speech : Spontaneous
-Relevance: Relevant
-Manner: Relaxed
-Deviation : Nil
22. 22
Perceptual Disturbances:
Hallucinations: present (internal)
Other perceptual disturbances: Absent
Thought:
Thought Stream is normal and Formal Thought Disorder, Thought Possession are absent.
Thought content: It is present (Preoccupations with religious).
“I have to keep doing what I have been doing but also at the same time try to learn a way or a
method to provide other people to go through a piece of my experience.
I am different and do not value human relation in the same way as them. They value the memory of
someone or something while I value them as a piece of life.”
23. 23
Mood and Affect:
Subjectively,
the patient said, “I am fine and relaxed’.
“I feel guilty that the reason for the break up with my girlfriend is me”
Objectively,
the patient appeared to be fine and relaxed.
- Mood and Affect are incongruence.
24. 24
Orientation:
-He was oriented to time, place, person and self.
-Time: The patient could tell the approximate time of day, date, month and year. The Patient told
that it is morning, and 22 July,2022.
-Place: He could tell current place.
-Person: He is aware of himself & family members.
Attention and concentration:
-His attention and concentration were aroused and sustained.
-The client could answer 10 digit forward and 6 digit backward.
-The patient was asked to Subtract 7 successively from 100 and this he could answer properly by
(93,86,79,…..,3)
25. 25
Memory:
-Immediate memory:
It was assessed by using digit span test. She could repeat 5 forward and 3 backward.
-Recent memory:
It was assessed by asking what he had for meal and he answered rice, dal and subji.
-Remote memory:
It was assessed by asking him the date of his birthday and when he came back to India from USA.
-Based on the above observation his memory was intact.
26. 26
Intelligence:
-Comprehension:
It was assessed by asking the patient, “ what would he do if felt cold ?. He replied that he could
wear a sweater to keep his body warm”
-Vocabulary:
The patient was asked to name as many words as he could with the letter ‘B’. He replied for this by
saying as many words as he can which started with letter ‘B’
27. 27
-Calculation:
It was assessed by giving him random number to multiply, which he could do.
-General Information:
The patient was asked ‘Who is the Prime Minister of India?’(Narendra Modi) Who is the Chief
Minister of Telangana?’(K. Chandra Shekar Rao), & ‘5 cities of India’ (Mumbai, Delhi,
Hyderabad, Kolkata, Chennai).
-Based on history and testing, intelligence was presumed to be average.
28. 28
Abstract Thinking:
Proverbs:
“Sky is limitless”
-The potential a human being carries is immense.
Similarities:
It was assessed by asking, “How are the following items similar?”
-an apple and an orange (round, fruit)
-a chair and a table (made of wood, furniture)
Differences:
It was assessed by asking, “ How are the following items different?”
-stone and potato (not edible/edible, hard/soft)
-iron and silver (heavy/light, dull/bright)
-His responses were found to be conceptual.
29. 29
Judgement:
Social:
Based on the patient’s behavior during the interview and past history, the social judgement was
intact.
Personal:
The patient wanted to write a novel and start his game programming and complete his education.
Test:
It was assessed by asking, “if when you are walking on the roadside you see a stamped and sealed
envelope with an address on it which someone had dropped, what will you do?
-Post it in the letter box or give it to the post man.
-Hence, his Social, personal & test judgement was intact.
31. 31
Diagnostic Formulation:
The index patient is a 21 years old male, unmarried, coming from Hindu family and studying BSc
Computer Sc which was uncompleted due to covid lockdown and his interest in sadh guru’s
teachings. After he watched sadh guru’s video and meditated for 20 mins around the year 2018, it
began to be a habit and from here he started to watched it regularly as it began to have a huge
impact on him in the following years, the more he did chanting and meditation he felt some
changes in his body and experience a pressure on his head and energy flow in his body. But these
energy flows starts to effect his daily life like taking bath once every 5 days, not brushing teeth,
eating food only once a day, neglects social interactions and stopped his studies and daily activities.
Onset and nature of illness are reported as insidious, continuous and deteriorating. Overall patient’s
interpersonal relationship with family are normal and his family are very supportive in him
recovering. The content of thought involved preoccupations with religious (spirituality).
32. 32
Assessments Administered:
N
o.
NAME OF ASSESSMENTS RATIONAL OF TEST
1
INTERNATIONAL PERSONALITY DISORDER EXAMINATION(IPDE) To assess personality disorder.
2 Rorschach INK BLOT TEST (RIBT)
To examine a person's personality
characteristics and emotional
functioning
3 NEO-FFI
To assess personality in the domains
of neuroticism, extraversion,
openness, conscientiousness, and
agreeableness
4 POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS)
To measure the symptom severity of
patients with schizophrenia
5 BRIEF PSYCHIATRIC RATING SCALE (BPRS)
To measure psychiatric symptoms
such as anxiety, depression, and
psychoses.
33. 33
Assessments Administered Findings:
1.IPDE:
The patient passed the screen test for Schizoid Personality.
2. RIBT:
Rorschach Psychodiagnostics was administered to assess the structure of the personality of the client as well
as to assess the current emotional and intellectual state of the client and ascertain presence of psychopathology.
The client’s Rorschach profile suggests the following features of the client.
Ego and environment:
The total number of responses given by the client is 64, which is above average indicating he is paying too
much attention in surroundings stimuli. he seemed interested toward his environment and was also willing to
respond to the stimulus. The initial reaction time to the Rorschach plates is 8.7 seconds, which suggest a very
quick reaction time. This indicates that his mental processing is very fast. The client’s Rorschach profile
suggests D dominated approach with most of the D responses having a poor form level. This suggests an
inability to organize the things in proper way. It may also be suggestive of an inability to organize things in his
life as well.
34. 34
The F+% of the client’s responses was found to be 0.40, which is well below average (79.25),
indicating poor reality contact/testing, poor ego strength and abstract ability. There were 4 colour
responses found in the protocol, indicating impulsivity and aggression , immature thinking and poor
control over emotions. The number of Human (H) responses given by the patient are 0 which
indicates not interested in relationships or human company , lacks empathy towards human group
and there exists interpersonal problems , of poor form level. The high number of Human Detail
(Hd) responses (14) on the Rorschach profile, most of which are of poor form level, suggesting
psychological constriction / stress displacement of anxiety on body parts. The client’s popular
responses were 4 ,indicating. The Lambda (L) index of the client’s responses is found to be 3 which
is above the average range (1.5 – 2.5), indicating that she may be tensed and constricted in
displaying his emotions.
35. 35
Cognitive Process
The Rorschach profile of the client is having above average W responses (27) for the client’s total number of
responses (64 ), but most of the responses are of poor form level. In most of the W responses, the client started
to combine big parts to form . This may be due to her active psychopathology at present. As mentioned earlier,
below average F+% indicating poor perceptual acuity of the client. The number of movement responses given
by the client in the protocol (19) are average (2.4) for the given number of responses but they are of poor form
quality. This may suggest that while the client has internal resources to cope with a stressful situation,
currently he is unable to utilize the internal resources to cope up with the stressful life situation. It may also
suggest dependency, submissiveness and withdrawal from the environment within the client. The A% of the
client’s responses was found to be 0.32% , which is well below average (46.65). This may suggest that he may
not be able to evaluate his own environmental stimuli which may lead to non-adaptive behaviour.
36. 36
Emotions
Colour responses on the client’s profile indicate immaturity, impulsivity and aggression thinking and poor
control over emotions. The Affective ratio (Afr) was found to be , which suggests restricted and constricted
emotionality in the client. The number of shading responses (Y) given by the client in the protocol are 2 ,
which is high (0.49 ), indicating impulsivity and poor control over emotions.
Qualitative Signs in the Rorschach protocol
Qualitative signs observed in the client’s Rorschach protocol are confabulation, contamination, card rotation
on majority of cards (except on card number 2 and 4) indicating signs of anxiety and tension. No card was
rejected and the patient followed the instructions well .
37. 37
3. NEO-FFI:
In neuroticism, the score is 11 (39) which indicates
Low in the personality trait of being emotional.
In extroversion, the score is 33 (60) which indicates
High in the personality trait of seeking fulfilment from
Sources outside the self or in community.
In openness to experience, the score is 31(56) which
Indicates high in the personality trait of seeking
new experience and intellectual pursuits.
In agreeableness, the score is 19 (31) which indicates
Very low in the personality trait of how the
individual adjust their behaviour to suit others.
In conscientiousness, the score is 24 (36) which indicates
low in the personality trait of being honest and
hard working.
Neuroticism
9%
Extroversion
28%
openness to
experience
26%
Agreeableness
16%
Conscientiousnes
21%
Neuroticism
Extroversion
openness to
experience
Agreeableness
38. 38
4. PANSS:
The patient scores are
Positive scale: 11
Negative scale: 9
General Psychopathology Scale: 16
Total score: 36
Hence, scores are not meeting the cut off.
5. BPRS:
The patient scores 3 (mild) in somatic concern and anxiety.
In unusual thought content, hallucination, self-neglect and elated mood he scores 6 (severe).
39. 39
Provisional Diagnosis:
-F 20.3 Undifferentiated Schizophrenia
Points in favor:
-meet the general criteria for disorders
-are either without sufficient symptoms to meet the criteria for only one of the subtypes
40. 40
Differential diagnosis:
-F 30.2 Mania with psychotic symptoms
Points in favor:
-Inflated self esteem
-Religious delusion
-Neglect of eating and personal hygiene
-Delusion of reference
Points against:
-Flight of ideas
-Pressure of speech
-Delusions of persecution
41. 41
Prognosis:
Good prognostic factors:
-No used of substance
-No childhood history of trauma
-Intellectual functioning
Bad Prognostic factors:
-Focuses only on one thing
- Difficult temperament (stubbornness)
-Awareness of being sick but denying at the same time.
