Psychiatry Case Presentation (Depression).pptx

CASE PRESNTATION
for
Diploma in Community Mental Health
Dr. IMMANUEL JOSHUA
Junior Resident
Dept. of Community Medicine
Banaras Hindu University
Varanasi-221005
CIP Digital Academy

SOCIO-DEMOGRAPHIC PROFILE
 Name: Mr. U
 Age: 25years
 Gender: Male
 Religion: Hindu
 Marital Status: Married
• Education: BA
• Occupation: Salesman
• Socioeconomic status: Middle
• Place: Chiraigao, Varanasi
• Informants: Self and Mother

CHIEF COMPLAINTS
 Easy fatigability x 4 months
 Sadness of mood x 3 months
 Decreased sleep x 3 months
 Decreased appetite x 3 months
 Decreased social interaction x 2 months
 Loss of interest in pleasurable activities x 2 months
 Ideas of guilt x 2 months

PRESENTING PROBLEMS
• Onset : Acute
• Course : Continuous
• Duration: 3-4 months
• Predisposing factor : Family history of depressive disorder
• Precipitating Factors : Quarrel or argument with his wife
• Perpetuating factors : Wife is not taking care

• Patient was apparently asymptomatic 6 months back when he got married.
• His wife is a housewife and she is not well versed with household chores.
• He felt stressed due to his allegation that his wife is not taking care of him
and that his wife comments on his mother.
HISTORY OF PRESENTING ILLNESS

 Decreased sleep:
• He developed difficulty in sleep initiation and maintenance.
• He falls asleep after 1-2 hours of lying in bed and his sleep was
disturbed frequently due to thinking of daily happenings at home.
• He wakes up several times during the night.
• He could hardly sleep for 4 hours in a day as compared to his previous
sleep of 6-7 hours.
Dr. IMMANUEL JOSHUA (BHU) 6

 Decreased appetite:
• He lost his appetite and ate only 2-3 roti compared
to his previous appetite of eating 6 roti per day.
• He ate only on repeated persuasion of his mother.

 Sadness of mood:
• He started remaining sad and gloomy all day.
• He did not like talking to family members particularly his wife.
• He did not like to go to work (salesman in a grocery shop)
 Easy fatigability:
• He felt tired the whole day and easily got tired after working for a while.
• He preferred lying in bed whenever he could spare time.

 Decreased social interaction:
• He did not like talking to his brother or sister over phone.
 Loss of interest in pleasurable activities:
• He lost interest in watching television and stopped
playing badminton with friends.
• He preferred sitting idle.
• He did not like going out for walk with his dog.

 Ideas of guilt:
• He started regretting because his father started asking about his
irregularities in his daily work.
• He felt cornered because his father was repeatedly comparing
him with his friends.

• He was brought to Psychiatry OPD in BHU 1month back (after a neighbour asked them
to consult) for the above complaints and he was started on treatment.
• Now he is brought for follow up after 1 month and is admitted in Psychiatry ward for
further management.
• Treatment given:
TREATMENT HISTORY
Drug name Dose
1)T. ESCITALOPRAM
2)T. CLONAZEPAM
20mg/day
0.5mg/day
Overall compliance to treatment is adequate
No h/o of any significant side effects

 No H/O diabetes/ HTN/ T.B./ prolong fever /seizure/mass lesion affecting CNS
 No H/O increase talk/ over-expenditure
 No H/O over-generosity/ over-religiosity / over-planning
 No H/O suspiciousness, hearing of voices
 No H/O thoughts being heard aloud loud/ mutism /incoherence
NEGATIVE HISTORY

 No significant history of any psychiatric illness in the past
PAST HISTORY
PAST MEDICAL & SURGICAL HISTORY
 No significant medical & surgical history

FAMILY HISTORY
Family of Origin Family of In-Laws
32 years
Married
Intermediate
28 years
Married
Intermediate
25 years
Married
BA
23 years
Married
Housewife
19 years
Unmarried
Graduate

 Type of family : Nuclear
 No of family members : 5
 Family concept about illness: His family
members think that he is very shy,
sensitive and his tolerance of stress is low.
 Family stress : Nil (as per respondent)
 Substance abuse :Nil
 Living arrangement : Family lives in a
pucca house in Chiraigao
FAMILY HISTORY
 Head of family : Patient’s father
 Chief caregiver in family : Patient’s
mother
 Chief decision maker : Patient’s father
 Chief earning member in family: Father
 Father has H/O depressive disorder

 Birth history: (from his mother)
• Patient was born at 9 months by normal vaginal delivery.
• Cried immediately after birth.
• All milestones were attained at right time .
 Childhood history:
• No h/s/o hyperactivity, inattention, impulsivity, repeated bullying other
children, stealing, lying, disobedience
 Academic:
• Started schooling at 3.5 years of age and education continued till BA.
• Patient was an average student & didn’t get complaints from his teachers.
PERSONAL HISTORY

 Average built.
 Conscious and co-operative
for the examination.
 BP- 134/84 mmHg
 Pulse- 92 beats/min
GENERAL PHYSICAL EXAMINATION
 Afebrile
 Weight-56kg
 Height-168cm
 BMI-19.84kg/m2
 No PICCLE

 No Abnormality Detected in examination of;
• Cardio-Vascular System
• Respiratory System
• GI System (per abdomen)
• Central Nervous System
SYSTEMIC EXAMINATION

1. General Appearance and Behavior:
• A young male of average built with normal gait & posture.
• Face looks fatigued, dull and downward.
• He was properly groomed & dressed.
• Hygiene was adequate.
• He was calm & co-operative throughout the interview
• He was well oriented to time, place & person.
• Eye to Eye contact established but not sustained.
• He feels shy to answer questions.
MENTAL STATUS EXAMINATION

 2. Speech:
• Non-spontaneous
• Coherent
• Relevant
• Goal directed
 3.1. Mood: “sad”
 3.2. Affect: “sad”
Quantity
Rate
Volume
Tone
Reaction Time
decreased
decreased
decreased
Normal
Increased

 4. Thought:
• Stream : decreased flow
• Form : NAD
• Possession of thought : NAD
• Content : Filled with complaints
• Impression : Ideas of guilt
 5. Perception: Hallucination or illusion could not be elicited

 6. Cognitive Function:
• Orientation: patient was oriented to time, place and person.
• Attention & Concentration : Arousable and sustained.
• Memory: Immediate, recent and remote memory are intact.
• Intelligence:
o Arithmetic: good skill (salesman)
o Comprehension: intact
• Adequate abstract thinking

 7. Judgement: Patient behaviour in Personals ,Social & Test are intact
 8. Insight: Present

A young married male belonging to Hindu middle class nuclear family with no significant
past psychiatric history and with Family H/O father having depressive disorder presented
with following complaints with total duration of illness for 3-4 months. The complaints
were acute in onset with continuous course characterised by decreased sleep, decreased
appetite, sadness of mood, loss of interest, anhedonia, easy fatigability, ideas of guilt.
Speech –Q/V/R decreased with increased RT
Affect is sad restricted, Thought content suggestive of ideas of guilt
Oriented to time/place/person, attention and concentration are arousable and sustained,
memory intact, average intelligence, abstract thinking, judgement intact, Insight is present.
CASE SUMMARY

 Moderate depression
PROVISIONAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
 Adjustment disorder with moderate depression

• Evaluate the patient with some
baseline investigations:
 CBC
 RBS
 LFT
 RFT
 Serum electrolytes
 Thyroid function test
MANAGEMENT
• Detailed general and systemic
examination of the patient
• HAM-D scale
• Treatment:
 T. ESCITALOPRAM (10mg /day)
 T. CLONAZEPAM (0.5mg) HS

• Psychoeducation to the patient and his family members
• Address current psychosocial stressor or the relationship difficulties
• Reactive social networks like family gathering ,outing with friends
• Structure physical activity for 45 min/day for 3 times/week
• Regular follow up in-person or by phone for re-assessing the improvement
NON PHARMACOLOGICAL MANAGEMENT

Psychiatry Case Presentation (Depression).pptx

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