Presentation based on a psychiatric case of Schizophrenia 1.pptx

It is an intern level presentation

1. Psychiatry Case Presentation Upala Ghosh

2. Patient Particulars My patient name Tanya age 30 yrs Female Residence of Adityapur , Freelancer by occupation and Hindu by religion. Informants is her mother and is reliable ,adequate Reason of Presentation- Academic seminar

3. Chief Complaints Hearing one female voice when no body is around × 14 years Allged case of drug overdose × 4 days

4. History of presenting illness My patient was apparently well 14 years back after which she started hearing voice when no one was around which says her to kill herself because her classmates was ahead of her .As a result she tried hanging herself but was saved. Again 5 years back she started hearing commands which stated her as useless, worthless as she was unemployed at that time and she overdosed herself with Antisychotic drugs but was saved again. Again 4 days back while she was under psychiatric treatment, she heard the same voice instigating her to finish herself because of lack of permanent job. So at 1:45 am she took 4 tabs of Lithium and 7 tabs of Setraline . She presented with vomiting and had dizziness afterwards and was brought to the hospital. In class 3 she was being bullied for her looks so she took Phenyl but that time it was not accompanied by any voices.

5. Substance abuse history Cigarette since 2018, not regular, last consumed in March 2025 Excessive consumption of weeds for 3 years – 10- 12 joints per day

6. Negative History No history of head trauma ,seizure, altered sensorium, chronic medical illness.

7. Psycosis history History of 2 nd person auditory hallucination

8. Past medical history Patient is a known case of Hypothyroidism and is being treated for the same.

9. Family history Patient lives with her mother, father , brother Patient talks less with the family members But have good bond with cousin sister. No other psychiatric illness in the family

10. Personal history Birth history normal Behaviour during childhood- nail biting, temper tantrums, wetting of bed ,nightmares Occupation- 2019 first job started ,no job satisfaction , ambitious to get permanent job Menstrual history- Menarche since 2007, no menstrual irregularities Sexual history- not significant

11. General physical examination Patient is alert, well oriented to time, place and person. No pallor,icterus, clubbing,cyanosis,lymphadenopathy, edema.

12. Mental status examination

13. Apperance and behaviour Normally dressed,well kempt, cooperative Rapport established Psychomotor activity- decreased No involuntary movements

14. Speech Monotonous low volume speech Amount- normal Tone –low Tempo- low Coherent Relevant Speech sample- mujhe koi permanent job nehi mil rahi hai

15. Thought No disorder in form Slow retardation of stream Possesion - Rumination of thought, Preoccupation, over thinking Content- hopelessness, helplessness, worthlessness, apathy, anhedonia

16. Perception 2 nd person hallucination No illusions present

17. Mood Patient claimed to be in low mood Affect- Dysphoric mood Intensity low Range – did not show entire spectrum of emotions Appropriateness present Lability absent Communicability present

18. Cognitive functions Attention and concerntration Digit span test forward= 6 ,backward = 5 Serial subtraction- could perform 5 times Orientation intact Memory intact

19. Intelligence Educational level= graduation Could perform arithmetic calculations

20. Judgement Personal and social judgement intact

21. Insight Present grade 5/6

22. Abstraction Similarities- could say 5 Similarities between orange and banana Difference- could say 5 Difference radio and cinema Proverb interpretation- could correctly answer the meaning

23. Provisional diagnosis Bipolar affective disorder currently depressive state with psychotic symptoms

24. Differential diagnosis Schizoaffective disoder with suicide idealism Major depressive disorder with suicide idealism

25. Management plans Screen for psychiatric illness Assess the severity of symptoms Decide on treatment settings

26. Investigations CBC, Serum electrolytes Serum blood glucose LFT KFT Ultrasound abdomen

27. Treatment Psychotherapy Medications- Antipsycotics - Olanzapine, Haloperidol. Antidepressants- SSRI like Escitalopram Mood stabilizers like Lithium to reduce suicide idealism