ABSTRACT | PDF
Case Conference I
Schizophrenia, unspecified
Dr. Rajesh Rongpi
Postgraduate Trainee of Psychiatry, Silchar Medical College and Hospital
S, 30 years old Muslim male from Karimganj district, was admitted in psychiatry ward of Silchar Medical College and Hospital through outdoor patients’ department (OPD). Adequate and reliable informant was his wife.
Patient had no complaints. According to informant, he was symptomatic with not doing work, not allowing others to work, sudden episodic outburst of anger and increased religiosity. Onset was gradual, course was progressive, and there was neither precipitating factor nor life event.
According to patient he had no illness but his wife and relatives were worried that he was crazy. According to wife he was alright five months back. After returning from Meghalaya as a coal mine worker, his mother asked him to join pilgrimage. He also valued the idea and joined pilgrimage for five months. After returning from pilgrimage seven days back, his behaviour seemed different. He would not work for daily wages. Day in and day out, he started reading namaz. He started preaching that all the relatives must go to masjid leaving all their work and enchant the name of Allah since He is the almighty who would provide everything. He disapproved his brothers and sister working hard in paddy field.
He started complaining his wife as Satan. The reason was she most of the time didn’t cover face and body properly by sari. His own earlier dress of pant and shirt gave way to lungi and white kurta along with a cap. He started growing beard.
He believed the teachings of clergyman and often said that one should not work hard as everything would be provided by Allah. He used to invite strangers for lunch and dinner until the last morsel. He got angry if wife didn’t follow the order. He said of going to places like Delhi, Bangladesh. His food habit changed and table manner became disciplined. There is no recent history of intoxication, head injury, or loss of consciousness.
No suggestive history of medical/surgical illness in the past. One year back, he was symptomatic with verbal and physical aggression, wandering, irrelevant talking, and suspiciousness. On treatment from psychiatrist for one month, he recovered and asymptomatic without medication in the intervening period.
This time following hospitalisation, he was on olanzapine 10mg and lorazepam 2mg at bedtime for three days followed by olanzapine 20mg at bedtime, sodium valproate 600mg in two divided doses, and lorazepam 2mg at bedtime. He was improving.
His libido had reduced for last one month and was habituated in chewing tobacco. His two sisters suffered from mental illnesses. Premorbidly he was not religious, extroverted, had lots of friends, mood was jolly.
Physical examination was within normal limits.
Mental state examination revealed average built, appropriately dressed, hygiene maintained, adequate eye contact, normal psychomotor activity, established rapport. Mood was euthymic, affect appropriate, full range, reactive, stable, congruent, normal intensity. In speech, no articulation defect, rhythm regular, normal rate, volume and quantity. There was no formal thought disorder. Content of thought showed religious grandiosity. There was no perceptual disturbance. On cognitive function, conscious and comprehensive, oriented to time, place and person, attention could be drawn and concentration was sustained, intact immediate, recent and remote memories. Abstract thinking was intact, average intelligence, judgement and reasoning intact, and level 1 insight.
Summary Thirty years old married father of three children of rural area from poor socioeconomic status hailing from Muslim community coming to psychiatry OPD with chief complaint by the patient having no illness and informant saying that not doing work, doesn’t allow others to work, sudden and episodic outburst of anger, increased religiosity with gradual onset and progressive course without any precipitating or perpetuating factor with past and family histories of psychiatric illnesses with premorbid personality of extrovert, jolly mood, poor morality, religiosity with normal physical examination and mental state examination showing average built and height, well groomed, hygiene maintained, adequate eye contact, cooperative, normal psychomotor activity, established rapport, euthymic mood, appropriate affect, normal speech, no formal thought disorder, preoccupied ideas of religiosity without perceptual disturbance with intact higher cognitive functions and insight level 1, was provisionally diagnosed according to the tenth edition of the International Classification of Diseases and Related Health Problems (ICD 10) as schizophrenia, unspecified (F20.9). Treatment with olanzapine 10mg at bedtime and lorazepam 2mg as needed.
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