ABSTRACT | PDF
CASE CONFERENCE
Acute polymorphic psychotic disorder with symptoms of schizophrenia with associated acute stress
Susmita Hazarika
Postgraduate Trainee of Psychiatry
Silchar Medical College and Hospital
Patient L. M., 22 years female unmarried Hindu hailing from lower middle class family of rural background, a Bachelor of Arts (B.A.) first year student, brought by her family members was admitted into female psychiatry ward through emergency with complaints of self withdrawn behaviour with self smiling, occasional aggressive behaviour, talking out of context for last ten days. Her history of present illness shows lack of interest in daily household activities with the presence of inflated self esteem with rapidly changing grandiose ideas to the extent of disturbing her social and interpersonal functioning with presence of some odd behaviours like separating garbage into different categories, staring at a particular direction while working reluctantly and speaking unusual things like “she is all powerful and everyone should follow her advice” or “she can destroy the universe with powers bestowed on her by goddess Durga”. Her biological functions were altered specially sleep and appetite. Informants report of a possible stressor of an unfulfilled love which they came to know from some of the secret letters which she wrote to the concerned person probably during the initial part of her illness, wherein she has penned down her emotional turmoil regarding her ambivalent situation whether she should go ahead or not in the intercaste relationship against the wishes of her family members. There is no significant past medical or surgical history, no history of past psychiatric illness. Family history of some psychiatric illness is present in her father’s cousin in the form of excessive talking for last 15 years. Patient had an extrovert type of premorbid personality and insignificant personal history. There was no significant finding in general and systemic examination and laboratory investigations. Mental status examination showed an average built person with proper dress and hygiene mostly gesturing and posturing with adequate eye contact with increased psychomotor activity, partially cooperative and rapport established with difficulty with pressured speech with decreased reaction time, talking mostly in high tone with increased quantity mostly relevant but at times irrelevant with dysphoric mood with inappropriate, labile affect with loosening of association, and rapidly changing grandiose ideas in thought with normal perception with unsustained concentration with intact memory with proper orientation to time, place and person with average intelligence with concretization of thinking with impaired judgement and reasoning and insight level one. She was diagnosed as acute polymorphic psychotic disorder with symptoms of schizophrenia with associated acute stress (F 23.11). After admission, she was put on inj lorazepan sos and tab quitiepin 50mg at bed time.Subsequently dose of tab quitiepin was increased to 100mg the next day and 200mg on day three. On fourth day it was further increased to 300mg in two divided doses and tab lorazepam 3mg in three divided doses was started. Patient showed improvement with the biological functions like sleep and appetite. Some of her symptoms like talking out of context, occasional aggressive behaviour and grandiose thoughts still persist.
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